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Muacevic A, Adler JR, Alessandro C, Ganz M, Glatt A, Rosenberg A, Wang R, Zimmerman J, Silverberg J, Zyskind I. SARS-CoV-2 Infection in Winter 2021/2022: The Association of Varying Clinical Manifestations With and Without Prior Vaccination. Cureus 2022; 14:e33190. [PMID: 36733791 PMCID: PMC9888590 DOI: 10.7759/cureus.33190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2022] [Indexed: 01/02/2023] Open
Abstract
Importance SARS-CoV-2 is a rapidly evolving virus with many strains. Although vaccines have proven to be effective against earlier strains of the virus, the efficacy of vaccination status against later strains is still an area of active research. Objective To determine if vaccination status was associated with symptomatology due to infection by later strains of SARS-CoV-2. Design This cross-sectional survey was sent to an adult Jewish population from December 2021 to March 2022. Setting This is a population-based study of Jewish communities throughout the tristate area. The subjects were recruited by local Jewish not-for-profit and social service organizations. Participants Surveys were sent to 14,714 adults who were recruited by local Jewish not-for-profit and social service organizations; 966 respondents completed the survey (6.57%). Only participants who received a positive COVID-19 nasal swab 10 weeks since December 1, 2021, were included in the main outcome. Exposure Participants were grouped by vaccine type (i.e., Johnson & Johnson {J&J}, Moderna, or Pfizer) and vaccination status (i.e., unvaccinated, single, full, or booster). Main outcomes and measures The primary study outcome was an association between immunization status and somatological presentation. Symptom severity classes were built using latent class analysis (LCA). Results Out of 14,714 recipients, 966 completed the survey (6.57%). The participants were mainly self-described Ashkenazi Jewish (97%) with a median age of 41. The LCA resulted in four classes: highly symptomatic (HS), less symptomatic (LS), anosmia, and asymptomatic (AS). Vaccinated participants were less likely to be in symptomatic groups than the unvaccinated participants (odds ratio {OR}: 0.326; 95% confidence interval {CI}: 0.157-0.679; p=0.002). Boosted participants were less likely to be in symptomatic groups than fully vaccinated participants (OR: 0.267; 95% CI: 0.122-0.626; p=0.002). Additionally, there was no association between symptomatology and vaccination type (p=0.353). Conclusions and relevance Participants who received COVID-19 vaccinations or booster shots were less likely to be symptomatic after Omicron infection compared to unvaccinated participants and vaccinated participants without boosters, respectively. There's no association between vaccination type and symptomatology. These results enhance our understanding that COVID-19 vaccinations improve clinical symptomatology, even in an unforeseen COVID-19 strain.
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102
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Musa HH, Musa TH. A systematic and thematic analysis of the top 100 cited articles on mRNA vaccine indexed in Scopus database. Hum Vaccin Immunother 2022; 18:2135927. [PMID: 36328513 DOI: 10.1080/21645515.2022.2135927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The success of mRNA vaccines against SARS-CoV-2 implies that this technology can be applied to target any pathogen. However, the scientific production and research trends using the bibliometric method are still unknown. The top 100 most cited articles on mRNA vaccine research were obtained from the Scopus database from 1995 to 2021. Bibliometrix, an R-Package, and VOSviewer 1.6.11 were used for data analysis. There is a rapid growth in scientific outputs with a gradual increase in 2021. The United States produced 45 (45%) of the articles, followed by Germany with 15 (15%) and Israel with 10 (10%). The New England Journal of Medicine published the most papers in this field 13 (13%), followed by Nature 6(6%). Barney S. Graham was the most productive author among the top 100 most cited mRNA vaccine articles. University of Pennsylvania Perelman School of Medicine, US, was the top ranking institution, having 37 (37%). The visualization map clearly and spontaneously displayed the current state and research hot spots of mRNA research from a specific perspective. The most frequent keywords were COVID-19, vaccine, mRNA vaccine, mRNA, SARS-CoV-2, and immunogenicity, among others. A systematic review of the articles provided evidence that out of 100 articles, approximately 25 (25%) were focused on vaccine production and evaluation, followed by 26 (26%) in mRNA vaccine safety and efficacy, 23 (23%) were into mRNA vaccination, 23 (23%) considered risk factors associated with mRNA vaccination, while 8 (8%) of the articles covered the issue of mRNA vaccine delivery. In addition, 42% of the articles focused on COVID-19, 17% on cancer, 8% on influenza virus, 4% on COVID-19 and kidney disease, 3% COVID-19 and myocarditis, and 3% on rabies virus, among others. The findings of this systematic and thematic analysis provided the knowledge basis for further research on mRNA vaccines globally.
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Affiliation(s)
- Hassan H Musa
- CAS Key Laboratory of Pathogen Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China.,Department of Medical Microbiology, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
| | - Taha H Musa
- Biomedical Research Institute, Darfur University College, Nyala, Sudan.,Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
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103
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Global Policy to Reduce the Incidence of Infection Spreading in Non-Vaccinated Healthcare Workers: A Literature Review. Vaccines (Basel) 2022; 10:vaccines10122058. [PMID: 36560468 PMCID: PMC9783052 DOI: 10.3390/vaccines10122058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022] Open
Abstract
Healthcare workers (HCWs) are at increased risk of SARS-CoV-2 infection because of their occupational exposure. Moreover, they can be a vehicle for the virus transmission among patients. The vaccination of healthcare personnel against COVID-19 is crucial in fighting the spread of SARS-CoV-2 infection, together with strict sanitary procedures that aim to limit the risk of contagion. Unfortunately, even if COVID-19 vaccination has been proved one of the most effective tools for protecting against COVID-19, many healthcare professionals are not yet vaccinated. The aim of the current review is to contribute to identifying an effective strategy for COVID-19 prevention especially among non-vaccinated HCWs. In this review, we collected the most recent and relevant findings from literature on the protection of unvaccinated HCWs, identifying three types of measures as principal actions to protect those operators: addressing vaccine hesitancy, improving non-pharmaceutical interventions and promoting actions at personal level (respiratory hygiene, hand hygiene and use of PPE). All these interventions are very effective in preventing contagion, if well respected and conducted; nevertheless, it is essential to promote vaccination, as it is the most effective measure.
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104
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Strickler SS, Esper A, Wells L, Wood A, Frediani JK, Nehl E, Waggoner JJ, Rebolledo PA, Levy JM, Figueroa J, Ramachandra T, Lam W, Martin GS. Severe acute respiratory syndrome coronavirus 2 vaccine breakthrough infections: A single metro-based testing network experience. Front Med (Lausanne) 2022; 9:1031083. [PMID: 36507539 PMCID: PMC9732086 DOI: 10.3389/fmed.2022.1031083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/10/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives Understanding the incidence and characteristics that influence severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine breakthrough infections (VBIs) is imperative for developing public health policies to mitigate the coronavirus disease of 2019 (COVID-19) pandemic. We examined these factors and post-vaccination mitigation practices in individuals partially and fully vaccinated against SARS-CoV-2. Materials and methods Adults >18 years old were voluntarily enrolled from a single metro-based SARS-CoV-2 testing network from January to July 2021. Participants were categorized as asymptomatic or symptomatic, and as unvaccinated, partially vaccinated, or fully vaccinated. All participants had confirmed SARS-CoV-2 infection based on standard of care (SOC) testing with nasopharyngeal swabs. Variant analysis by rRT-PCR was performed in a subset of time-matched vaccinated and unvaccinated individuals. A subgroup of partially and fully vaccinated individuals with a positive SARS-CoV-2 rRT-PCR was contacted to assess disease severity and post-vaccination mitigation practices. Results Participants (n = 1,317) voluntarily underwent testing for SARS-CoV-2 during the enrollment period. A total of 29.5% of the population received at least one SARS-CoV-2 vaccine (n = 389), 12.8% partially vaccinated (n = 169); 16.1% fully vaccinated (n = 213). A total of 21.3% of partially vaccinated individuals tested positive (n = 36) and 9.4% of fully vaccinated individuals tested positive (n = 20) for SARS-CoV-2. Pfizer/BioNTech mRNA-1273 was the predominant vaccine received (1st dose = 66.8%, 2nd dose = 67.9%). Chronic liver disease and immunosuppression were more prevalent in the vaccinated (partially/fully) group compared to the unvaccinated group (p = 0.003, p = 0.021, respectively). There were more asymptomatic individuals in the vaccinated group compared to the unvaccinated group [n = 6 (10.7%), n = 16 (4.1%), p = 0.045]. CT values were lower for the unvaccinated group (median 24.3, IQR 19.1-30.5) compared to the vaccinated group (29.4, 22.0-33.7, p = 0.004). In the vaccinated group (n = 56), 18 participants were successfully contacted, 7 were lost to follow-up, and 2 were deceased. A total of 50% (n = 9) required hospitalization due to COVID-19 illness. Adherence to nationally endorsed mitigation strategies varied post-vaccination. Conclusion The incidence of SARS-CoV-2 infection at this center was 21.3% in the partially vaccinated group and 9.4% in the fully vaccinated group. Chronic liver disease and immunosuppression were more prevalent in the vaccinated SARS-CoV-2 positive group, suggesting that these may be risk factors for VBIs. Partially and fully vaccinated individuals had a higher incidence of asymptomatic SARS-CoV-2 and higher CT values compared to unvaccinated SARS-CoV-2 positive individuals.
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Affiliation(s)
- Samantha S. Strickler
- School of Medicine, Emory University, Atlanta, GA, United States,*Correspondence: Samantha S. Strickler,
| | - Annette Esper
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Leona Wells
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Anna Wood
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Jennifer K. Frediani
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Eric Nehl
- Rollins School of Public Health, Atlanta, GA, United States
| | | | - Paulina A. Rebolledo
- School of Medicine, Emory University, Atlanta, GA, United States,Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, United States
| | - Joshua M. Levy
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Janet Figueroa
- School of Medicine, Emory University, Atlanta, GA, United States
| | | | - Wilbur Lam
- School of Medicine, Emory University, Atlanta, GA, United States,Georgia Institute of Technology, Atlanta, GA, United States
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105
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The importance of sustained compliance with physical distancing during COVID-19 vaccination rollout. COMMUNICATIONS MEDICINE 2022; 2:146. [DOI: 10.1038/s43856-022-00207-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 10/26/2022] [Indexed: 11/21/2022] Open
Abstract
Abstract
Background
Increasing vaccination coverage against SARS-CoV-2 enabled relaxation of lockdowns in many countries in Europe. As the vaccination rollouts progressed, the public health authorities were seeking recommendations on the continuation of physical distancing measures during ongoing vaccination rollouts. Compliance with these measures was declining while more transmissible virus variants have emerged.
Methods
We used a SARS-CoV-2 transmission model to investigate the feedback between compliance, infection incidence, and vaccination coverage. We quantified our findings in terms of cumulative number of new hospitalisations three and six months after the start of vaccination.
Results
Our results suggest that the combination of fast waning compliance in non-vaccinated individuals, low compliance in vaccinated individuals, low vaccine efficacy against infection and more transmissible virus variants may result in a higher cumulative number of new hospitalisations than in a situation without vaccination. These adverse effects can be alleviated by deploying behavioural interventions that should preferably target both vaccinated and non-vaccinated individuals. The choice of the most appropriate intervention depends on vaccination rate and vaccine efficacy against infection.
Conclusions
Supplementary behavioural interventions aiming to boost compliance to physical distancing measures can improve the outcome of vaccination programmes, until vaccination coverage is sufficiently high. For optimal results, these interventions should be selected based on the vaccine efficacy against infection and expected vaccination rate. While we considered the dynamics of SARS-CoV-2, the qualitative effects of the interplay between infectious disease spread and behavior on the outcomes of a vaccination programme can be used as guidance in a future similar pandemic.
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106
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Early Real-World Data to Assess Benefits and Risks of COVID-19 Vaccines: A Systematic Review of Methods. Vaccines (Basel) 2022; 10:vaccines10111896. [DOI: 10.3390/vaccines10111896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/12/2022] Open
Abstract
Since the authorization of the first COVID-19 vaccines in December 2020, multiple studies using real-world data (RWD) have been published to assess their effectiveness/safety profile. This systematic review aimed to characterize the methods and outcomes of studies using RWD for assessment of COVID-19 vaccines, four months after vaccine approval. MEDLINE and EMBASE were searched to identify published studies until 6 May 2021. Two independent researchers selected relevant publications and extracted data from included studies. The risk of bias was assessed using New-Castle Ottawa tools. After screening 1086 studies, 15 were included. Out of the 15 studies, 12 (80%) followed a cohort design, 8 (53%) were based on USA data, 7 (47%) assessed health care professionals, and 14 articles (93%) assessed the BNT162b2 vaccine. Data sources included institutional databases, electronic health records, and patient-generated data. The primary endpoint mainly described was SARS-CoV-2-infection. Hospitalization and mortality were assessed in 2 studies. For the comparability domain, six studies (40%) had a high risk of bias. A few months after the beginning of COVID-19 vaccination, Real-world Evidence (RWE) provided timely safety surveillance and comparative effectiveness with findings that showed similar findings to Randomized control trial (RCT). Most of the initiatives assessed BNT162b2 and were conducted in the USA and used healthcare workers’ data.
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107
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Jiménez-Sepúlveda N, Chico-Sánchez P, Castro-García JM, Escribano-Cañadas I, Merino-Lucas E, Ronda-Pérez E, Sánchez-Payá J, Gras-Valentí P. The Waning of BNT162b2 Vaccine Effectiveness for SARS-CoV-2 Infection Prevention over Time: A Test-Negative Study in Health Care Professionals of a Health Department from January 2021 to December 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113884. [PMID: 36360764 PMCID: PMC9653695 DOI: 10.3390/ijerph192113884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 06/01/2023]
Abstract
The duration of protection of vaccines against SARS-CoV-2 infection has been evaluated in previous studies, but uncertainty remains about the persistence of effectiveness over time and the ideal timing for booster doses. Therefore, the aim of this study was to evaluate BNT162b2 vaccine effectiveness against SARS-CoV-2 infection in health care workers (HCWs) at a tertiary hospital depending on time elapsed since the completion of a two-dose vaccination regimen. We conducted a case-control with negative test study between 25 January and 12 December 2021 that included 1404 HCWs who underwent an active infection diagnostic test (AIDT) to rule out SARS-CoV-2 infection due to COVID-19 suspicion or prior close contact with patients diagnosed with COVID-19. The adjusted vaccine effectiveness (aVE) for the prevention of SARS-CoV-2 infection 12 to 120 days after completing the full two-dose vaccination regimen was 91.9%. Then, aVE decreased to 63.7% between 121 to 240 days after completing the full two-dose regimen and to 37.2% after 241 days since the second dose. Vaccination against SARS-CoV-2 infection in HCWs remains highly effective after 12 to 120 days have elapsed since the administration of two doses of the BNT162b2 vaccine; however, effectiveness decreases as time elapses since its administration.
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Affiliation(s)
- Natali Jiménez-Sepúlveda
- Epidemiology Unit, Department of Preventive Medicine, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital Dr. Balmis, 03010 Alicante, Spain
| | - Pablo Chico-Sánchez
- Epidemiology Unit, Department of Preventive Medicine, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital Dr. Balmis, 03010 Alicante, Spain
| | | | - Isabel Escribano-Cañadas
- Department of Microbiology, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital Dr. Balmis, 03010 Alicante, Spain
| | - Esperanza Merino-Lucas
- Unit of Infectious Diseases, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital Dr. Balmis, 03010 Alicante, Spain
| | - Elena Ronda-Pérez
- Preventive Medicine and Public Health Area, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain
- Centre of Networked Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - José Sánchez-Payá
- Epidemiology Unit, Department of Preventive Medicine, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital Dr. Balmis, 03010 Alicante, Spain
| | - Paula Gras-Valentí
- Epidemiology Unit, Department of Preventive Medicine, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital Dr. Balmis, 03010 Alicante, Spain
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108
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Panahi Y, Einollahi B, Beiraghdar F, Darvishi M, Fathi S, Javanbakht M, Shafiee S, Akhavan-Sigari R. Fully understanding the efficacy profile of the COVID-19 vaccination and its associated factors in multiple real-world settings. Front Immunol 2022; 13:947602. [PMID: 36389777 PMCID: PMC9641184 DOI: 10.3389/fimmu.2022.947602] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/25/2022] [Indexed: 09/29/2023] Open
Abstract
We performed a review study according to recent COVID-19 vaccines' real-world data to provide comparisons between COVID-19 vaccines regarding their relative efficacy. Although most vaccine platforms showed comparable effectiveness and efficacy, we highlight critical points and recent developments generated in studies that might affect vaccine efficacy including population-dependent effects of the vaccine (transplantation, adiposity, and specific comorbidities, as well as older age, male sex, ethnicity, and prior infection), vaccine type, variants of concern (VOC), and an extended vaccine schedule. Owing to these factors, community-based trials can be of great importance in determining vaccine effectiveness in a systematic manner; thus, uncertainty remains regarding vaccine efficacy. Long immune protection of vaccination with BNT162b2 or ChAdOx1 nCoV-19 has been demonstrated to be up to 61 months and 5-12 months after the previous infection, and boosting infection-acquired immunity for both the first and second doses of the BNT162b2 and ChAdOx1 nCoV-19 vaccines was correlated with high and durable protection. However, large cohort and longitudinal studies are required for the evaluation of immunity dynamics and longevity in unvaccinated, vaccinated, and infected individuals, as well as vaccinated convalescent individuals in real-world settings. Regarding the likelihood of vaccine escape variants evolving, an ongoing examination of the protection conferred against an evolving virus (new variant) by an extended schedule can be crucial.
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Affiliation(s)
- Yunes Panahi
- Pharmacotherapy Department, Faculty of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Fatemeh Beiraghdar
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Darvishi
- Infectious Diseases and Tropical Medicine Research Center (IDTMRC), Department of Aerospace and Subaquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Saeid Fathi
- Department of Parasite Vaccine Research and Production, Razi Vaccine and Serum Research Institute, Agriculture Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Mohammad Javanbakht
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sepehr Shafiee
- Department of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Akhavan-Sigari
- Department of Neurosurgery, University Medical Center Tuebingen, Tuebingen, Germany
- Department of Health Care Management and Clinical Research, Collegium Humanum Warsaw Management University, Warsaw, Poland
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109
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Scheithauer S, Bludau A, Heinemann S, Anton M, Knolle P. [COVID-19 vaccination strategy for employees of German hospitals: results of a survey of infection control practitioners within the B-FAST project]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:1299-1306. [PMID: 36269337 PMCID: PMC9589530 DOI: 10.1007/s00103-022-03607-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/28/2022] [Indexed: 11/29/2022]
Abstract
Hintergrund und Ziel Zu Beginn der COVID-19-Impfkampagne in Deutschland wurden Beschäftigte in medizinischen Einrichtungen aufgrund des hohen Expositionsrisikos und des Kontakts mit vulnerablen Gruppen priorisiert gegen SARS-CoV‑2 geimpft. Die Krankenhäuser waren angehalten die Impfungen ihrer Beschäftigten möglichst schnell zu organisieren und durchzuführen. Ziel der vorliegenden Arbeit war es, die Impfstrategie für die Mitarbeitenden deutscher Kliniken zu erfassen. Methoden In einer Querschnittstudie mit selbstentwickeltem Fragebogen wurden die Leitungen der (Krankenhaus‑)Hygiene aller deutschen Universitätskliniken sowie der Nicht-Universitätskliniken in Niedersachsen und Bayern im März 2021 befragt. Die Daten wurden nach den beiden Versorgungsstufen stratifiziert. Ergebnisse 100 von 416 versendeten Fragebögen wurden vollständig ausgefüllt (Universitätsklinik: 33, Nicht-Universitätsklinik: 67). Universitätskliniken berichteten von einer größeren Impfkapazität als Nicht-Universitätskliniken, ein begrenzender Faktor waren die ungewissen Impfstofflieferungen. 89 % der Kliniken planten Informationskampagnen zum Thema Impfung oder hatten diese bereits durchgeführt. 70 % gaben an, keine Antikörpertests bei geimpften Beschäftigten durchführen zu wollen. Eine Nachverfolgung geimpfter Beschäftigter zur Detektion möglicher SARS-CoV-2-Infektionen mittels Erregernachweis durch PCR wurde von 41 % geplant. Im Falle des Nachweises einer SARS-CoV-2-Infektion bei geimpften Beschäftigten hatten 72 % weitere Diagnostik geplant. Diskussion Alle Krankenhäuser konnten eine schnelle Umsetzung der COVID-19-Vakzinierung ihrer Beschäftigten erreichen. Zum Zeitpunkt der Befragung gab es große Unsicherheit bezüglich des Umgangs mit Durchbruchsinfektionen und der Notwendigkeit von Auffrischimpfungen. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-022-03607-x) enthalten.
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Affiliation(s)
- Simone Scheithauer
- Institut für Krankenhaushygiene und Infektiologie, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Anna Bludau
- Institut für Krankenhaushygiene und Infektiologie, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
| | - Stephanie Heinemann
- Lokale Task Force Netzwerk Universitätsmedizin (NUM), Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Göttingen, Deutschland.,Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Göttingen, Deutschland
| | - Martina Anton
- Institut für Molekulare Immunologie und Experimentelle Onkologie, Fakultät für Medizin, Universitätsklinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - Percy Knolle
- Institut für Molekulare Immunologie und Experimentelle Onkologie, Fakultät für Medizin, Universitätsklinikum rechts der Isar der Technischen Universität München, München, Deutschland.,Standort München, Deutsches Zentrum für Infektionsforschung, München, Deutschland.,Lokale Task Force Netzwerk Universitätsmedizin (NUM), Fakultät für Medizin, Technische Universität München, München, Deutschland
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Kapar B, Buigut S, Rana F. Winners and losers from Pfizer and Biontech's vaccine announcement: Evidence from S&P 500 (Sub)sector indices. PLoS One 2022; 17:e0275773. [PMID: 36240218 PMCID: PMC9565377 DOI: 10.1371/journal.pone.0275773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/23/2022] [Indexed: 11/05/2022] Open
Abstract
This study explores how the US stock market reacted to the news of a successful development of vaccine by Pfizer and Biontech on November 9, 2020. In particular, the study analyses the effect of the vaccine announcement on 11 sector indices and 79 subsector indices. A key contribution of the present study is to provide a deeper subsector level of analysis lacking in existing literature. An event study approach is applied in identifying abnormal returns due to the November 9th vaccine announcement. Several event periods (-1, 0, 1, 2, 3, 0-1, 0-3) are analysed to provide a more complete picture of the effects. Based on analysis, it is established that there are considerable inter and intra sectoral variations in the impact of the vaccine news. The results show that the impact follows a clear pattern. The sectors that were hit hardest by the pandemic such as energy, financials, as well as subsectors like hotels and casinos, benefited the most from positive vaccine news. Subsectors that gained from the pandemic such as airfreight, household appliances and computers and electronics retail were depressed the most by the news. These findings suggest that while the availability of vaccines is expected to help steer economies gradually to normalcy, the re-adjustment is likely to be asymmetric across subsectors. While some subsectors expect to expand as these industries recover from the contraction inflicted by the COVID-19 environment, other subsectors expect adjustment losses as these industries shed off the above average gains driven by the COVID-19 environment.
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Affiliation(s)
- Burcu Kapar
- American University in Dubai, Dubai, United Arab Emirates
- * E-mail: ,
| | - Steven Buigut
- Canadian University Dubai, Dubai, United Arab Emirates
| | - Faisal Rana
- American University in Dubai, Dubai, United Arab Emirates
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111
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Nickel KB, Fraser VJ, Babcock HM, Kwon JH. Coronavirus disease 2019 (COVID-19) vaccine breakthrough infections among healthcare personnel, December 2020-April 2021. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e169. [PMID: 36483397 PMCID: PMC9726500 DOI: 10.1017/ash.2022.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 06/17/2023]
Abstract
Coronavirus disease 2019 (COVID-19) vaccine effectiveness in the early months of vaccine availability was high among healthcare personnel (HCP) at 88.3% for 2-doses. Among those testing positive for severe acute respiratory coronavirus virus 2 (SARS-CoV-2), those with breakthrough infection after vaccination were more likely to have had a non-work-related SARS-CoV-2 exposure compared to unvaccinated HCP.
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Affiliation(s)
- Katelin B. Nickel
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Victoria J. Fraser
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Hilary M. Babcock
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jennie H. Kwon
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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Igual-Rouilleault AC, Soriano I, Elizalde A, Quan PL, Fernandez-Montero A, Sobrido C, Pina L. Axillary lymph node imaging in mRNA, vector-based, and mix-and-match COVID-19 vaccine recipients: ultrasound features. Eur Radiol 2022; 32:6598-6607. [PMID: 35554651 PMCID: PMC9098792 DOI: 10.1007/s00330-022-08846-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To assess ultrasound characteristics of ipsilateral axillary lymph nodes after two doses of four different COVID-19 vaccination protocols, to determine whether these parameters differed with age, and to describe how they changed on follow-up imaging. METHODS A total of 247 volunteer employees from our center who had received two doses of COVID-19 vaccination were recruited and followed prospectively. Axillary ultrasound of the ipsilateral vaccinated arm was performed the week after receiving the second dose to analyze lymph node features (number, long-axis, cortical thickness, morphology, and vascular imaging). Axillary lymphadenopathy resulting from four vaccination protocols-mRNA (BNT162b2, mRNA-1273), ChAdOx1-S, and mix-and-match-was compared. Analysis was conducted using the Kruskal-Wallis test and post hoc analysis with Bonferroni corrections. Nodal reactogenicity was evaluated for two age groups: young (< 45 years old) and middle-aged ( ≥ 45 years old). All parameters were compared between both groups using an unpaired-sample Student t test. A p value < 0.05 was considered statistically significant. RESULTS Significantly higher values for total number of visible nodes, cortical thickness, Bedi's classification (p < 0.001), and vascularity (p < 0.05) were observed in mRNA vaccine recipients compared to full ChAdOx1-S protocol recipients. Moreover, mix-and-match protocol recipients showed greater nodal cortical thickness and higher Bedi's classification than full ChAdOx1-S recipients (p < 0.001). Analyses between age groups revealed greater cortical thickness, Bedi's classification, and color Doppler signal in younger patients (p < 0.05). CONCLUSIONS Nodal parameters of Bedi's classification and cortical thickness were more often increased in mRNA and mix-and-match vaccine recipients when compared to ChAdOx1-S vaccine alone, especially in younger patients. KEY POINTS • Hyperplastic lymphadenopathy was observed more frequently in mRNA and mix-and-match vaccine protocols compared to full vector-based vaccination. • Higher values for cortical thickness, Bedi's classification, and color Doppler signal parameters were identified in younger patients. • Observed lymph node findings normalized in greater than 80% of patients by the third month following vaccination.
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Affiliation(s)
| | - Ignacio Soriano
- Department of Radiology, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008, Pamplona, Spain
| | - Arlette Elizalde
- Breast Imaging Unit, Department of Radiology, Clínica Universidad de Navarra, Avenida Pío XII, 36, Pamplona, Spain
| | - Paola Leonor Quan
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Avenida Pío XII, 36, Pamplona, Spain
| | | | - Carolina Sobrido
- Breast Imaging Unit, Department of Radiology, Clínica Universidad de Navarra, C. Marquesado de Sta. Marta, 1, Madrid, Spain
| | - Luis Pina
- Breast Imaging Unit, Department of Radiology, Clínica Universidad de Navarra, Avenida Pío XII, 36, Pamplona, Spain
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Baradaran HR, Dehghanbanadaki H, Moradpour F, Eshrati B, Moradi G, Azami M, Haji Ghadery A, Mehrabi Nejad MM, Moradi Y. The effect of COVID-19 mRNA vaccines against postvaccination laboratory-confirmed SARS-CoV-2 infection, symptomatic COVID-19 infection, hospitalization, and mortality rate: a systematic review and meta-analysis. Expert Rev Vaccines 2022; 21:1455-1464. [PMID: 35830883 DOI: 10.1080/14760584.2022.2102001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 07/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We systematically reviewed the literature to investigate the pooled effect of COVID-19 mRNA vaccination against SARS-CoV-2 infection and its clinical outcomes. METHODS Scopus, Web of Science, PubMed (Medline), and Embase were searched on 9 September 2021. The odds ratio (OR) of COVID-19 infection and its clinical outcomes in fully/ partially vaccinated versus unvaccinated participants were calculated and pooled by using a random-effects model. RESULTS The pooled analysis showed that among health care workers and general population, vaccinated participants with one or two doses were less likely to infect with SARS-CoV-2 (OR = 0.16; 95%CI: 0.08-0.32; I2 = 79.86%; 95%CI I2: 68.99-87.21%), to develop symptomatic COVID-19 infection (OR = 0.09; 95%CI: 0.03-0.32; I2 = 80.43%; 95%CI I2: 70.83-89.33%), to admit to the hospital because of COVID-19 (OR = 0.13; 95%CI: 0.06-0.28; I2 = 86.19%; 95%CI I2: 67.80-93.88%), and to die from COVID-19 (OR = 0.14; 95%CI: 0.06-0.35; I2 = 66.76%; 95%CI I2: 54.00-76.99%) than unvaccinated participants. CONCLUSIONS COVID-19 mRNA vaccines, especially following administration of two doses, are extremely effective. It would be suggested further studies with large sample size and different ethnicities to be conducted among the general population to warrant these results.
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Affiliation(s)
- Hamid Reza Baradaran
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hojat Dehghanbanadaki
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Moradpour
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Babak Eshrati
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mobin Azami
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Abdolkarim Haji Ghadery
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mehdi Mehrabi Nejad
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Yousef Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Chico-Sánchez P, Gras-Valentí P, Algado-Sellés N, Jiménez-Sepúlveda N, Vanaclocha H, Peiró S, Burgos JS, Berenguer A, Navarro D, Sánchez-Payá J. The effectiveness of mRNA vaccines to prevent SARS-CoV-2 infection and hospitalisation for COVID-19 according to the time elapsed since their administration in health professionals in the Valencian Autonomous Community (Spain). Prev Med 2022; 163:107237. [PMID: 36057393 PMCID: PMC9433063 DOI: 10.1016/j.ypmed.2022.107237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/29/2022] [Accepted: 08/28/2022] [Indexed: 11/30/2022]
Abstract
The objective was to understand the effectiveness of the BNT162b2 and mRNA-1273 vaccines against SARS-CoV-2 in health professionals(HPs) in the Valencian Autonomous Community(Spain) who had completed a full vaccination regimen, both in terms of preventing infections and avoiding hospitalisations, according to the time elapsed since the vaccine administration. Case-controlled study with negative test results. HPs who had undergone at least one PCR or antigen(Ag) active infection diagnostic test(AIDT) to rule out SARS-CoV-2 infection between 25 January and 18 July 2021 were included. HPs with positive AIDT result were considered as cases and those with a negative result controls. Adjusted vaccine effectiveness(VEa) to prevent SARS-CoV-2 infection and its 95% confidence interval(95% CI) were calculated using the formula VEa = (1 - OR) × 100. The VEa for the prevention of SARS-CoV-2 infection 12 to 120 days after completing the full two-dose vaccine regimen was 91.6%(95%CI[89.6%,93.2%]) for the BNT162b2 vaccine and 95.2%(95%CI[88.3%,98.1%]) for the mRNA-1273 vaccine. After 120 days the VEa was 71.5%(95%CI[67.0%,75.5%]) for the BNT162b2 vaccine and 88.3%(95%CI[75.7,94.4%]) for the mRNA-1273 vaccine. The VEa for prevention of hospitalisation for COVID-19 for the complete two-dose regimen of mRNA vaccines (BNT162b2 and mRNA-1273) was 96.8%(95%CI[76.1%,99.6%]). The administration of the complete regimen of the BNT162b2 and mRNA-1273 vaccine against SARS-CoV-2 was highly effective for the prevention of COVID-19 cases in HPs when 12 to 120 days had elapsed since the second dose. However, said effectiveness decreased as time from the vaccine administration elapsed, although it was maintained for the prevention of hospitalisation of HPs.
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Affiliation(s)
- Pablo Chico-Sánchez
- Epidemiology Unit, Preventive Medicine Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Paula Gras-Valentí
- Epidemiology Unit, Preventive Medicine Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Natividad Algado-Sellés
- Epidemiology Unit, Preventive Medicine Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Natali Jiménez-Sepúlveda
- Epidemiology Unit, Preventive Medicine Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - Salvador Peiró
- Foundation for the promotion of health and biomedical research of the Valencian Community (FISABIO), Valencia, Spain
| | | | | | - David Navarro
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain; Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - José Sánchez-Payá
- Epidemiology Unit, Preventive Medicine Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
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Harith AA, Ab Gani MH, Griffiths R, Abdul Hadi A, Abu Bakar NA, Myers J, Mahjom M, Robat RM, Zubir MZ. Incidence, Prevalence, and Sources of COVID-19 Infection among Healthcare Workers in Hospitals in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12485. [PMID: 36231783 PMCID: PMC9564780 DOI: 10.3390/ijerph191912485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/19/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic introduced significant novel risks for healthcare workers and healthcare services. This study aimed to determine the prevalence, trends, characteristics, and sources of COVID-19 infection among healthcare workers during the early COVID-19 pandemic in Malaysian hospitals. A cross-sectional study used secondary data collected from a COVID-19 surveillance system for healthcare workers between January and December 2020. Two surges in COVID-19 cases among healthcare workers in Malaysia were epidemiologically correlated to a similarly intense COVID-19 pattern of transmission in the community. The period prevalence of COVID-19 infection and the mortality rate among healthcare workers in Malaysia were 1.03% and 0.0019%, respectively. The majority of infections originated from the workplace (53.3%); a total of 36.3% occurred among staff; a total of 17.0% occurred between patients and staff; and 43.2% originated from the community. Healthcare workers had a 2.9 times higher incidence risk ratio for the acquisition of COVID-19 infection than the general population. Nursing professionals were the most highly infected occupational group (40.5%), followed by medical doctors and specialists (24.1%), and healthcare assistants (9.7%). The top three departments registering COVID-19 infections were the medical department (23.3%), the emergency department (17.7%), and hospital administration and governance (9.1%). Occupational safety and health units need to be vigilant for the early detection of a disease outbreak to prevent the avoidable spread of disease in high-risk settings. The transformation of some tertiary hospitals to dedicated COVID-19 care, the monitoring of new procedures for the management of COVID-19 patients, and appropriate resource allocation are key to successful risk mitigation strategies.
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Affiliation(s)
- Abdul Aziz Harith
- Occupational and Aviation Medicine Department, University of Otago Wellington, New Zealand, 23A Mein Street, Newtown, Wellington 6242, New Zealand
- Occupational Health Research Centre, Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Mohd Hafiz Ab Gani
- Occupational Health Research Centre, Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Robin Griffiths
- Occupational and Aviation Medicine Department, University of Otago Wellington, New Zealand, 23A Mein Street, Newtown, Wellington 6242, New Zealand
| | - Azlihanis Abdul Hadi
- Medical Development Division, Ministry of Health Malaysia, Aras 3-7, Blok E1, Pusat Pentadbiran Kerajaan Persekutuan, Wilayah Persekutuan Putrajaya 62590, Malaysia
| | - Nor Aishah Abu Bakar
- Medical Development Division, Ministry of Health Malaysia, Aras 3-7, Blok E1, Pusat Pentadbiran Kerajaan Persekutuan, Wilayah Persekutuan Putrajaya 62590, Malaysia
| | - Julia Myers
- Occupational and Aviation Medicine Department, University of Otago Wellington, New Zealand, 23A Mein Street, Newtown, Wellington 6242, New Zealand
| | - Maznieda Mahjom
- Occupational Health Research Centre, Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Rosnawati Muhamad Robat
- Occupational Health Unit, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Muhammad Zulfakhar Zubir
- Medical Development Division, Ministry of Health Malaysia, Aras 3-7, Blok E1, Pusat Pentadbiran Kerajaan Persekutuan, Wilayah Persekutuan Putrajaya 62590, Malaysia
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Cabanilla KI, Enriquez EAT, Velasco AC, Mendoza VMP, Mendoza R. Optimal selection of COVID-19 vaccination sites in the Philippines at the municipal level. PeerJ 2022; 10:e14151. [PMID: 36199283 PMCID: PMC9528907 DOI: 10.7717/peerj.14151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/07/2022] [Indexed: 01/21/2023] Open
Abstract
In this work, we present an approach to determine the optimal location of coronavirus disease 2019 (COVID-19) vaccination sites at the municipal level. We assume that each municipality is subdivided into smaller administrative units, which we refer to as barangays. The proposed method solves a minimization problem arising from a facility location problem, which is formulated based on the proximity of the vaccination sites to the barangays, the number of COVID-19 cases, and the population densities of the barangays. These objectives are formulated as a single optimization problem. As an alternative decision support tool, we develop a bi-objective optimization problem that considers distance and population coverage. Lastly, we propose a dynamic optimization approach that recalculates the optimal vaccination sites to account for the changes in the population of the barangays that have completed their vaccination program. A numerical scheme that solves the optimization problems is presented and the detailed description of the algorithms, which are coded in Python and MATLAB, are uploaded to a public repository. As an illustration, we apply our method to determine the optimal location of vaccination sites in San Juan, a municipality in the province of Batangas, in the Philippines. We hope that this study may guide the local government units in coming up with strategic and accessible plans for vaccine administration.
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La Verde N, Riva A, Cona MS, Gabrieli A, Cattaneo M, Fasola C, Lipari G, De Stradis C, Favorito V, Lombardi Stocchetti B, Chizzoniti D, Covizzi A, Rulli E, Galli F, Ruggieri L, Gambaro A, Ferrario S, Dalu D, Tarkowski MS. Immunogenicity of two doses of BNT162b2 and mRNA-1273 vaccines for solid cancer patients on treatment with or without a previous SARS-CoV-2 infection. Int J Cancer 2022; 152:661-671. [PMID: 36056571 PMCID: PMC9538813 DOI: 10.1002/ijc.34273] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/19/2022] [Accepted: 08/18/2022] [Indexed: 02/01/2023]
Abstract
Previous studies on the immunogenicity of SARS-CoV-2 mRNA vaccines showed a reduced seroconversion in cancer patients. The aim of our study is to evaluate the immunogenicity of two doses of mRNA vaccines in solid cancer patients with or without a previous exposure to the virus. This is a single-institution, prospective, nonrandomized study. Patients in active treatment and a control cohort of healthy people received two doses of BNT162b2 (Comirnaty, BioNTech/Pfizer, The United States) or mRNA-1273 (Spikevax, Moderna). Vaccine was administered before starting anticancer therapy or on the first day of the treatment cycle. SARS-CoV-2 antibody levels against S1, RBD (to evaluate vaccine response) and N proteins (to evaluate previous infection) were measured in plasma before the first dose and 30 days after the second one. From January to June 2021, 195 consecutive cancer patients and 20 healthy controls were enrolled. Thirty-one cancer patients had a previous exposure to SARS-CoV-2. Cancer patients previously exposed to the virus had significantly higher median levels of anti-S1 and anti-RBD IgG, compared to healthy controls (P = .0349) and to cancer patients without a previous infection (P < .001). Vaccine type (anti-S1: P < .0001; anti-RBD: P = .0045), comorbidities (anti-S1: P = .0274; anti-RBD: P = .0048) and the use of G-CSF (anti-S1: P = .0151) negatively affected the antibody response. Conversely, previous exposure to SARS-CoV-2 significantly enhanced the response to vaccination (anti-S1: P < .0001; anti-RBD: P = .0026). Vaccine immunogenicity in cancer patients with a previous exposure to SARS-CoV-2 seems comparable to that of healthy subjects. On the other hand, clinical variables of immune frailty negatively affect humoral immune response to vaccination.
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Affiliation(s)
- Nicla La Verde
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Agostino Riva
- Department of Infectious DiseasesSacco Hospital, ASST Fatebenefratelli SaccoMilanItaly,Luigi Sacco Department of Biomedical and Clinical Sciences DIBICUniversity of MilanMilanItaly
| | - Maria Silvia Cona
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Arianna Gabrieli
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBICUniversity of MilanMilanItaly
| | - Monica Cattaneo
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Cinzia Fasola
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Giuseppe Lipari
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBICUniversity of MilanMilanItaly
| | - Claudia De Stradis
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBICUniversity of MilanMilanItaly
| | - Valentina Favorito
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | | | - Davide Chizzoniti
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Alice Covizzi
- Department of Infectious DiseasesSacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Eliana Rulli
- Laboratory of Methodology for Clinical ResearchIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Francesca Galli
- Laboratory of Methodology for Clinical ResearchIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Lorenzo Ruggieri
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Anna Gambaro
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Sabrina Ferrario
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Davide Dalu
- Department of OncologySacco Hospital, ASST Fatebenefratelli SaccoMilanItaly
| | - Maciej S. Tarkowski
- Luigi Sacco Department of Biomedical and Clinical Sciences DIBICUniversity of MilanMilanItaly
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Duhen R, Beymer M, Jensen SM, Abbina S, Abraham S, Jain N, Thomas A, Geall AJ, Hu HM, Fox BA, Weinberg AD. OX40 agonist stimulation increases and sustains humoral and cell-mediated responses to SARS-CoV-2 protein and saRNA vaccines. Front Immunol 2022; 13:896310. [PMID: 36238275 PMCID: PMC9551348 DOI: 10.3389/fimmu.2022.896310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/08/2022] [Indexed: 12/01/2022] Open
Abstract
To prevent SARS-CoV-2 infections and generate long-lasting immunity, vaccines need to generate strong viral-specific B and T cell responses. Previous results from our lab and others have shown that immunizations in the presence of an OX40 agonist antibody lead to higher antibody titers and increased numbers of long-lived antigen-specific CD4 and CD8 T cells. Using a similar strategy, we explored the effect of OX40 co-stimulation in a prime and boost vaccination scheme using an adjuvanted SARS-CoV-2 spike protein vaccine in C57BL/6 mice. Our results show that OX40 engagement during vaccination significantly increases long-lived antibody responses to the spike protein. In addition, after immunization spike protein-specific proliferation was greatly increased for both CD4 and CD8 T cells, with enhanced, spike-specific secretion of IFN-γ and IL-2. Booster (3rd injection) immunizations combined with an OX40 agonist (7 months post-prime) further increased vaccine-specific antibody and T cell responses. Initial experiments assessing a self-amplifying mRNA (saRNA) vaccine encoding the spike protein antigen show a robust antigen-specific CD8 T cell response. The saRNA spike-specific CD8 T cells express high levels of GrzmB, IFN-γ and TNF-α which was not observed with protein immunization and this response was further increased by the OX40 agonist. Similar to protein immunizations the OX40 agonist also increased vaccine-specific CD4 T cell responses. In summary, this study compares and contrasts the effects and benefits of both protein and saRNA vaccination and the extent to which an OX40 agonist enhances and sustains the immune response against the SARS-CoV-2 spike protein.
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Affiliation(s)
- Rebekka Duhen
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, United States
- *Correspondence: Rebekka Duhen,
| | - Michael Beymer
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, United States
| | - Shawn M. Jensen
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, United States
| | | | | | - Nikita Jain
- Precision NanoSystems Inc, Vancouver, BC, Canada
| | | | | | - Hong-Ming Hu
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, United States
| | - Bernard A. Fox
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, United States
| | - Andrew D. Weinberg
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, United States
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ÇEVİK B. Association of COVID-19 vaccine with lymph node reactivity: an ultrasound-based study. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1123597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Millions of people worldwide have been infected and died due to the pandemic caused by COVID-19. Vaccination is the most effective way to deal with the pandemic. Though vaccines are safe, they are not completely risk-free, and some side effects can occur after vaccination such as lymphadenopathy. This study, it was aimed to measure the lymph node reactivity that may develop after mRNA vaccination.
Material and Method: A total of 50 healthy people were included in the study. Left axillary and supraclavicular ultrasound examinations were performed before and one week after the administration of the mRNA vaccine. Each patient was assessed for supraclavicular and level 1 axillary lymph region in terms of the presence, size (long and short axis), and cortex thickness of the lymph nodes.
Results: Of the patients participating in the study, 23 (46 %) were male, 27 (54 %) were female, and the median age was 33. In comparison, the difference in long, short axis and cortex diameter measurements of the supraclavicular lymph node before and after vaccination was found to be statistically significant (p=0.034, 0.021, 0.004, respectively). Similarly, the difference in the long, short axis, and cortex thickness of the left axillary lymph node before and after vaccination was statistically significant (p<0.001, <0.001, <0.001, respectively).
Conclusion: Anti-Covid-19 vaccines may cause lymphadenopathy as a result of reactivation in lymph nodes in the left axillary and supraclavicular regions. When lymphadenopathy is detected in these regions, the vaccine should be questioned in the clinical history and ultrasound follow-up should be performed on the patient.
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Reynolds MW, Secora A, Joules A, Albert L, Brinkley E, Kwon T, Mack C, Toovey S, Dreyer NA. Evaluating real-world COVID-19 vaccine effectiveness using a test-negative case-control design. J Comp Eff Res 2022; 11:1161-1172. [PMID: 36148919 PMCID: PMC9504802 DOI: 10.2217/cer-2022-0069] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: It is important to assess if clinical trial efficacy translates into real-world effectiveness for COVID-19 vaccines. Materials & methods: We conducted a modified test-negative design (TND) to evaluate the real-world effectiveness of three COVID-19 vaccines. We defined cases in two ways: self-reported COVID-19-positive tests, and self-reported positive tests with ≥1 moderate/severe COVID-19 symptom. Results: Any vaccination was associated with a 95% reduction in subsequently reporting a positive COVID-19 test, and a 71% reduction in reporting a positive test and ≥1 moderate/severe symptom. Conclusion: We observed high effectiveness across all three marketed vaccines, both for self-reported positive COVID-19 tests and moderate/severe COVID-19 symptoms. This innovative TND approach can be implemented in future COVID-19 vaccine and treatment real-world effectiveness studies. Clinicaltrials.gov identifier:NCT04368065. Evaluating real-world COVID-19 vaccine effectiveness. #COVID19 #Vaccines #TND #PRO #patientreportedoutcomes
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Affiliation(s)
| | - Alex Secora
- IQVIA Real-World Solutions. 201 Broadway, Cambridge, MA 02139, USA
| | - Alice Joules
- IQVIA Real-World Solutions. 201 Broadway, Cambridge, MA 02139, USA
| | - Lisa Albert
- IQVIA Real-World Solutions. 201 Broadway, Cambridge, MA 02139, USA
| | - Emma Brinkley
- IQVIA Real-World Solutions. 201 Broadway, Cambridge, MA 02139, USA
| | - Tom Kwon
- IQVIA Real-World Solutions. 201 Broadway, Cambridge, MA 02139, USA
| | - Christina Mack
- IQVIA Real-World Solutions. 201 Broadway, Cambridge, MA 02139, USA
| | - Stephen Toovey
- Pegasus Research, Neuschwaendistrasse 6, Engelberg, 6390, Switzerland
| | - Nancy A Dreyer
- IQVIA Real-World Solutions. 201 Broadway, Cambridge, MA 02139, USA
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Florea A, Sy LS, Qian L, Ackerson BK, Luo Y, Tubert JE, Lee GS, Ku JH, Bruxvoort KJ, Talarico CA, Qiu S, Tian Y, Tseng HF. Effectiveness of Messenger RNA-1273 Vaccine Booster Against Coronavirus Disease 2019 in Immunocompetent Adults. Clin Infect Dis 2022; 76:252-262. [PMID: 36134518 PMCID: PMC9619452 DOI: 10.1093/cid/ciac785] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND We conducted a prospective cohort study at Kaiser Permanente Southern California to evaluate the relative vaccine effectiveness (rVE) of a booster dose vs 2-dose primary series of messenger RNA (mRNA)-1273 in immunocompetent individuals. METHODS Immunocompetent adults who received a booster dose of mRNA-1273 from October 2021 through December 2021 were matched 1:1 to randomly selected 2-dose mRNA-1273 recipients by age, sex, race/ethnicity, and second-dose date and followed up through January 2022. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs), comparing outcomes (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection and coronavirus disease 2019 [COVID-19] hospitalization and hospital death) in the booster-dose and 2-dose groups. Adjusted rVE (%) was calculated as (1 - aHR) × 100. aHRs and rVE were also estimated by subgroup and month of follow-up. RESULTS The study included 431 328 booster-dose vaccinated adults matched to 431 328 2-dose vaccinated adults. rVE was 61.3% (95% CI: 60.5%-62.2%) against SARS-CoV-2 infection, 89.0% (86.2%-91.2%) against COVID-19 hospitalization, and 96.0% (68.0%-99.5%) against COVID-19 hospital death. rVE against SARS-CoV-2 infection ranged from 55.6% to 66.7% across all subgroups. rVE against SARS-CoV-2 infection decreased from 67.1% (0 to <1 month of follow-up) to 30.5% (2 to <3 months). For COVID-19 hospitalization, rVE decreased from 91.2% (0 to <1 month) to 78.7% (2 to <3 months). CONCLUSIONS Among immunocompetent adults, the mRNA-1273 booster conferred additional protection against SARS-CoV-2 infection and severe COVID-19 disease compared with the 2-dose mRNA-1273 primary series during periods of Delta and Omicron predominance.
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Affiliation(s)
- Ana Florea
- Correspondence: A. Florea, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA 91101, USA ()
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Lei Qian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Bradley K Ackerson
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Yi Luo
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Julia E Tubert
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Gina S Lee
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jennifer H Ku
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Katia J Bruxvoort
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA,Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Carla A Talarico
- Infectious Disease, Clinical Development, Moderna, Inc, Cambridge, Massachusetts, USA
| | - Sijia Qiu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Yun Tian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Hung Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
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Grøsland M, Larsen VB, Telle K, Gjefsen HM. Has vaccination alleviated the strain on hospitals due to COVID-19? A combined difference-in-difference and simulation approach. BMC Health Serv Res 2022; 22:1183. [PMID: 36131346 PMCID: PMC9490737 DOI: 10.1186/s12913-022-08541-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Serious measures, including mass vaccination, have been taken to ensure sufficient hospital capacity during the COVID-19 pandemic. Due to high hospitalization risk in the oldest age groups, most countries prioritized elderly for vaccines. The aim of this study is to broaden the understanding of how vaccination in younger age groups relieved the strain on hospitals during the pandemic. Methods To determine the impact of vaccination on hospitalization, we relied on individual level data on health care use and vaccination from the Norwegian Emergency Preparedness Register Beredt C19. Using a pre-post design, we estimated the increase in hospitalization days from before to after confirmed COVID-19 for individuals aged 18-64 who were fully vaccinated (N=2 419) or unvaccinated (N=55 168) with comparison groups of vaccinated (N=4 818) and unvaccinated (N= 97 126) individuals without COVID-19. To evaluate whether vaccination itself contributed to a strain in hospitals, we use a similar design to study hospitalization rates before and after vaccination by comparing individuals vaccinated with the first dose (N=67 687) to unvaccinated individuals (N=130 769). These estimates were incorporated into a simulation of hospitalization days with different vaccine scenarios to show how the estimated results might have mattered for the hospitals and their capacity. Results Hospitalization days increased by 0.96 percentage point each day during the first week and 1.57 percentage points during the second week after testing positive for COVID-19 for unvaccinated individuals. The corresponding increase was 0.46 and 0.32 for vaccinated individuals, i.e., a substantial difference. The increase was significantly higher for those aged 45-64 than for those aged 18-25. We find no increase in hospitalization days due to vaccination. Simulation results show that vaccination reduced hospitalization days by 25 percent, mainly driven by age 45-64. Conclusion Our findings indicate that vaccination of individuals aged 18-64 did alleviate pressure on hospitals. Whereas there was a substantial relieve from vaccinating the 45-64 age group, there was no such contribution from vaccinating the 18-25 age group. Our study highlights how simulation models can be useful when evaluating alternative vaccine strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08541-x.
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Affiliation(s)
- Mari Grøsland
- Norwegian Institute of Public Health, Cluster for Health Services Research, Postboks 222, Skøyen, N-0213, 0473, Oslo, Norway.
| | - Vilde Bergstad Larsen
- Norwegian Institute of Public Health, Cluster for Health Services Research, Postboks 222, Skøyen, N-0213, 0473, Oslo, Norway
| | - Kjetil Telle
- Norwegian Institute of Public Health, Cluster for Health Services Research, Postboks 222, Skøyen, N-0213, 0473, Oslo, Norway
| | - Hege Marie Gjefsen
- Norwegian Institute of Public Health, Cluster for Health Services Research, Postboks 222, Skøyen, N-0213, 0473, Oslo, Norway
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Kamal MA, Kuznik A, Qi L, Więcek W, Hussein M, Hassan H, Patel K, Obadia T, Toroghi MK, Conrado DJ, Al‐Huniti N, Casciano R, O'Brien MP, Barnabas RV, Cohen MS, Smith PF. Assessing the Combined Public Health Impact of Pharmaceutical Interventions on Pandemic Transmission and Mortality: An Example in SARS CoV-2. Clin Pharmacol Ther 2022; 112:1224-1235. [PMID: 35984050 PMCID: PMC9538838 DOI: 10.1002/cpt.2728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/15/2022] [Indexed: 01/31/2023]
Abstract
To assess the combined role of anti-viral monoclonal antibodies (mAbs) and vaccines in reducing severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) transmission and mortality in the United States, an agent-based model was developed that accounted for social contacts, movement/travel, disease progression, and viral shedding. The model was calibrated to coronavirus disease 2019 (COVID-19) mortality between October 2020 and April 2021 (aggressive pandemic phase), and projected an extended outlook to estimate mortality during a less aggressive phase (April-August 2021). Simulated scenarios evaluated mAbs for averting infections and deaths in addition to vaccines and aggregated non-pharmaceutical interventions. Scenarios included mAbs as a treatment of COVID-19 and for passive immunity for postexposure prophylaxis (PEP) during a period when variants were susceptible to the mAbs. Rapid diagnostic testing paired with mAbs was evaluated as an early treatment-as-prevention strategy. Sensitivity analyses included increasing mAb supply and vaccine rollout. Allocation of mAbs for use only as PEP averted up to 14% more infections than vaccine alone, and targeting individuals ≥ 65 years averted up to 37% more deaths. Rapid testing for earlier diagnosis and mAb use amplified these benefits. Doubling the mAb supply further reduced infections and mortality. mAbs provided benefits even as proportion of the immunized population increased. Model projections estimated that ~ 42% of expected deaths between April and August 2021 could be averted. Assuming sensitivity to mAbs, their use as early treatment and PEP in addition to vaccines would substantially reduce SARS-CoV-2 transmission and mortality even as vaccination increases and mortality decreases. These results provide a template for informing public health policy for future pandemic preparedness.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ruanne V. Barnabas
- Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Myron S. Cohen
- Institute for Global Health and Infectious Diseases, University of North CarolinaChapel HillNorth CarolinaUSA
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Vaccination Decreases the Infectious Viral Load of Delta Variant SARS-CoV-2 in Asymptomatic Patients. Viruses 2022; 14:v14092071. [PMID: 36146877 PMCID: PMC9503182 DOI: 10.3390/v14092071] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 02/08/2023] Open
Abstract
The Delta variant of SARS-CoV-2 has caused many breakthrough infections in fully vaccinated individuals. While vaccine status did not generally impact the number of viral RNA genome copies in nasopharyngeal swabs of breakthrough patients, as measured by Ct values, it has been previously found to decrease the infectious viral load in symptomatic patients. We quantified the viral RNA, infectious virus, and anti-spike IgA in nasopharyngeal swabs collected from individuals asymptomatically infected with the Delta variant of SARS-CoV-2. Vaccination decreased the infectious viral load, but not the amount of viral RNA. Furthermore, vaccinees with asymptomatic infections had significantly higher levels of anti-spike IgA in their nasal secretions compared to unvaccinated individuals with asymptomatic infections. Thus, vaccination may decrease the transmission risk of Delta, and perhaps other variants, despite not affecting the amount of viral RNA measured in nasopharyngeal swabs.
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125
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El-Menyar A, Khan NA, Mekkodathil A, Rizoli S, Consunji R, Elmenyar E, Galwankar S, Al-Thani H. A quick scoping review of the first year of vaccination against the COVID-19 pandemic: Do we need more shots or time? Medicine (Baltimore) 2022; 101:e30609. [PMID: 36123868 PMCID: PMC9477714 DOI: 10.1097/md.0000000000030609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The emergence of new severe acute respiratory syndrome coronavirus 2 variants, along with the waning of vaccine-induced immunity, has increased breakthrough infections and urged booster jabs and debates. In the short term, the administration of booster doses has been reported to be safe and enhance severe acute respiratory syndrome coronavirus 2-specific neutralizing antibody levels. However, the effects of these doses on the pandemic trajectory and herd immunity are unclear. There is insufficient evidence that a third booster shot of the coronavirus disease 2019 (COVID-19) vaccine maintains longer immunity and covers new viral variants. The lack of sufficient evidence, combined with the fact that millions of people have not yet received 1 or 2 jabs of the COVID-19 vaccine, has raised concerns regarding the call for booster vaccinations. METHODS We conducted a quick scoping review to explore the literature on the need for a booster COVID-19 vaccination from January 1, 2021, to April 30, 2022. RESULTS Sixty-one relevant publications were identified, of which 17 were related to waning immunity after 2 doses of the vaccine among the general population or healthcare workers, 19 were related to the third or booster dose of vaccination after the second dose among the general population or healthcare workers, and 25 were related to booster dose among immunocompromised patient. CONCLUSIONS Initially, the need for a booster dose was equivocal; however, several studies demonstrated the benefit of the booster dose over time. Adequate scientific information is required regarding the administration of booster doses to the general population as well as the high-risk individuals.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Trauma and Vascular Surgery Clinical Research, Hamad Medical Corporation, Qatar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Naushad Ahmad Khan
- Department of Surgery, Trauma and Vascular Surgery Clinical Research, Hamad Medical Corporation, Qatar
| | - Ahammed Mekkodathil
- Department of Surgery, Trauma and Vascular Surgery Clinical Research, Hamad Medical Corporation, Qatar
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Qatar
| | - Rafael Consunji
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Qatar
| | | | - Sagar Galwankar
- Department of Emergency Medicine, Sarasota Memorial Hospital, Sarasota, FL
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Qatar
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126
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Li X, Zhang X, Shi X, Shi H, Wang Z, Peng C. Review in isothermal amplification technology in food microbiological detection. Food Sci Biotechnol 2022; 31:1501-1511. [PMID: 36119387 PMCID: PMC9469833 DOI: 10.1007/s10068-022-01160-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 11/04/2022] Open
Abstract
Food-borne diseases caused by microbial contamination have always been a matter of great concern to human beings. Hence, the research on these problems has never stopped. With the development of microorganism amplification technology, more and more detection methods have come into our vision. However, traditional detection technologies presents more or less drawbacks, such as complicated operation, low accuracy, low sensitivity, long-time detection, and so on. Therefore, more convenient, accurate, and sensitive measurement for the microorganism are needed. Isothermal amplification technology is one of the alternative approach containing the above mentioned advantages. This work mainly summarizes the principles of loop-mediated isothermal amplification (LAMP) and rolling circle amplification (RCA) which belong to isothermal amplification. Meanwhile, the application of LAMP and RCA in food microorganism detection is introduced.
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127
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Zheutlin A, Ott M, Sun R, Zemlianskaia N, Meyer CS, Rubel M, Hayden J, Neri B, Kamath T, Khan N, Schneeweiss S, Sarsour K. Durability of Protection Post-Primary COVID-19 Vaccination in the United States. Vaccines (Basel) 2022; 10:vaccines10091458. [PMID: 36146536 PMCID: PMC9505933 DOI: 10.3390/vaccines10091458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 12/27/2022] Open
Abstract
The durability of immune responses after COVID-19 vaccination will drive long-term vaccine effectiveness across settings and may differ by vaccine type. To determine durability of protection of COVID-19 vaccines (BNT162b2, mRNA-1273, and Ad26.COV2.S) following primary vaccination in the United States, a matched case-control study was conducted in three cohorts between 1 January and 7 September 2021 using de-identified data from a database covering 168 million lives. Odds ratios (ORs) for developing outcomes of interest (breakthrough SARS-CoV-2 infection, hospitalization, or intensive care unit admission) were determined for each vaccine (no direct comparisons). In total, 17,017,435 individuals were identified. Relative to the baseline, stable protection was observed for Ad26.COV2.S against infections (OR [95% confidence interval (CI)], 1.31 [1.18–1.47]) and hospitalizations (OR [95% CI], 1.25 [0.86–1.80]). Relative to the baseline, protection waned over time against infections for BNT162b2 (OR [95% CI], 2.20 [2.01–2.40]) and mRNA-1273 (OR [95% CI], 2.07 [1.87–2.29]) and against hospitalizations for BNT162b2 (OR [95% CI], 2.38 [1.79–3.17]). Baseline protection remained stable for intensive care unit admissions for all three vaccines. Calculated baseline VE was consistent with published literature. This study suggests that the three vaccines in three separate populations may have different durability profiles.
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Affiliation(s)
- Amanda Zheutlin
- Data Sciences, Research & Development, Janssen Pharmaceuticals, Titusville, NJ 08560, USA
| | - Miles Ott
- Data Sciences, Research & Development, Janssen Pharmaceuticals, Titusville, NJ 08560, USA
| | - Ran Sun
- Data Sciences, Research & Development, Janssen Pharmaceuticals, Titusville, NJ 08560, USA
| | - Natalia Zemlianskaia
- Data Sciences, Research & Development, Janssen Pharmaceuticals, Titusville, NJ 08560, USA
| | - Craig S. Meyer
- Data Sciences, Research & Development, Janssen Pharmaceuticals, Titusville, NJ 08560, USA
| | - Meagan Rubel
- Data Sciences, Research & Development, Janssen Pharmaceuticals, Titusville, NJ 08560, USA
| | - Jennifer Hayden
- Data Sciences, Research & Development, Janssen Pharmaceuticals, Titusville, NJ 08560, USA
| | - Breno Neri
- Data Sciences, Research & Development, Janssen Pharmaceuticals, Titusville, NJ 08560, USA
| | - Tripthi Kamath
- Data Sciences, Research & Development, Janssen Pharmaceuticals, Titusville, NJ 08560, USA
| | - Najat Khan
- Data Sciences, Research & Development, Janssen Pharmaceuticals, Titusville, NJ 08560, USA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02120, USA
| | - Khaled Sarsour
- Data Sciences, Research & Development, Janssen Pharmaceuticals, Titusville, NJ 08560, USA
- Correspondence: ; Tel.: +1-650-296-0719
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Real-world impact of vaccination on coronavirus disease 2019 (COVID-19) incidence in healthcare personnel at an academic medical center. Infect Control Hosp Epidemiol 2022; 43:1194-1200. [PMID: 34287111 PMCID: PMC8353192 DOI: 10.1017/ice.2021.336] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) vaccination effectiveness in healthcare personnel (HCP) has been established. However, questions remain regarding its performance in high-risk healthcare occupations and work locations. We describe the effect of a COVID-19 HCP vaccination campaign on SARS-CoV-2 infection by timing of vaccination, job type, and work location. METHODS We conducted a retrospective review of COVID-19 vaccination acceptance, incidence of postvaccination COVID-19, hospitalization, and mortality among 16,156 faculty, students, and staff at a large academic medical center. Data were collected 8 weeks prior to the start of phase 1a vaccination of frontline employees and ended 11 weeks after campaign onset. RESULTS The COVID-19 incidence rate among HCP at our institution decreased from 3.2% during the 8 weeks prior to the start of vaccinations to 0.38% by 4 weeks after campaign initiation. COVID-19 risk was reduced among individuals who received a single vaccination (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.40-0.68; P < .0001) and was further reduced with 2 doses of vaccine (HR, 0.17; 95% CI, 0.09-0.32; P < .0001). By 2 weeks after the second dose, the observed case positivity rate was 0.04%. Among phase 1a HCP, we observed a lower risk of COVID-19 among physicians and a trend toward higher risk for respiratory therapists independent of vaccination status. Rates of infection were similar in a subgroup of nurses when examined by work location. CONCLUSIONS Our findings show the real-world effectiveness of COVID-19 vaccination in HCP. Despite these encouraging results, unvaccinated HCP remain at an elevated risk of infection, highlighting the need for targeted outreach to combat vaccine hesitancy.
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129
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Sadigh KS, Kugeler KJ, Bressler S, Massay SC, Schmoll E, Milroy L, Cavanaugh AM, Sierocki A, Fischer M, Nolen LD. Evaluating risk factors associated with COVID-19 infections among vaccinated people early in the U.S. vaccination campaign: an observational study of five states, January-March 2021. BMC Infect Dis 2022; 22:718. [PMID: 36050630 PMCID: PMC9434543 DOI: 10.1186/s12879-022-07702-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background COVID-19 vaccines are an effective tool to prevent illness due to SARS-CoV-2 infection. However, infection after vaccination still occurs. We evaluated all infections identified among recipients of either the Pfizer-BioNTech or Moderna COVID-19 vaccine in five U.S. states during January–March 2021. Methods Using observational data reported to CDC, we compared the incidence of SARS-CoV-2 infection among vaccinated and unvaccinated persons, and the sex, age, and vaccine product received for individuals with vaccine breakthrough infections to those of the vaccinated population using Poisson regression models. We also compared the proportion of vaccine breakthrough cases due to a SARS-CoV-2 variant of concern to data reported to CDC’s national genomic surveillance program. Results The age-adjusted incidence of reported SARS-CoV-2 infection was 97% lower among vaccinated as compared to unvaccinated persons aged ≥ 16 years (68 vs 2252 cases per 100,000 people). Vaccinated adults aged ≥ 85 years were 1.6 times (95% CI 1.3–1.9) as likely to become infected with SARS-CoV-2 than vaccinated adults aged < 65 years. Pfizer-BioNTech COVID-19 vaccine recipients were 1.4 times (95% CI 1.3–1.6) as likely to experience infection compared to Moderna COVID-19 recipients. The proportion of infections among vaccinated persons caused by SARS-CoV-2 variants of concern was similar to the proportion of circulating viruses identified as variants of concern in the five states during the same time. Conclusions Vaccinated persons had a substantially lower incidence of SARS-CoV-2 infection compared to unvaccinated persons. Adults aged ≥ 85 years and Pfizer-BioNTech vaccine recipients had a higher risk of infection following vaccination. We provide an analytic framework for ongoing evaluation of patterns associated with SARS-CoV-2 infection among vaccinated persons using observational surveillance and immunization data. Our findings reinforce the effectiveness of COVID-19 vaccines in preventing infection in real-world settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07702-x.
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Affiliation(s)
- Katrin S Sadigh
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30329, USA.,Epidemic Intelligence Service, Center for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30329, USA
| | - Kiersten J Kugeler
- Centers for Disease Control and Prevention, 3156 Rampart Rd, Fort Collins, CO, 80521, USA.
| | - Sara Bressler
- Centers for Disease Control and Prevention, 4055 Tudor Centre Dr, Anchorage, AK, 99508, USA
| | - Stephanie C Massay
- Alaska Department of Health and Social Services, 3601 C St, Anchorage, AK, 99503, USA
| | - Emma Schmoll
- Colorado Department of Public Health and Environment, 4300 Cherry Creek South Dr, Denver, CO, 80246, USA
| | - Lauren Milroy
- Indiana Department of Health, 2 N. Meridian St, Indianapolis, IN, 46204, USA
| | - Alyson M Cavanaugh
- Epidemic Intelligence Service, Center for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30329, USA.,Kentucky Department for Public Health, 275 E Main St, Frankfort, KY, 40601, USA
| | - Allison Sierocki
- Tennessee Department of Health, 710 James Robertson Parkway, Nashville, TN, 37243, USA
| | | | - Marc Fischer
- Centers for Disease Control and Prevention, 4055 Tudor Centre Dr, Anchorage, AK, 99508, USA
| | - Leisha D Nolen
- Centers for Disease Control and Prevention, 4055 Tudor Centre Dr, Anchorage, AK, 99508, USA
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130
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Arashiro T, Arima Y, Muraoka H, Sato A, Oba K, Uehara Y, Arioka H, Yanai H, Kuramochi J, Ihara G, Chubachi K, Yanagisawa N, Nagura Y, Kato Y, Ueda A, Numata A, Kato H, Ishii K, Ooki T, Oka H, Nishida Y, Stucky A, Smith C, Hibberd M, Ariyoshi K, Suzuki M. Coronavirus Disease 19 (COVID-19) Vaccine Effectiveness Against Symptomatic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection During Delta-Dominant and Omicron-Dominant Periods in Japan: A Multicenter Prospective Case-control Study (Factors Associated with SARS-CoV-2 Infection and the Effectiveness of COVID-19 Vaccines Study). Clin Infect Dis 2022; 76:e108-e115. [PMID: 35918782 PMCID: PMC9384625 DOI: 10.1093/cid/ciac635] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/19/2022] [Accepted: 08/01/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although several coronavirus disease 2019 (COVID-19) vaccines initially showed high efficacy, there have been concerns because of waning immunity and the emergence of variants with immune escape capacity. METHODS A test-negative design case-control study was conducted in 16 healthcare facilities in Japan during the Delta-dominant period (August-September 2021) and the Omicron-dominant period (January-March 2022). Vaccine effectiveness (VE) against symptomatic severe acute respiratory syndrome coronavirus 2 infection was calculated for 2 doses for the Delta-dominant period and 2 or 3 doses for the Omicron-dominant period compared with unvaccinated individuals. RESULTS The analysis included 5795 individuals with 2595 (44.8%) cases. Among vaccinees, 2242 (55.8%) received BNT162b2 and 1624 (40.4%) received messenger RNA (mRNA)-1273 at manufacturer-recommended intervals. During the Delta-dominant period, VE was 88% (95% confidence interval [CI], 82-93) 14 days to 3 months after dose 2 and 87% (95% CI, 38-97) 3 to 6 months after dose 2. During the Omicron-dominant period, VE was 56% (95% CI, 37-70) 14 days to 3 months since dose 2, 52% (95% CI, 40-62) 3 to 6 months after dose 2, 49% (95% CI, 34-61) 6+ months after dose 2, and 74% (95% CI, 62-83) 14+ days after dose 3. Restricting to individuals at high risk of severe COVID-19 and additional adjustment for preventive measures (ie, mask wearing/high-risk behaviors) yielded similar estimates, respectively. CONCLUSIONS In Japan, where most are infection-naïve, and strict prevention measures are maintained regardless of vaccination status, 2-dose mRNA vaccines provided high protection against symptomatic infection during the Delta-dominant period and moderate protection during the Omicron-dominant period. Among individuals who received an mRNA booster dose, VE recovered to a high level.
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Affiliation(s)
- Takeshi Arashiro
- Correspondence: T. Arashiro, Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Toyama 1-23-1, Shinjuku, Tokyo 162-8640, Japan ()
| | - Yuzo Arima
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | | | | | - Kunihiro Oba
- Department of Pediatrics, Showa General Hospital, Tokyo, Japan
| | - Yuki Uehara
- Department of Clinical Laboratory, St. Luke’s International Hospital, Tokyo, Japan
| | - Hiroko Arioka
- Department of General Internal Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Hideki Yanai
- Fukujuji Hospital, Japan Anti-Tuberculosis Association, Kiyose, Japan
| | | | | | - Kumi Chubachi
- Chubachi Internal Respiratory Medicine Clinic, Tokyo, Japan
| | | | | | - Yasuyuki Kato
- Department of Infectious Diseases, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Akihiro Ueda
- Department of Infectious Diseases, Japanese Red Cross Medical Center, Tokyo, Japan
| | | | - Hideaki Kato
- Infection Prevention and Control Department, Yokohama City University Hospital, Yokohama, Japan
| | - Koji Ishii
- Saitama Sekishinkai Hospital, Saitama, Japan
| | - Takao Ooki
- Saitama Sekishinkai Hospital, Saitama, Japan
| | - Hideaki Oka
- Department of General Internal Medicine and Infectious Diseases, Saitama Medical Center, Saitama, Japan
| | - Yusuke Nishida
- Department of General Internal Medicine and Infectious Diseases, Saitama Medical Center, Saitama, Japan
| | - Ashley Stucky
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Chris Smith
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Martin Hibberd
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Koya Ariyoshi
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Sasanami M, Kayano T, Nishiura H. Monitoring the COVID-19 immune landscape in Japan. Int J Infect Dis 2022; 122:300-306. [PMID: 35688309 PMCID: PMC9173820 DOI: 10.1016/j.ijid.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES COVID-19 vaccination in Japan started on February 17, 2021. Because the timing of vaccination and the risk of severe COVID-19 greatly varied with age, the present study aimed to monitor the age-specific fractions of the population who were immune to SARS-CoV-2 infection after vaccination. METHODS Natural infection remained extremely rare, accounting for less than 5% of the population by the end of 2021; thus, we ignored natural infection-induced immunity and focused on vaccine-induced immunity. We estimated the fraction of the population immune to infection by age group using vaccination registry data from February 17, 2021, to October 17, 2021. We accounted for two important sources of delay: (i) reporting delay and (ii) time from vaccination until immune protection develops. RESULTS At the end of the observation period, the proportion of individuals still susceptible to SARS-CoV-2 infection substantially varied by age and was estimated to be ≥90% among people aged 0-14 years, in contrast to approximately 20% among the population aged ≥65 years. We also estimated the effective reproduction number over time using a next-generation matrix while accounting for differences in the proportion immune to infection by age. CONCLUSION The COVID-19 immune landscape greatly varied by age, and a substantial proportion of young adults remained susceptible. Vaccination contributed to a marked decrease in the reproduction number.
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Affiliation(s)
| | | | - Hiroshi Nishiura
- Corresponding author: Hiroshi Nishiura, Kyoto University School of Public Health, Yoshida-Konoe, Sakyo, Kyoto 606-8601, Japan Tel: +81 75 753 4456; Fax: +81 75 753 4458
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132
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Bester JC. A Clinician's Obligation to be Vaccinated: Four Arguments that Establish a Duty for Healthcare Professionals to be Vaccinated Against COVID-19. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:451-465. [PMID: 35362931 PMCID: PMC8972764 DOI: 10.1007/s11673-022-10182-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/11/2022] [Indexed: 05/14/2023]
Abstract
This paper defends four lines of argument that establish an ethical obligation for clinicians to be vaccinated against COVID-19. They are:(1) The obligation to protect patients against COVID-19 spread;(2) The obligation to maintain professional competence and remain available for patients;(3) Clinicians' role and place in society in relation to COVID-19;(4) The obligation to encourage societal vaccination uptake.These arguments stand up well against potential objections and provide a compelling case to consider acceptance of COVID-19 vaccination a duty for all clinicians. This duty brings with it the implication that vaccine refusal amounts to a dereliction of the professional's ethical obligations, which means such clinicians should be subject to disciplinary action. Furthermore, this duty provides grounding for mandatory vaccination policies for clinicians.
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Affiliation(s)
- Johan Christiaan Bester
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas 2040 W Charleston Blvd, Las Vegas, NV, 89102, USA.
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133
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Hosseini-Moghaddam SM, He S, Calzavara A, Campitelli MA, Kwong JC. Association of Influenza Vaccination With SARS-CoV-2 Infection and Associated Hospitalization and Mortality Among Patients Aged 66 Years or Older. JAMA Netw Open 2022; 5:e2233730. [PMID: 36169955 PMCID: PMC9520345 DOI: 10.1001/jamanetworkopen.2022.33730] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Vaccine effectiveness studies have rarely implemented strategies to reduce the healthy vaccinee bias arising from differences in health care-seeking behavior between vaccinated and unvaccinated individuals. Although previous observational studies suggest that influenza vaccination is associated with a reduced risk of SARS-CoV-2-associated outcomes, the healthy vaccinee bias may have led to overestimating the vaccination effect. OBJECTIVE To estimate the association between influenza vaccination and SARS-CoV-2-associated outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted over 2 consecutive influenza vaccination campaigns (2019-2020 and 2020-2021), owing to the substantial COVID-19 burden and the greater validity of influenza vaccination data in the studied age group. The study population included community-dwelling adults aged 66 years or older in Ontario, Canada. EXPOSURE Influenza vaccination for a given season. MAIN OUTCOMES AND MEASURES The outcomes of interest included SARS-CoV-2 infection, SARS-CoV-2-associated hospitalization, SARS-CoV-2-associated death, and a composite of SARS-CoV-2-associated hospitalization or death. Cox proportional hazards models were used to measure the association between influenza vaccination and SARS-CoV-2-associated outcomes, censoring individuals who moved into long-term care, received COVID-19 vaccines, or died before the observation period end date. Primary care periodic health examinations (PHEs) were explored as a negative tracer exposure (ie, no association expected with SARS-CoV-2 outcomes) and as an effect modifier of the association between influenza vaccination and SARS-CoV-2 outcomes. RESULTS Of 2 922 449 individuals aged 66 years or older (54.2% female) living in Ontario, 2 279 805 were included in the study. Among these, 1 234 647 (54.2%) were female and 1 045 158 (45.8%) were male; their mean (SD) age was 75.08 (7.21) years. Those who had received influenza vaccination exhibited a lower incidence of SARS-CoV-2 infection than unvaccinated individuals for the 2019-2020 cohort (adjusted hazards ratio [aHR], 0.78; 95% CI, 0.73-0.84) and the 2020-2021 cohort (aHR, 0.76; 95% CI, 0.74-0.78). This association was also observed for SARS-CoV-2-associated hospitalization or death (2019-2020: aHR, 0.83; 95% CI, 0.74-0.92; 2020-2021: aHR, 0.66; 95% CI, 0.63-0.70). Similarly, undergoing a PHE was also associated with a lower incidence of SARS-CoV-2 infection (aHR, 0.85; 95% CI, 0.78-0.91) and SARS-CoV-2-associated hospitalization or death (aHR, 0.80; 95% CI, 0.70-0.90), and modified the association between influenza vaccination and SARS-CoV-2 infection for vaccinated individuals who underwent PHE (aHR, 0.62; 95% CI, 0.52-0.74) and for vaccinated individuals who did not undergo PHE (aHR, 0.81; 95% CI, 0.76-0.87), and also SARS-CoV-2-associated hospitalization or death in vaccinated individuals who underwent PHE (aHR, 0.66; 95% CI, 0.49-0.88) and vaccinated individuals who did not undergo PHE (aHR, 0.85, 95% CI, 0.76-0.95). CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that undergoing a PHE may at least partially modify the association between influenza vaccination and SARS-CoV-2-associated outcomes in individuals aged 66 years or older, providing evidence of the healthy vaccinee bias that may affect vaccine effectiveness studies.
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Affiliation(s)
- Seyed M. Hosseini-Moghaddam
- ICES, Toronto, Ontario, Canada
- Ajmera Transplant Centre, University Health Network, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Siyi He
- ICES, Toronto, Ontario, Canada
| | | | | | - Jeffrey C. Kwong
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
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134
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Morgan RW, Atkins DL, Hsu A, Kamath-Rayne BD, Aziz K, Berg RA, Bhanji F, Chan M, Cheng A, Chiotos K, de Caen A, Duff JP, Fuchs S, Joyner BL, Kleinman M, Lasa JJ, Lee HC, Lehotzky RE, Levy A, McBride ME, Meckler G, Nadkarni V, Raymond T, Roberts K, Schexnayder SM, Sutton RM, Terry M, Walsh B, Zelop CM, Sasson C, Topjian A. Guidance for Cardiopulmonary Resuscitation of Children With Suspected or Confirmed COVID-19. Pediatrics 2022; 150:188494. [PMID: 35818123 DOI: 10.1542/peds.2021-056043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/24/2022] Open
Abstract
This article aims to provide guidance to health care workers for the provision of basic and advanced life support to children and neonates with suspected or confirmed coronavirus disease 2019 (COVID-19). It aligns with the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular care while providing strategies for reducing risk of transmission of severe acute respiratory syndrome coronavirus 2 to health care providers. Patients with suspected or confirmed COVID-19 and cardiac arrest should receive chest compressions and defibrillation, when indicated, as soon as possible. Because of the importance of ventilation during pediatric and neonatal resuscitation, oxygenation and ventilation should be prioritized. All CPR events should therefore be considered aerosol-generating procedures. Thus, personal protective equipment (PPE) appropriate for aerosol-generating procedures (including N95 respirators or an equivalent) should be donned before resuscitation, and high-efficiency particulate air filters should be used. Any personnel without appropriate PPE should be immediately excused by providers wearing appropriate PPE. Neonatal resuscitation guidance is unchanged from standard algorithms, except for specific attention to infection prevention and control. In summary, health care personnel should continue to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission through vaccination and use of appropriate PPE during pediatric resuscitations. Health care organizations should ensure the availability and appropriate use of PPE. Because delays or withheld CPR increases the risk to patients for poor clinical outcomes, children and neonates with suspected or confirmed COVID-19 should receive prompt, high-quality CPR in accordance with evidence-based guidelines.
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Affiliation(s)
- Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Dianne L Atkins
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Antony Hsu
- Department of Emergency Medicine, St. Joseph Mercy Ann Arbor Hospital, Superior Township, Michigan
| | - Beena D Kamath-Rayne
- Global Newborn and Child Health, American Academy of Pediatrics, Itasca, Illinois
| | - Khalid Aziz
- Department of Pediatrics, Division of Newborn Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Farhan Bhanji
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Melissa Chan
- Departments of Pediatrics and Pediatric Emergency Medicine, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Cheng
- Department of Paediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Kathleen Chiotos
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Allan de Caen
- Department of Pediatrics, Division of Critical Care, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jonathan P Duff
- Department of Pediatrics, Division of Critical Care, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | - Benny L Joyner
- Departments of Pediatrics, Anesthesiology & Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Monica Kleinman
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Javier J Lasa
- Cardiovascular ICU, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Henry C Lee
- Division of Neonatology, Stanford University, Stanford, California
| | | | - Arielle Levy
- Departments of Pediatrics and Pediatric Emergency Medicine, Sainte-Justine Hospital University Center, University of Montreal, Montreal, Quebec, Canada
| | - Mary E McBride
- Cardiology, and Critical Care Medicine, Northwestern University, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Garth Meckler
- Departments of Pediatrics and Pediatric Emergency Medicine, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Tia Raymond
- Department of Pediatric Cardiac Critical Care, Medical City Children's Hospital, Dallas, Texas
| | - Kathryn Roberts
- Center for Nursing Excellence, Education & Innovation, Joe DiMaggio Children's Hospital, Hollywood, Florida
| | - Stephen M Schexnayder
- Departments of Critical Care Medicine and Emergency Medicine, Arkansas Children's Hospital, Springdale, Arkansas
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mark Terry
- National Registry of Emergency Medical Technicians, Columbus, Ohio
| | - Brian Walsh
- Respiratory Care, Children's Hospital Colorado, Aurora, Colorado
| | - Carolyn M Zelop
- Department of Obstetrics and Gynecology, NYU School of Medicine and The Valley Hospital, New York City, New York
| | - Comilla Sasson
- ECC Science & Innovation, American Heart Association, Dallas, Texas
| | - Alexis Topjian
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Rahmani K, Shavaleh R, Forouhi M, Disfani HF, Kamandi M, Oskooi RK, Foogerdi M, Soltani M, Rahchamani M, Mohaddespour M, Dianatinasab M. The effectiveness of COVID-19 vaccines in reducing the incidence, hospitalization, and mortality from COVID-19: A systematic review and meta-analysis. Front Public Health 2022; 10:873596. [PMID: 36091533 PMCID: PMC9459165 DOI: 10.3389/fpubh.2022.873596] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/26/2022] [Indexed: 01/21/2023] Open
Abstract
Background Vaccination, one of the most important and effective ways of preventing infectious diseases, has recently been used to control the COVID-19 pandemic. The present meta-analysis study aimed to evaluate the effectiveness of COVID-19 vaccines in reducing the incidence, hospitalization, and mortality from COVID-19. Methods A systematic search was performed independently in Scopus, PubMed via Medline, ProQuest, and Google Scholar electronic databases as well as preprint servers using the keywords under study. We used random-effect models and the heterogeneity of the studies was assessed using I 2 and χ2 statistics. In addition, the Pooled Vaccine Effectiveness (PVE) obtained from the studies was calculated by converting based on the type of outcome. Results A total of 54 studies were included in this meta-analysis. The PVE against SARS-COV 2 infection were 71% [odds ratio (OR) = 0.29, 95% confidence intervals (CI): 0.23-0.36] in the first dose and 87% (OR = 0.13, 95% CI: 0.08-0.21) in the second dose. The PVE for preventing hospitalization due to COVID-19 infection was 73% (OR = 0.27, 95% CI: 0.18-0.41) in the first dose and 89% (OR = 0.11, 95% CI: 0.07-0.17) in the second dose. With regard to the type of vaccine, mRNA-1273 and combined studies in the first dose and ChAdOx1 and mRNA-1273 in the second dose had the highest effectiveness in preventing infection. Regarding the COVID-19-related mortality, PVE was 68% (HR = 0.32, 95% CI: 0.23-0.45) in the first dose and 92% (HR = 0.08, 95% CI: 0.02-0.29) in the second dose. Conclusion The results of this meta-analysis indicated that vaccination against COVID-19 with BNT162b2 mRNA, mRNA-1273, and ChAdOx1, and also their combination, was associated with a favorable effectiveness against SARS-CoV2 incidence rate, hospitalization, and mortality rate in the first and second doses in different populations. We suggest that to prevent the severe form of the disease in the future, and, in particular, in the coming epidemic picks, vaccination could be the best strategy to prevent the severe form of the disease. Systematic review registration PROSPERO International Prospective Register of Systematic Reviews: http://www.crd.york.ac.uk/PROSPERO/, identifier [CRD42021289937].
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Affiliation(s)
- Kazem Rahmani
- Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Rasoul Shavaleh
- Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran,*Correspondence: Rasoul Shavaleh
| | - Mahtab Forouhi
- Department of Pharmacy, Shahid Behest University of Medical Sciences, Tehran, Iran
| | - Hamideh Feiz Disfani
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mostafa Kamandi
- Hematologist-Oncologist, Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Rozita Khatamian Oskooi
- Department of Emergency Medicine, Faculty of Medicine, Birgand University of Medical Sciences, Birjand, Iran
| | - Molood Foogerdi
- Department of Emergency Medicine, Faculty of Medicine, Birgand University of Medical Sciences, Birjand, Iran
| | - Moslem Soltani
- Department of Gastroenterology and Hepatology, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Maryam Rahchamani
- Department of Internal Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohaddespour
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mostafa Dianatinasab
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands,Mostafa Dianatinasab
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136
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Nopour R, Shanbehzadeh M, Kazemi-Arpanahi H. Predicting the Need for Intubation among COVID-19 Patients Using Machine Learning Algorithms: A Single-Center Study. Med J Islam Repub Iran 2022; 36:30. [PMID: 35999913 PMCID: PMC9386770 DOI: 10.47176/mjiri.36.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/04/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Owing to the shortage of ventilators, there is a crucial demand for an objective and accurate prognosis for 2019 coronavirus disease (COVID-19) critical patients, which may necessitate a mechanical ventilator (MV). This study aimed to construct a predictive model using machine learning (ML) algorithms for frontline clinicians to better triage endangered patients and priorities who would need MV.
Methods: In this retrospective single-center study, the data of 482 COVID-19 patients from February 9, 2020, to December 20, 2020, were analyzed by several ML algorithms including, multi-layer perception (MLP), logistic regression (LR), J-48 decision tree, and Naïve Bayes (NB). First, the most important clinical variables were identified using the Chi-square test at P < 0.01. Then, by comparing the ML algorithms' performance using some evaluation criteria, including TP-Rate, FP-Rate, precision, recall, F-Score, MCC, and Kappa, the best performing one was identified. Results: Predictive models were trained using 15 validated features, including cough, contusion, oxygen therapy, dyspnea, loss of taste, rhinorrhea, blood pressure, absolute lymphocyte count, pleural fluid, activated partial thromboplastin time, blood glucose, white cell count, cardiac diseases, length of hospitalization, and other underline diseases. The results indicated the J-48 with F-score = 0.868 and AUC = 0.892 yielded the best performance for predicting intubation requirement.
Conclusion: ML algorithms are potentials to improve traditional clinical criteria to forecast the necessity for intubation in COVID-19 in-hospital patients. Such ML-based prediction models may help physicians with optimizing the timing of intubation, better sharing of MV resources and personnel, and increase patient clinical status.
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Affiliation(s)
- Raoof Nopour
- Student Research Committee, School of Health Management and Information Sciences Branch, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Shanbehzadeh
- Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Hadi Kazemi-Arpanahi
- Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran.,Department of Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran
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Sachdev DD, Chew Ng R, Sankaran M, Ernst A, Hernandez KT, Servellita V, Sotomayor-Gonzalez A, Stoltey J, Cohen SE, Nguyen TQ, Chiu CY, Philip S. Contact-Tracing Outcomes Among Household Contacts of Fully Vaccinated Coronavirus Disease 2019 (COVID-19) Patients: San Francisco, California, 29 January-2 July 2021. Clin Infect Dis 2022; 75:e267-e275. [PMID: 34928340 PMCID: PMC8755335 DOI: 10.1093/cid/ciab1042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The extent to which vaccinated persons diagnosed with coronavirus disease 2019 (COVID-19) can transmit to other vaccinated and unvaccinated persons is unclear. METHODS Using data from the San Francisco Department of Public Health, this report describes outcomes of household contact tracing during 29 January-2 July 2021, where fully vaccinated patients with COVID-19 were the index case in the household. RESULTS Among 248 fully vaccinated patients with breakthrough infections, 203 (82%) were symptomatic and 105 were identified as the index patient within their household. Among 179 named household contacts, 71 (40%) contacts tested, over half (56%) were fully vaccinated and the secondary attack rate was 28%. Overall transmission from a symptomatic fully vaccinated patient with breakthrough infection to household contacts was suspected in 14 of 105 (13%) of households. Viral genomic sequencing of samples from 44% of fully vaccinated patients showed that 82% of those sequenced were infected by a variant of concern or interest and 77% by a variant carrying mutation(s) associated with resistance to neutralizing antibodies. CONCLUSIONS Transmission from fully vaccinated symptomatic index patients to vaccinated and unvaccinated household contacts can occur. Indoor face masking and timely testing of all household contacts should be considered when a household member receives a positive test result in order to identify and interrupt transmission chains.
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Affiliation(s)
- Darpun D Sachdev
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Rilene Chew Ng
- San Francisco Department of Public Health, San Francisco, California, USA
- US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Madeline Sankaran
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Alexandra Ernst
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | | | - Venice Servellita
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Alicia Sotomayor-Gonzalez
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Juliet Stoltey
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Stephanie E Cohen
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Trang Quyen Nguyen
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Charles Y Chiu
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Susan Philip
- San Francisco Department of Public Health, San Francisco, California, USA
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138
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Tyner HL, Burgess JL, Grant L, Gaglani M, Kuntz JL, Naleway AL, Thornburg NJ, Caban-Martinez AJ, Yoon SK, Herring MK, Beitel SC, Blanton L, Nikolich-Zugich J, Thiese MS, Pleasants JF, Fowlkes AL, Lutrick K, Dunnigan K, Yoo YM, Rose S, Groom H, Meece J, Wesley MG, Schaefer-Solle N, Louzado-Feliciano P, Edwards LJ, Olsho LEW, Thompson MG. Neutralizing Antibody Response to Pseudotype Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Differs Between mRNA-1273 and BNT162b2 Coronavirus Disease 2019 (COVID-19) Vaccines and by History of SARS-CoV-2 Infection. Clin Infect Dis 2022; 75:e827-e837. [PMID: 34928334 PMCID: PMC8755309 DOI: 10.1093/cid/ciab1038] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Data on the development of neutralizing antibodies (nAbs) against SARS-CoV-2 after SARS-CoV-2 infection and after vaccination with mRNA COVID-19 vaccines are limited. METHODS From a prospective cohort of 3975 adult essential and frontline workers tested weekly from August 2020 to March 2021 for SARS-CoV-2 infection by reverse transcription-polymerase chain reaction assay irrespective of symptoms, 497 participants had sera drawn after infection (170), vaccination (327), and after both infection and vaccination (50 from the infection population). Serum was collected after infection and each vaccine dose. Serum-neutralizing antibody titers against USA-WA1/2020-spike pseudotype virus were determined by the 50% inhibitory dilution. Geometric mean titers (GMTs) and corresponding fold increases were calculated using t tests and linear mixed-effects models. RESULTS Among 170 unvaccinated participants with SARS-CoV-2 infection, 158 (93%) developed nAbs with a GMT of 1003 (95% confidence interval, 766-1315). Among 139 previously uninfected participants, 138 (99%) developed nAbs after mRNA vaccine dose 2 with a GMT of 3257 (2596-4052). GMT was higher among those receiving mRNA-1273 vaccine (GMT, 4698; 3186-6926) compared with BNT162b2 vaccine (GMT, 2309; 1825-2919). Among 32 participants with prior SARS-CoV-2 infection, GMT was 21 655 (14 766-31 756) after mRNA vaccine dose 1, without further increase after dose 2. CONCLUSIONS A single dose of mRNA vaccine after SARS-CoV-2 infection resulted in the highest observed nAb response. Two doses of mRNA vaccine in previously uninfected participants resulted in higher nAbs to SARS-CoV-2 than after 1 dose of vaccine or SARS-CoV-2 infection alone. nAb response also differed by mRNA vaccine product.
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Affiliation(s)
- Harmony L Tyner
- St. Luke’s Regional Health Care System, Duluth, Minnesota, USA
| | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health and the College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Lauren Grant
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, Texas, USA
- Texas A&M University College of Medicine, Temple, Texas, USA
| | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Natalie J Thornburg
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | | | - Sarang K Yoon
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | | | - Shawn C Beitel
- Mel and Enid Zuckerman College of Public Health and the College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Lenee Blanton
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Janko Nikolich-Zugich
- Mel and Enid Zuckerman College of Public Health and the College of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Matthew S Thiese
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | | | - Ashley L Fowlkes
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Karen Lutrick
- Mel and Enid Zuckerman College of Public Health and the College of Medicine, University of Arizona, Tucson, Arizona, USA
| | | | - Young M Yoo
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Spencer Rose
- Baylor Scott and White Health, Temple, Texas, USA
| | - Holly Groom
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon, USA
| | - Jennifer Meece
- the Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | | | | | | | | | | | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
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139
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Modelling vaccination capacity at mass vaccination hubs and general practice clinics: a simulation study. BMC Health Serv Res 2022; 22:1059. [PMID: 35986322 PMCID: PMC9388987 DOI: 10.1186/s12913-022-08447-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background COVID-19 mass vaccination programs place an additional burden on healthcare services. We aim to model the queueing process at vaccination sites to inform service delivery. Methods We use stochastic queue network models to simulate queue dynamics in larger mass vaccination hubs and smaller general practice (GP) clinics. We estimate waiting times and daily capacity based on a range of assumptions about appointment schedules, service times and staffing and stress-test these models to assess the impact of increased demand and staff shortages. We also provide an interactive applet, allowing users to explore vaccine administration under their own assumptions. Results Based on our assumed service times, the daily throughput for an eight-hour clinic at a mass vaccination hub ranged from 500 doses for a small hub to 1400 doses for a large hub. For GP clinics, the estimated daily throughput ranged from about 100 doses for a small practice to almost 300 doses for a large practice. What-if scenario analysis showed that sites with higher staff numbers were more robust to system pressures and mass vaccination sites were more robust than GP clinics. Conclusions With the requirement for ongoing COVID-19 booster shots, mass vaccination is likely to be a continuing feature of healthcare delivery. Different vaccine sites are useful for reaching different populations and maximising coverage. Stochastic queue networks offer a flexible and computationally efficient approach to simulate vaccination queues and estimate waiting times and daily throughput to inform service delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08447-8.
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140
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Piekos SN, Hwang YM, Roper RT, Sorensen T, Price ND, Hood L, Hadlock JJ. The effect of COVID-19 vaccination and booster on maternal-fetal outcomes: a retrospective multicenter cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.08.12.22278727. [PMID: 36032974 PMCID: PMC9413719 DOI: 10.1101/2022.08.12.22278727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background COVID-19 infection in pregnant people has previously been shown to increase the risk for poor maternal-fetal outcomes. Despite this, there has been a lag in COVID-19 vaccination in pregnant people due to concerns over the potential effects of the vaccine on maternal-fetal outcomes. Here we examine the impact of COVID-19 vaccination and booster on maternal COVID-19 breakthrough infections and birth outcomes. Methods This was a retrospective multicenter cohort study on the impact of COVID-19 vaccination on maternal-fetal outcomes for people that delivered (n=86,833) at Providence St. Joseph Health across Alaska, California, Montana, Oregon, New Mexico, Texas, and Washington from January 26, 2021 through July 11, 2022. Cohorts were defined by vaccination status at time of delivery: unvaccinated (n=48,492), unvaccinated propensity score matched (n=26,790), vaccinated (n=26,792; two doses of mRNA-1273 Moderna or BNT162b2 Pfizer-BioNTech), and/or boosted (n=7,616). The primary outcome was maternal COVID-19 infection. COVID-19 vaccination status at delivery, COVID-19 infection-related health care, preterm birth (PTB), stillbirth, very low birth weight (VLBW), and small for gestational age (SGA) were evaluated as secondary outcomes. Findings Vaccinated pregnant people were significantly less likely to have a maternal COVID-19 infection than unvaccinated matched (p<0.0001) pregnant people. During a maternal COVID-19 infection, vaccinated pregnant people had similar rates of hospitalization (p=0.23), but lower rates of supplemental oxygen (p<0.05) or vasopressor (p<0.05) use than those in an unvaccinated matched cohort. Compared to an unvaccinated matched cohort, vaccinated people had significantly lower stillbirth rate (p<0.01) as well as no difference in rate of PTB (p=0.35), SGA (p=0.79), or rate of VLBW (>1,500 g; 0.31). Vaccinated people who were boosted had significantly lower rates of maternal COVID-19 infections (p<0.0001), COVID-19 related hospitalization (p<0.05), PTB (p<0.05), stillbirth (p<0.01), SGA (p<0.05), and VLBW (p<0.01), compared to vaccinated people that did not receive a third booster dose five months after completing the initial vaccination series. Interpretation COVID-19 vaccination protects against adverse maternal-fetal outcomes with booster doses conferring additional protection against COVID-19 infection. It is therefore important for pregnant people to have high priority status for vaccination, and for them to stay current with their COVID-19 vaccination schedule. Funding This study was funded by the National Institute for Child Health & Human Development and the William O. and K. Carole Ellison Foundation.
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Affiliation(s)
| | | | | | - Tanya Sorensen
- Swedish Health Services, Swedish Medical Center, Seattle, WA, USA
| | - Nathan D Price
- Institute for Systems Biology, Seattle, WA, USA
- Thorne HealthTech, New York, NY, USA
| | - Leroy Hood
- Institute for Systems Biology, Seattle, WA, USA
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141
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Yan VKC, Wan EYF, Ye X, Mok AHY, Lai FTT, Chui CSL, Li X, Wong CKH, Li PH, Ma T, Qin S, Wong VKC, Tsang TC, Tsui SH, Chui WCM, Cowling BJ, Leung GM, Lau CS, Wong ICK, Chan EWY. Effectiveness of BNT162b2 and CoronaVac vaccinations against mortality and severe complications after SARS-CoV-2 Omicron BA.2 infection: a case-control study. Emerg Microbes Infect 2022; 11:2304-2314. [PMID: 35980089 PMCID: PMC9553171 DOI: 10.1080/22221751.2022.2114854] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Data regarding protection against mortality and severe complications after Omicron BA.2 infection with CoronaVac and BNT162b2 vaccines remains limited. We conducted a case–control study to evaluate the risk of severe complications and mortality following 1–3 doses of CoronaVac and BNT162b2 using electronic health records database. Cases were adults with their first COVID-19-related mortality or severe complications between 1 January and 31 March 2022, matched with up-to 10 controls by age, sex, index date, and Charlson Comorbidity Index. Vaccine effectiveness against COVID-19-related mortality and severe complications by type and number of doses was estimated using conditional logistic regression adjusted for comorbidities and medications. Vaccine effectiveness (95% CI) against COVID-19-related mortality after two doses of BNT162b2 and CoronaVac were 90.7% (88.6–92.3) and 74.8% (72.5–76.9) in those aged ≥65, 87.6% (81.4–91.8) and 80.7% (72.8–86.3) in those aged 50–64, 86.6% (71.0–93.8) and 82.7% (56.5–93.1) in those aged 18–50. Vaccine effectiveness against severe complications after two doses of BNT162b2 and CoronaVac were 82.1% (74.6–87.3) and 58.9% (50.3–66.1) in those aged ≥65, 83.0% (69.6–90.5) and 67.1% (47.1–79.6) in those aged 50–64, 78.3% (60.8–88.0) and 77.8% (49.6–90.2) in those aged 18–50. Further risk reduction with the third dose was observed especially in those aged ≥65 years, with vaccine effectiveness of 98.0% (96.5–98.9) for BNT162b2 and 95.5% (93.7–96.8) for CoronaVac against mortality, 90.8% (83.4–94.9) and 88.0% (80.8–92.5) against severe complications. Both CoronaVac and BNT162b2 vaccination were effective against COVID-19-related mortality and severe complications amidst the Omicron BA.2 pandemic, and risks decreased further with the third dose.
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Affiliation(s)
- Vincent Ka Chun Yan
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Eric Yuk Fai Wan
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China.,Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Hong Kong China.,Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Xuxiao Ye
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Anna Hoi Ying Mok
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Francisco Tsz Tsun Lai
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China.,Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Hong Kong China
| | - Celine Sze Ling Chui
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Hong Kong China.,School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China.,School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Xue Li
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China.,Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Hong Kong China.,Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Carlos King Ho Wong
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China.,Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Hong Kong China.,Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Philip Hei Li
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Tiantian Ma
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China.,Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Hong Kong China
| | - Simon Qin
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China.,Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Hong Kong China
| | | | - Tat Chi Tsang
- Department of Accident and Emergency, Queen Mary Hospital, Hong Kong China
| | - Sik Hon Tsui
- Department of Accident and Emergency, Queen Mary Hospital, Hong Kong China
| | | | - Benjamin John Cowling
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Hong Kong China.,World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Gabriel Matthew Leung
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Hong Kong China.,World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Chak Sing Lau
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China.,Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Hong Kong China.,Research Department of Practice and Policy, School of Pharmacy, University College London, London, United Kingdom.,Aston Pharmacy School, Aston University, Birmingham, B4 7ET, UK.,Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Esther Wai Yin Chan
- Centre for Safe Medication Practice and research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong China.,Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Hong Kong China.,Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China
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Almendro-Vázquez P, Chivite-Lacaba M, Utrero-Rico A, González-Cuadrado C, Laguna-Goya R, Moreno-Batanero M, Sánchez-Paz L, Luczkowiak J, Labiod N, Folgueira MD, Delgado R, Paz-Artal E. Cellular and humoral immune responses and breakthrough infections after three SARS-CoV-2 mRNA vaccine doses. Front Immunol 2022; 13:981350. [PMID: 36059485 PMCID: PMC9428395 DOI: 10.3389/fimmu.2022.981350] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background SARS-CoV-2 vaccination has proven the most effective measure to control the COVID-19 pandemic. Booster doses are being administered with limited knowledge on their need and effect on immunity. Objective To determine the duration of specific T cells, antibodies and neutralization after 2-dose vaccination, to assess the effect of a third dose on adaptive immunity and to explore correlates of protection against breakthrough infection. Methods 12-month longitudinal assessment of SARS-CoV-2-specific T cells, IgG and neutralizing antibodies triggered by 2 BNT162b2 doses followed by a third mRNA-1273 dose in a cohort of 77 healthcare workers: 17 with SARS-CoV-2 infection prior to vaccination (recovered) and 60 naïve. Results Peak levels of cellular and humoral response were achieved 2 weeks after the second dose. Antibodies declined thereafter while T cells reached a plateau 3 months after vaccination. The decline in neutralization was specially marked in naïve individuals and it was this group who benefited most from the third dose, which resulted in a 20.9-fold increase in neutralization. Overall, recovered individuals maintained higher levels of T cells, antibodies and neutralization 1 to 6 months post-vaccination than naïve. Seventeen asymptomatic or mild SARS-CoV-2 breakthrough infections were reported during follow-up, only in naïve individuals. This viral exposure boosted adaptive immunity. High peak levels of T cells and neutralizing antibodies 15 days post-vaccination associated with protection from breakthrough infections. Conclusion Booster vaccination in naïve individuals and the inclusion of viral antigens other than spike in future vaccine formulations could be useful strategies to prevent SARS-CoV-2 breakthrough infections.
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Affiliation(s)
- Patricia Almendro-Vázquez
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- *Correspondence: Patricia Almendro-Vázquez,
| | - Marta Chivite-Lacaba
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Alberto Utrero-Rico
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | | | - Rocio Laguna-Goya
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas (CIBERINFEC – Instituto de Salud Carlos III), Madrid, Spain
| | | | - Laura Sánchez-Paz
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Joanna Luczkowiak
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Nuria Labiod
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - María Dolores Folgueira
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rafael Delgado
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas (CIBERINFEC – Instituto de Salud Carlos III), Madrid, Spain
- Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Department of Medicine, Medical School, Universidad Complutense de Madrid, Madrid, Spain
| | - Estela Paz-Artal
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Infecciosas (CIBERINFEC – Instituto de Salud Carlos III), Madrid, Spain
- Department of Immunology, Ophthalmology and ENT, Medical School, Universidad Complutense de Madrid, Madrid, Spain
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143
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McCormick DW, Konkle SL, Magleby R, Chakrabarti AK, Cherney B, Lindell K, Namageyo-Funa A, Visser S, Soto RA, Donnelly MAP, Stringer G, Austin B, Beatty ME, Stous S, Albanese BA, Chu VT, Chuey M, Dietrich EA, Drobeniuc J, Folster JM, Killerby ME, Lehman JA, McDonald EC, Ruffin J, Schwartz NG, Sheldon SW, Sleweon S, Thornburg NJ, Hughes LJ, Petway M, Tong S, Whaley MJ, Kirking HL, Tate JE, Hsu CH, Matanock A. SARS-CoV-2 infection risk among vaccinated and unvaccinated household members during the Alpha variant surge - Denver, Colorado, and San Diego, California, January-April 2021. Vaccine 2022; 40:4845-4855. [PMID: 35803846 PMCID: PMC9250903 DOI: 10.1016/j.vaccine.2022.06.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND COVID-19 vaccination reduces SARS-CoV-2 infection and transmission. However, evidence is emerging on the degree of protection across variants and in high-transmission settings. To better understand the protection afforded by vaccination specifically in a high-transmission setting, we examined household transmission of SARS-CoV-2 during a period of high community incidence with predominant SARS-CoV-2 B.1.1.7 (Alpha) variant, among vaccinated and unvaccinated contacts. METHODS We conducted a household transmission investigation in San Diego County, California, and Denver, Colorado, during January-April 2021. Households were enrolled if they had at least one person with documented SARS-CoV-2 infection. We collected nasopharyngeal swabs, blood, demographic information, and vaccination history from all consenting household members. We compared infection risks (IRs), RT-PCR cycle threshold values, SARS-CoV-2 culture results, and antibody statuses among vaccinated and unvaccinated household contacts. RESULTS We enrolled 493 individuals from 138 households. The SARS-CoV-2 variant was identified from 121/138 households (88%). The most common variants were Alpha (75/121, 62%) and Epsilon (19/121, 16%). There were no households with discordant lineages among household members. One fully vaccinated secondary case was symptomatic (13%); the other 5 were asymptomatic (87%). Among unvaccinated secondary cases, 105/108 (97%) were symptomatic. Among 127 households with a single primary case, the IR for household contacts was 45% (146/322; 95% Confidence Interval [CI] 40-51%). The observed IR was higher in unvaccinated (130/257, 49%, 95% CI 45-57%) than fully vaccinated contacts (6/26, 23%, 95% CI 11-42%). A lower proportion of households with a fully vaccinated primary case had secondary cases (1/5, 20%) than households with an unvaccinated primary case (66/108, 62%). CONCLUSIONS Although SARS-CoV-2 infections in vaccinated household contacts were reported in this high transmission setting, full vaccination protected against SARS-CoV-2 infection. These findings further support the protective effect of COVID-19 vaccination and highlight the need for ongoing vaccination among eligible persons.
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Affiliation(s)
- David W McCormick
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Stacey L Konkle
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reed Magleby
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ayan K Chakrabarti
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Blake Cherney
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristine Lindell
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Apophia Namageyo-Funa
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susanna Visser
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Raymond A Soto
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marisa A P Donnelly
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ginger Stringer
- Colorado Department of Public Health and the Environment, Denver, CO, USA
| | - Brett Austin
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Mark E Beatty
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Sarah Stous
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | | | - Victoria T Chu
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Meagan Chuey
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Elizabeth A Dietrich
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jan Drobeniuc
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer M Folster
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marie E Killerby
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer A Lehman
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eric C McDonald
- County of San Diego Health and Human Services Agency, San Diego, CA, USA
| | - Jasmine Ruffin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Noah G Schwartz
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah W Sheldon
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sadia Sleweon
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Natalie J Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laura J Hughes
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marla Petway
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suxiang Tong
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Melissa J Whaley
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hannah L Kirking
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacqueline E Tate
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christopher H Hsu
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Almea Matanock
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Young-Xu Y, Zwain GM, Izurieta HS, Korves C, Powell EI, Smith J, Balajee A, Holodniy M, Beenhouwer DO, Rodriguez-Barradas MC, Brown ST, Marconi VC. Effectiveness of mRNA COVID-19 vaccines against Omicron and Delta variants in a matched test-negative case-control study among US veterans. BMJ Open 2022; 12:e063935. [PMID: 35922100 PMCID: PMC9352567 DOI: 10.1136/bmjopen-2022-063935] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To estimate the effectiveness of messenger RNA (mRNA) booster doses during the period of Delta and Omicron variant dominance. DESIGN We conducted a matched test-negative case-control study to estimate the vaccine effectiveness (VE) of three and two doses of mRNA vaccines against infection (regardless of symptoms) and against COVID-19-related hospitalisation and death. SETTING Veterans Health Administration. PARTICIPANTS We used electronic health record data from 114 640 veterans who had a SARS-CoV-2 test during November 2021-January 2022. Patients were largely 65 years or older (52%), male (88%) and non-Hispanic white (59%). MAIN OUTCOME MEASURES First positive result for a SARS-CoV-2 PCR or antigen test. RESULTS Against infection, booster doses had higher estimated VE (64%, 95% CI 63 to 65) than two-dose vaccination (12%, 95% CI 10 to 15) during the Omicron period. For the Delta period, the VE against infection was 90% (95% CI 88 to 92) among boosted vaccinees, higher than the VE among two-dose vaccinees (54%, 95% CI 50 to 57). Against hospitalisation, booster dose VE was 89% (95% CI 88 to 91) during Omicron and 94% (95% CI 90 to 96) during Delta; two-dose VE was 63% (95% CI 58 to 67) during Omicron and 75% (95% CI 69 to 80) during Delta. Against death, the VE with a booster dose was 94% (95% CI 90 to 96) during Omicron and 96% (95% CI 87 to 99) during Delta. CONCLUSIONS Among an older, mostly male, population with comorbidities, we found that an mRNA vaccine booster was highly effective against infection, hospitalisation and death. Although the effectiveness of booster vaccination against infection was moderately higher against Delta than against the Omicron SARS-CoV-2 variant, effectiveness against severe disease and death was similarly high against both variants.
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Affiliation(s)
- Yinong Young-Xu
- White River Junction VA Medical Center, US Department of Veterans Affairs, White River Junction, Vermont, USA
| | - Gabrielle M Zwain
- White River Junction VA Medical Center, US Department of Veterans Affairs, White River Junction, Vermont, USA
| | | | - Caroline Korves
- White River Junction VA Medical Center, US Department of Veterans Affairs, White River Junction, Vermont, USA
| | - Ethan I Powell
- White River Junction VA Medical Center, US Department of Veterans Affairs, White River Junction, Vermont, USA
| | - Jeremy Smith
- White River Junction VA Medical Center, US Department of Veterans Affairs, White River Junction, Vermont, USA
| | - Abirami Balajee
- White River Junction VA Medical Center, US Department of Veterans Affairs, White River Junction, Vermont, USA
| | - Mark Holodniy
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Public Health Program Office, Department of Veterans Affairs, Washington, District of Columbia, USA
- Department of Medicine, Stanford University, Palo Alto, California, USA
| | - David O Beenhouwer
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Maria C Rodriguez-Barradas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Sheldon T Brown
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- James J. Peters Veterans Affairs Medical Center, New York City, New York, USA
| | - Vincent C Marconi
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
- Department of Global Health, Rollins School of Public Health, Atlanta, Georgia, USA
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Jemal SS, Alemu BD. Modeling the Transmission Dynamics of COVID-19 Among Five High Burden African Countries. Clin Epidemiol 2022; 14:1013-1029. [PMID: 36051859 PMCID: PMC9426766 DOI: 10.2147/clep.s366142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/21/2022] [Indexed: 12/22/2022] Open
Affiliation(s)
- Sebwedin Surur Jemal
- Department of Statistics, College of Natural and Computational Sciences, Mizan-Tepi University, Tepi, Ethiopia
- Correspondence: Sebwedin Surur Jemal, Department of Statistics, College of Natural and Computational Sciences, Mizan-Tepi University, Tepi, Ethiopia, Tel +251977237466, Email
| | - Bizuwork Derebew Alemu
- Department of Statistics, College of Natural and Computational Sciences, Mizan-Tepi University, Tepi, Ethiopia
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146
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Tchoumi SY, Rwezaura H, Tchuenche JM. Dynamic of a two-strain COVID-19 model with vaccination. RESULTS IN PHYSICS 2022; 39:105777. [PMID: 35791392 PMCID: PMC9242689 DOI: 10.1016/j.rinp.2022.105777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 05/09/2023]
Abstract
COVID-19 is a respiratory illness caused by an ribonucleic acid (RNA) virus prone to mutations. In December 2020, variants with different characteristics that could affect transmissibility emerged around the world. To address this new dynamic of the disease, we formulate and analyze a mathematical model of a two-strain COVID-19 transmission dynamics with strain 1 vaccination. The model is theoretically analyzed and sufficient conditions for the stability of its equilibria are derived. In addition to the disease-free and endemic equilibria, the model also has single-strain 1 and strain 2 endemic equilibria. Using the center manifold theory, it is shown that the model does not exhibit the phenomenon of backward bifurcation, and global stability of the model equilibria are proved using various approaches. Simulations to support the model theoretical results are provided. We calculate the basic reproductive number R 1 and R 2 for both strains independently. Results indicate that - both strains will persist when R 1 > 1 and R 2 > 1 - Stain 2 could establish itself as the dominant strain if R 1 < 1 and R 2 > 1 , or when R 2 > R 1 > 1 . However, because of de novo herd immunity due to strain 1 vaccine efficacy and provided the initial stain 2 transmission threshold parameter R 2 is controlled to remain below unity, strain 2 will not establish itself/persist in the community.
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Affiliation(s)
- S Y Tchoumi
- Department of Mathematics and Computer Sciences ENSAI, University of Ngaoundere, P.O. Box 455 Ngaoundere, Cameroon
| | - H Rwezaura
- Mathematics Department, University of Dar es Salaam, P.O. Box 35062, Dar es Salaam, Tanzania
| | - J M Tchuenche
- School of Computational and Applied Mathematics, University of the Witwatersrand, Johannesburg, Private Bag 3, Wits 2050, South Africa
- School of Computational and Communication Sciences and Engineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
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147
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Paternina-Caicedo A, Jit M, Alvis-Guzmán N, Fernández JC, Hernández J, Paz-Wilches JJ, Rojas-Suarez J, Dueñas-Castell C, Alvis-Zakzuk NJ, Smith AD, Hoz-Restrepo FDL. Effectiveness of CoronaVac and BNT162b2 COVID-19 mass vaccination in Colombia: A population-based cohort study. LANCET REGIONAL HEALTH. AMERICAS 2022; 12:100296. [PMID: 35791428 PMCID: PMC9246705 DOI: 10.1016/j.lana.2022.100296] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background In February 2021, Colombia began mass vaccination against COVID-19 using mainly BNT162b2 and CoronaVac vaccines. We aimed to estimate vaccine effectiveness (VE) to prevent COVID-19 symptomatic cases, hospitalization, critical care admission, and deaths in a cohort of 796,072 insured subjects older than 40 years in northern Colombia, a setting with a high SARS-CoV-2 transmission. Methods We identified individuals vaccinated between March 1st of 2021 and August 15th of 2021. We included symptomatic cases, hospitalizations, critical care admissions, and deaths in patients with confirmed COVID-19 as main outcomes. We calculated VE for each outcome from the hazard ratio in Cox proportionally hazards regressions (adjusted by age, sex, place of residence, diabetes, human immunodeficiency virus, cancer, hypertension, tuberculosis, neurological diseases, and chronic renal disease), with 95% confidence intervals (CI). Findings A total of 719,735 insured participants of 40 and more years were followed. We found 21,545 laboratory-confirmed symptomatic COVID-19 among unvaccinated population, along with 2874 hospitalizations, 1061 critical care admissions, and 1329 deaths, for a rate of 207.2 per million person-days, 27.1 per million person-days, 10.0 per million person-days, and 12.5 per million person-days, respectively. We found CoronaVac was not effective for any outcome in subjects above 80 years old; but for people 40-79 years of age, we found two doses of CoronaVac reduced hospitalization (33.1%; 95% CI, 14.5-47.7), critical care admission (47.2%; 95% CI, 18.5-65.8), and death (55.7%; 95% CI, 32.5-70.0). We found BNT162b2 was effective for all outcomes in the entire population of subjects above 40 years of age, significantly declining for subjects ≥80 years. Interpretation Two doses of either CoronaVac in population between 40 and 79 years of age, or BNT162b2 among vaccinated above 40 years old significantly reduced deaths of confirmed COVID-19 in a cohort of individuals from Colombia. Vaccine effectiveness for CoronaVac and BNT162b2 declined with increasing age. Funding UK National Institute for Health Research, the European Union's Horizon 2020 research and innovation programme, and the Bill & Melinda Gates Foundation.
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Affiliation(s)
| | - Mark Jit
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nelson Alvis-Guzmán
- Universidad de Cartagena, Cartagena, Colombia
- Universidad de la Costa - CUC, Barranquilla, Colombia
| | | | | | | | - José Rojas-Suarez
- Universidad de Cartagena, Cartagena, Colombia
- Corporación Universitaria Rafael Núñez, Cartagena, Colombia
| | | | - Nelson J Alvis-Zakzuk
- Universidad de la Costa - CUC, Barranquilla, Colombia
- Universidade de São Paulo, São Paulo, Brazil
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148
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Redmond ML, Mayes P, Morris K, Ramaswamy M, Ault KA, Smith SA. Learning from maternal voices on COVID-19 vaccine uptake: Perspectives from pregnant women living in the Midwest on the COVID-19 pandemic and vaccine. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2630-2643. [PMID: 35419848 PMCID: PMC9088262 DOI: 10.1002/jcop.22851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/21/2022] [Accepted: 03/12/2022] [Indexed: 05/07/2023]
Abstract
The aim of this study was to understand COVID-19 vaccine perceptions and decision-making among a racially/ethnically diverse population of pregnant and lactating women in the Midwest. Pregnant female participants (N = 27) at least 18 years. or older living in the Midwest were recruited to participate in a maternal voices survey. A mix-methods approach was used to capture the perceptions of maternal voices concerning the COVID-19 vaccine. Participants completed an online survey on COVID-19 disease burden, vaccine knowledge, and readiness for uptake. A total of 27 participants completed the Birth Equity Network Maternal Voices survey. Most participants were African American (64%). Sixty-three percent intend to get the vaccine. Only 25% felt at-risk for contracting COVID-19, and 74% plan to consult their provider about getting the COVID-19 vaccine. At least 66% had some concerns about the safety of the vaccine. Participants indicated a willingness to receive the COVID-19 vaccine, especially if recommended by their provider. We found little racial/ethnic differences in perceptions of COVID-19 and low vaccine hesitancy.
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Affiliation(s)
- Michelle L. Redmond
- Department of Population HealthUniversity of Kansas School of Medicine‐WichitaWichitaKansasUSA
| | - Paigton Mayes
- Department of Population HealthUniversity of Kansas School of Medicine‐WichitaWichitaKansasUSA
| | - Kyla Morris
- Department of Population HealthUniversity of Kansas School of Medicine‐WichitaWichitaKansasUSA
- Department of Population HealthUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Megha Ramaswamy
- Department of Population HealthUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Kevin A. Ault
- Department of Obstetrics and GynecologyUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Sharla A. Smith
- Department of Population HealthUniversity of Kansas Medical CenterKansas CityKansasUSA
- Department of Obstetrics and GynecologyUniversity of Kansas Medical CenterKansas CityKansasUSA
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149
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High viral loads: what drives fatal cases of COVID-19 in vaccinees? - an autopsy study. Mod Pathol 2022; 35:1013-1021. [PMID: 35365771 PMCID: PMC8974809 DOI: 10.1038/s41379-022-01069-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 01/07/2023]
Abstract
The rate of SARS-CoV-2 infections in vaccinees has become a relevant serious issue. This study aimed to determine the causes of death, histological organ alteration, and viral spread in relation to demographic, clinical-pathological, viral variants, and vaccine types for deceased individuals with proven SARS-CoV-2 infection after vaccination who died between January and November 2021. Twenty-nine consecutively collected cases were analyzed and compared to 141 nonvaccinated control cases. Autopsies were performed on 16 partially and 13 fully vaccinated individuals. Most patients were elderly and suffered from several relevant comorbidities. Real-time RT-PCR (RT-qPCR) identified a significantly increased rate of generalized viral dissemination within organ systems in vaccinated cases versus nonvaccinated cases (45% vs. 16%, respectively; P = 0.008) mainly with Ct-values of higher than 25 in non-respiratory samples. However, vaccinated cases also showed high viral loads, reaching Ct-values below 10, especially in the upper airways and lungs. This was accompanied by high rates of pulmonal bacterial or mycotic superinfections and the occurrence of immunocompromising factors, such as malignancies, immunosuppressive drug intake, or decreased immunoglobulin levels. All these findings were particularly accentuated in partially vaccinated patients compared to fully vaccinated individuals. The virus dissemination observed in our case study may indicate that patients with an impaired immune system have a decreased ability to eliminate the virus. However, the potential role of antibody-dependent enhancement must also be ruled out in future studies. Fatal cases of COVID-19 in vaccinees were rare and often associated with severe comorbidities or other immunosuppressive conditions.
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150
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Jutel M, Torres MJ, Palomares O, Akdis CA, Eiwegger T, Untersmayr E, Barber D, Zemelka-Wiacek M, Kosowska A, Palmer E, Vieths S, Mahler V, Canonica WG, Nadeau K, Shamji MH, Agache I. COVID-19 vaccination in patients receiving allergen immunotherapy (AIT) or biologicals-EAACI recommendations. Allergy 2022; 77:2313-2336. [PMID: 35147230 PMCID: PMC9111382 DOI: 10.1111/all.15252] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 12/16/2022]
Abstract
Immune modulation is a key therapeutic approach for allergic diseases, asthma and autoimmunity. It can be achieved in an antigen-specific manner via allergen immunotherapy (AIT) or in an endotype-driven approach using biologicals that target the major pathways of the type 2 (T2) immune response: immunoglobulin (Ig)E, interleukin (IL)-5 and IL-4/IL-13 or non-type 2 response: anti-cytokine antibodies and B-cell depletion via anti-CD20. Coronavirus disease 2019 (COVID-19) vaccination provides an excellent opportunity to tackle the global pandemics and is currently being applied in an accelerated rhythm worldwide. The vaccine exerts its effects through immune modulation, induces and amplifies the response against the severe acute respiratory syndrome coronavirus (SARS-CoV-2). Thus, as there may be a discernible interference between these treatment modalities, recommendations on how they should be applied in sequence are expected. The European Academy of Allergy and Clinical Immunology (EAACI) assembled an expert panel under its Research and Outreach Committee (ROC). This expert panel evaluated the evidence and have formulated recommendations on the administration of COVID-19 vaccine in patients with allergic diseases and asthma receiving AIT or biologicals. The panel also formulated recommendations for COVID-19 vaccine in association with biologicals targeting the type 1 or type 3 immune response. In formulating recommendations, the panel evaluated the mechanisms of COVID-19 infection, of COVID-19 vaccine, of AIT and of biologicals and considered the data published for other anti-infectious vaccines administered concurrently with AIT or biologicals.
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Affiliation(s)
- Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
- ALL-MED Medical Research Institute, Wroclaw, Poland
| | - Maria J Torres
- Allergy Unit, Regional University Hospital of Malaga, IBIMA-UMA-ARADyAL-BIONAND, Malaga, Spain
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Zurich, Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Thomas Eiwegger
- Division of Immunology and Allergy, The Department of 13 Pediatrics, Food Allergy and Anaphylaxis Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Translational Medicine Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Domingo Barber
- Facultad de Medicina, Departamento de Ciencias Médicas Básicas, Instituto de Medicina Molecular Aplicada (IMMA), Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | | | - Anna Kosowska
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
- ALL-MED Medical Research Institute, Wroclaw, Poland
| | - Elizabeth Palmer
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London. MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - Stefan Vieths
- Paul-Ehrlich-Institut, Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | | | - Walter G Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine Asthma, & Allergy Center-IRCCS Humanitas Research Hospital, Milan, Italy
| | - Kari Nadeau
- Division of Pulmonary, Allergy and Critical Care Medicine, Dept of Medicine, Stanford, California, USA
| | - Mohamed H Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London. MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
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