Efficacy and safety of COVID-19 vaccines

Barriers to initial COVID-19 booster among US adults who completed a primary vaccine series in the CHASING COVID cohort, September 2021-October 2022

It is crucial to understand factors associated with COVID-19 booster uptake in the United States given the updated COVID-19 vaccine recommendations. Using data from a national prospective cohort (n = 4616) between September 2021 and October 2022, we examined socioeconomic, demographic, and behavioral factors of initial booster uptake among participants fully vaccinated with the primary COVID-19 vaccines series. Cox proportional hazards models were used to estimate the associations of each factor with time to initial booster uptake. Most participants (86.5%) reported receiving their initial booster. After adjusting for age, race/ethnicity, education, region, and employment, participants with greater risk for severe COVID-19 had similar booster uptake compared with those with lower risk (adjusted hazard ratio [aHR], 1.04; 95% CI, 0.95-1.14). Participants with greater barriers to healthcare (aHR, 0.89; 95% CI, 0.84-0.96), food insecurity (aHR, 0.82; 95% CI, 0.75-0.89), and housing instability (aHR, 0.81; 95% CI, 0.73-0.90) were less likely to report receiving initial booster compared with those without those barriers. Factors motivating the decision to vaccinate changed from safety-related concerns for the primary series to perceived need for the booster. It is key to address economic and health access barriers to achieve equitable COVID-19 vaccine uptake and continued protection against COVID-19.

Impact of COVID-19 and factors associated with long COVID and COVID-19 vaccine uptake in people with HIV in the United Kingdom: Results from Positive Voices 2022

OBJECTIVES

We assessed the impact of COVID-19, and the prevalence and factors associated with a history of COVID-19 infection, long COVID and incomplete COVID-19 vaccine uptake among people with HIV.

METHODS

Positive Voices 2022 is a questionnaire study of people accessing HIV care in the United Kingdom (March 2022-April 2023). Logistic regression assessed factors associated with a history of COVID-19 (previous positive test), long COVID among those with a history of COVID-19 (ongoing symptoms, with COVID-19 onset >3 months previously) and incomplete COVID-19 vaccine uptake (less than three doses of vaccine), adjusted for: age; gender; ethnicity; and year of HIV diagnosis.

RESULTS

In all, 4188 participants were included. Commonly reported negative impacts of the pandemic were on social contact (44% of participants), mental health (30%), healthcare access (26%) and financial security (25%). Overall, 2068 of 4188 (49.4%) participants had a history of COVID-19. Of these, 10.8% met criteria for long COVID, associated with female gender, unemployment, financial hardship, earlier HIV diagnosis date, diabetes diagnosis, asthma/chronic obstructive pulmonary disease diagnosis, obesity and symptoms of depression and anxiety. Overall, 95.8% reported having at least one vaccine dose, but 649 (15.7%) participants had incomplete vaccine uptake, associated with younger age, female gender, Black African ethnicity, lower education, financial hardship, unemployment, multioccupancy household, more recent HIV diagnosis, detectable HIV viral load and symptoms of depression and anxiety.

CONCLUSIONS

About half of participants had a history of COVID-19, of whom 11% had persistent symptoms (long COVID). COVID-19 vaccine uptake was high, but incomplete uptake was apparent for 16% of participants and was more common among women, younger people, Black African individuals and those with socio-economic disadvantage.

Vaccines for preventing infections in adults with solid tumours

BACKGROUND

Infections are one of the most frequent complications seen in adults with cancer, often arising from the underlying condition or as a result of immunosuppressive treatments. Certain infections (e.g. influenza, pneumococcal disease, and meningococcal disease) may be prevented through vaccination. However, adults with solid tumours may elicit varying immune responses compared to healthy individuals.

OBJECTIVES

To assess the benefits and risks of vaccines for the prevention of infectious diseases in adults with solid tumours.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, two further databases, and two study registries from inception to 2 December 2024 for randomised controlled trials (RCTs) and controlled non-randomised studies of interventions (NRSIs).

SELECTION CRITERIA

We included RCTs evaluating vaccines against the following infectious diseases in adults (≥ 18 years of age) with any diagnosis of solid tumour cancer compared to placebo or no vaccine: pneumococcal disease, Haemophilus influenzae type b disease, meningococcal disease, pertussis, hepatitis B, tetanus, polio, diphtheria, influenza, herpes zoster, and COVID-19. In cases where RCTs were unavailable, we included prospective controlled NRSIs. We excluded live-attenuated vaccines.

DATA COLLECTION AND ANALYSIS

We followed standard Cochrane methodology. Two review authors independently screened search results, extracted data, and assessed the risk of bias (RoB) in the included studies using the Cochrane RoB 2 tool for RCTs and ROBINS-I for NRSIs. We rated the certainty in the evidence using the GRADE approach for the following prioritised outcomes: incidence of infection concerned, all-cause mortality, quality of life, adverse events (AEs) of any grade, serious adverse events (SAEs), localised events at the injection site, and systemic events.

MAIN RESULTS

We included 10 studies (five RCTs and five NRSIs) involving 81,823 adults with solid tumours receiving vaccines to prevent infections with herpes zoster, influenza, or COVID-19. Six studies included participants with varied solid tumours, while two focused on neck and oesophageal cancer or lung cancer. We assessed the RCTs to be at low or moderate risk of bias, whereas most NRSIs were at critical risk of bias due to concerns about confounding. We identified two ongoing studies: one RCT evaluating an influenza vaccine, and one NRSI evaluating COVID-19 vaccines. Twelve studies are awaiting assessment. We did not identify RCTs or NRSIs of vaccines for preventing pneumococcal disease, Haemophilus influenzae type b disease, meningococcal disease, pertussis, hepatitis B, tetanus, polio, or diphtheria compared to placebo or no vaccine. The results from the RCTs are presented below. The results from the NRSIs are detailed in the main text of the review. No study reported quality of life. Vaccines for preventing herpes zoster compared to placebo or no vaccine Three RCTs (3054 participants) evaluated vaccines to prevent herpes zoster. Herpes zoster vaccines decrease the incidence of herpes zoster up to 29.4 months after the final dose (RR 0.37, 95% CI 0.23 to 0.59; 1 RCT, 2678 participants; high-certainty evidence). Herpes zoster vaccines probably make little or no difference to all-cause mortality up to 28 days after the final dose (RR 1.17, 95% CI 0.91 to 1.50; 2 RCTs, 2744 participants; moderate-certainty evidence); make little or no difference to any-grade AEs up to 30 days after final dose (RR 1.02, 95% CI 0.98 to 1.05; 3 RCTs, 2976 participants; high-certainty evidence), and probably make little or no difference in SAEs up to 30 days (RR 1.08, 95% CI 0.93 to 1.24; I² = 0%; 3 RCTs, 2976 participants; moderate-certainty evidence). Vaccines to prevent herpes zoster increase the number of participants with localised events at the injection site compared to placebo or no vaccine (RR 6.81, 95% CI 2.52 to 18.40; 3 RCTs, 2966 participants; high-certainty evidence) and may make little or no difference to the number of participants with systemic events up to 30 days after final dose (RR 1.08, 95% CI 0.77 to 1.50; 3 RCTs, 2966 participants; low-certainty evidence). Vaccines for preventing influenza compared to placebo or no vaccine One RCT (75 participants) evaluated vaccines to prevent influenza. We are uncertain about the effects of influenza vaccines administered prior to surgery on all-cause mortality (RR 1.00, 95% CI 0.07 to 15.33; 1 RCT, 66 participants; very low-certainty evidence), any-grade AEs (RR 1.17, 95% CI 0.89 to 1.54; 1 RCT, 75 participants; very low-certainty evidence), and SAEs (RR 1.46, 95% CI 0.76 to 2.83; 1 RCT, 75 participants; very low-certainty evidence) up to 15 days post-surgery. The RCT did not report the incidence of influenza, localised events at the injection site, or systemic events. Vaccines for preventing COVID-19 compared to placebo or no vaccine One RCT (2256 participants) evaluated vaccines to prevent COVID-19. Participants may have been exposed to the SARS-CoV-2 variants alpha, beta, and gamma. Vaccines to prevent COVID-19 probably decrease the incidence of COVID-19 in participants without previous COVID-19 infection up to six months after the second dose (RR 0.08, 95% CI 0.02 to 0.25; 1 RCT, 2100 participants; moderate-certainty evidence). The COVID-19 vaccines probably increase any-grade AEs (RR 1.99, 95% CI 1.71 to 2.30; 1 RCT, 2328 participants; moderate-certainty evidence). They may have little or no effect on SAEs up to 6 months after the second dose (RR 1.43, 95% CI 0.80 to 2.54; 1 RCT, 2328 participants; low-certainty evidence). The RCT did not report localised events at the injection site or systemic events.

AUTHORS' CONCLUSIONS

In adults with solid tumours, herpes zoster vaccines reduced the incidence of herpes zoster (high-certainty evidence), although localised events at the injection site were more likely to occur (high-certainty evidence). The evidence is very uncertain about the effects of influenza vaccines on all-cause mortality, any-grade AEs, and SAEs (very low-certainty evidence); the incidence of influenza was not measured in the studies. COVID-19 vaccines probably decrease the incidence of COVID-19 in those without prior infection (moderate-certainty evidence) but probably increase any-grade AEs (moderate-certainty evidence). We found no RCTs or NRSIs investigating vaccines for preventing pneumococcal disease, Haemophilus influenzae type b disease, meningococcal disease, pertussis, hepatitis B, tetanus, polio, diphtheria compared to placebo or no vaccine, in adults with solid tumours. Additional research, preferably of RCT design, is necessary to resolve uncertainties.

Safety and Immunogenicity of SARS-CoV-2 Spike Receptor-Binding Domain and N-Terminal Domain mRNA Vaccine

BACKGROUND

mRNA-1283 is an investigational coronavirus disease 2019 (COVID-19) mRNA vaccine encoding the receptor-binding and N-terminal domains of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein in contrast to the original mRNA-1273 vaccine, which encodes the full-length spike protein.

METHODS

A phase 2a, dose-ranging, observer-blind, randomized study conducted in adults (aged ≥18 years) previously vaccinated with mRNA-1273 evaluated the safety and immunogenicity of a single dose of mRNA-1283 (2.5, 5, and 10 µg) and its bivalent formulation, mRNA-1283.211 (5 and 10 µg; encoding original SARS-CoV-2 and Beta) against the comparator mRNA-1273 vaccine, 50 µg (part A). A subsequent, open-label study (part B) evaluated the safety and immunogenicity of a monovalent Omicron BA.1 vaccine, mRNA-1283.529 (5 and 10 µg).

RESULTS

A total of 340 participants were randomized in part A, and 200 participants were enrolled in part B. All dose levels of mRNA-1283 vaccines were well tolerated and increased the neutralizing antibody (nAb) responses at day 29 compared to baseline against SARS-CoV-2 D614G and Beta. The nAb responses elicited by mRNA-1283 were higher than those elicited by mRNA-1273. mRNA-1283.529 (part B) increased nAb at day 29 against Omicron BA.1. Antibody responses remained detectable for a year postvaccination.

CONCLUSIONS

mRNA-1283 was well tolerated and exhibited improved immunogenicity compared to mRNA-1273.

CLINICAL TRIALS REGISTRATION

NCT05137236.

Serum Fibronectin Levels Increased Significantly Following the Administration of an Inactivated SARS-CoV-2 Vaccine: A Prospective Observational Study

Background

There has been a lack of comprehensive studies on the long-term observation of laboratory values following the administration of SARS-CoV-2 vaccines. The objective of this study is to assess the long-term impact of inactivated SARS-CoV-2 vaccines on coagulation function and other health indicators.

Methods

We enrolled residents of Chengdu who consented to receive inactivated SARS-CoV-2 vaccines, categorizing them into two groups: healthy donors (n=40) and survivors of COVID-19 infection (n=34), based on their SARS-CoV-2 infection status prior to vaccination. Blood samples from the subjects were collected at specific intervals following vaccination.

Results

The levels of Fibronectin (FN) increased significantly in both healthy donors and survivors of COVID-19 infection after receiving two doses of the inactivated SARS-CoV-2 vaccine (both P < 0.001), and there was no statistically significant difference in the degree of FN increase between the two groups (153.05 ± 77.19 mg/L vs 172.32±90.42 mg/L, P=0.326). The rate of elevated FN levels was significantly higher six months after vaccination compared to the rate before vaccination, both in healthy donors (85.0% vs 5.0%, P<0.001) and in survivors of COVID-19 infection (94.1% vs 29.4%, P<0.001). Additionally, the levels of FN in healthy donors further increased six months after receiving a booster dose of the inactivated vaccine compared to pre-booster levels (569.90±119.44 mg/L vs 467.35±62.04 mg/L, P < 0.001).

Conclusion

The study indicates that serum FN levels increased significantly following the administration of the inactivated SARS-CoV-2 vaccine, and these elevated FN levels may persist for more than six months. However, it remains unclear whether this increase could result in any adverse effects.

New-onset hematologic disorders following COVID-19 vaccination: a systematic review

Purpose

Coronavirus disease 2019 (COVID-19) vaccination reduced morbimortality rates due to severe acute respiratory syndrome coronavirus 2 infection worldwide. However, various complications have been reported, including hematologic disorders.

Materials and Methods

We conducted a systematic review to synthesize and analyze the current available evidence on the development of hematological disorders associated with COVID-19 vaccination.

Results

A total of 227 patients were reported in the papers that were selected to be included. There was a slight predominance of females (n=114, 50.22%) compared to males (n=113, 49.78%), and the calculated mean age was 54.86±18.94 years. The most frequently reported hematological disorders were Immune thrombocytopenic purpura (n=58, 25.55%), followed by thrombotic thrombocytopenic purpura (n=38, 16.74%). The less frequently recorded cases were acquired factor XIII/13 deficiency (n=2, 0.88%) and pernicious anemia (n=2, 0.88%). Messenger RNA (mRNA)-based COVID-19 vaccines, including Pfizer BioNTech 162b2 (n=106, 46.70%), Moderna mRNA 127-3 (n = 42, 18.50%), and the Bivalent vaccine (n = 1, 0.44%), were the most prevalent (n=150, 66.08%). Most cases developed after the first dose (n=120, 52.86%). In most cases, patient outcomes were favorable (n=175, 77.09%), but there were significant mortality cases (n=23, 10.13%).

Conclusion

Our findings suggest close monitoring of patients who receive the first dose with mRNA technology vaccines, regardless of sex, especially in adults, as they appear more vulnerable to developing hematologic disorders.

Trial Registration

PROSPERO Identifier: CRD42023452589.

Prophylactic vaccination strategies for adult patients with diabetes: a narrative review of safety profiles and clinical effectiveness

This narrative review analyzed roles of several prophylactic vaccinations in adult patients with diabetes, focusing on their safety profiles and clinical effectiveness. Individuals with diabetes mellitus are at increased risk for infections, making vaccination a critical component of their healthcare. The review assessed various vaccines that are particularly relevant for this population, i.e., vaccines for pneumococcus, meningococcus, severe acute respiratory syndrome coronavirus 2, influenza, herpes zoster, human papillomavirus, and dengue. It highlighted the safety profiles and clinical effectiveness of these vaccines in preventing serious infections and improving long-term health outcomes in diabetic patients. Taken together, this review emphasized the importance of prophylactic vaccinations in reducing infection-related morbidity and mortality as well as encouraged fostering greater adoption and advocacy for immunization programs among diabetic adults.

Predicting coronavirus disease 2019 severity using explainable artificial intelligence techniques

Predictive models for determining coronavirus disease 2019 (COVID-19) severity have been established; however, the complexity of the interactions among factors limits the use of conventional statistical methods. This study aimed to establish a simple and accurate predictive model for COVID-19 severity using an explainable machine learning approach. A total of 3,301 patients ≥ 18 years diagnosed with COVID-19 between February 2020 and October 2022 were included. The discovery cohort comprised patients whose disease onset fell before October 1, 2020 (N = 1,023), and the validation cohort comprised the remaining patients (N = 2,278). Pointwise linear and logistic regression models were used to extract 41 features. Reinforcement learning was used to generate a simple model with high predictive accuracy. The primary evaluation was the area under the receiver operating characteristic curve (AUC). The predictive model achieved an AUC of ≥ 0.905 using four features: serum albumin levels, lactate dehydrogenase levels, age, and neutrophil count. The highest AUC value was 0.906 (sensitivity, 0.842; specificity, 0.811) in the discovery cohort and 0.861 (sensitivity, 0.804; specificity, 0.675) in the validation cohort. Simple and well-structured predictive models were established, which may aid in patient management and the selection of therapeutic interventions.

Introduction to network meta-analysis: understanding what it is, how it is done, and how it can be used for decision-making

Network meta-analysis (NMA), a statistical technique that allows systematic reviewers to simultaneously compare more than 2 alternatives, makes use of indirect evidence from studies comparing interventions of interest to a common comparator. The capacity for multiple simultaneous comparisons makes NMA appealing for evidence-based decision-makers. This article, aimed at users of systematic reviews (SRs) with NMAs and at those who are considering conducting SRs with NMAs, provides an introductory level overview of this topic. We describe the main considerations that those conducting systematic reviews with NMA should bear in mind, including decisions regarding grouping interventions into analysis nodes, and testing the assumptions that assure the validity of NMA. We explain and illustrate how both systematic reviewers and users should draw conclusions from NMA that are appropriate and useful for decision-making. Finally, we provide a list of tools that facilitate the conduct and interpretation of NMAs.

Potential biases in test-negative design studies of COVID-19 vaccine effectiveness arising from the inclusion of asymptomatic individuals

The test-negative design (TND) is a popular method for evaluating vaccine effectiveness (VE). A "classical" TND study includes symptomatic individuals tested for the disease targeted by the vaccine to estimate VE against symptomatic infection. However, recent applications of the TND have attempted to estimate VE against infection by including all tested individuals, regardless of their symptoms. In this article, we use directed acyclic graphs and simulations to investigate potential biases in TND studies of COVID-19 VE arising from the use of this "alternative" approach, particularly when applied during periods of widespread testing. We show that the inclusion of asymptomatic individuals can potentially lead to collider stratification bias, uncontrolled confounding by health and healthcare-seeking behaviors (HSBs), and differential outcome misclassification. While our focus is on the COVID-19 setting, the issues discussed here may also be relevant in the context of other infectious diseases. This may be particularly true in scenarios where there is either a high baseline prevalence of infection, a strong correlation between HSBs and vaccination, different testing practices for vaccinated and unvaccinated individuals, or settings where both the vaccine under study attenuates symptoms of infection and diagnostic accuracy is modified by the presence of symptoms.

Efficacy and safety of SARS-CoV-2 vaccination in pregnancy to prevent COVID-19 in mothers and early infancy

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of SARS-CoV-2 vaccination during pregnancy, versus placebo or no vaccination during pregnancy, for preventing COVID-19 disease in mothers and infants.

Impact of the COVID-19 pandemic on cardiac magnetic resonance imaging practices: insights from the MRCT registry

PURPOSE

To assess the relationship between the COVID-19 pandemic and the spectrum of indications for cardiac magnetic resonance imaging (MRI) with a focus on myocarditis.

MATERIALS AND METHODS

This was a retrospective analysis of data from the MRCT registry of the European Society of Cardiovascular Radiology (ESCR). Data regarding indications and diagnoses of myocarditis between January 1, 2018, and April 30, 2024, were extracted. Data was analyzed for the periods before and after the beginning (i.e., March 11, 2020) of the COVID-19 pandemic.

RESULTS

Data from 112,361 cardiac MRI examinations was analyzed (63.5% male, median age 58 [IQR 44-69]). Over the entire period, assessment of myocarditis was the most common indication for cardiac MRI (31%, n = 34,906/112,361). Before the pandemic, this indication comprised 28% of examinations and increased to a maximum of 41% in 2022 after the onset of the pandemic. Simultaneously, the positivity rate of these examinations decreased from 21% before the pandemic to 14% in 2022. Male patients had a higher positivity rate than female patients both before and during the pandemic, with mirroring trends between sexes. The proportion of cardiac MRI examinations performed for suspected and known coronary artery disease showed an inverse relationship with those performed for myocarditis and decreased from 24% and 17% pre-pandemic to a minimum of 21% and 13% during the pandemic.

CONCLUSION

The COVID-19 pandemic considerably influenced the pattern of referrals for cardiac MRI examinations in Europe, leading to a higher proportion of examinations for suspected myocarditis but a reduced positivity rate, suggesting a lower referral threshold for this indication. At the same time, proportionally fewer examinations were performed for suspected and known coronary artery disease.

KEY POINTS

Question The COVID-19 pandemic may have influenced the spectrum and positivity rates of indications for cardiac MRI, especially examinations for myocarditis. Findings The COVID-19 pandemic led to a higher proportion of cardiac MRI examinations for suspected myocarditis but a reduced positivity rate. Clinical relevance The spectrum and proportions of indications for cardiac MRI give important information on the historical and current trends in cardiac imaging and provide insight into resource deployment.

Monitoring and active surveillance of adverse events following the booster dose of AZD1222 vaccine in people vaccinated with Sinopharm BBIBP-CorV: a cohort study

BACKGROUND

Given the limited evidence on the side effects of AZD1222 booster in individuals previously vaccinated with Sinopharm BBIBP-CorV, we conducted a cohort event monitoring study to capture adverse events in those receiving AZD1222 booster doses (first or second) after Sinopharm BBIBP-CorV vaccination in Iran.

METHODS

This active COVID-19 vaccine safety surveillance study was conducted in vaccination centers across 12 provinces in Iran. The study population included individuals who had received two doses of Sinopharm BBIBP-CorV and either a first or second AZD1222 booster dose. Each participant was followed for 13 weeks after their booster dose.

RESULTS

A total of 28,742 participants were included, with 13,428 females (46.72%) and 15,314 males (53.28%). The average age was 43.25 ± 14.90 years. Of the total, 82.46% were recruited retrospectively through vaccination registration. Among 16,944 individuals with available polymerase chain reaction test results, 118 tested positive for COVID-19 between 14 and 90 days post-booster. There were 123 hospital admissions, with 18 cases showing a higher likelihood of being associated with adverse events following immunization (AEFIs) or serious adverse events (SAEs). After excluding deaths unrelated to vaccination, four deaths were potentially linked to AEFIs or SAEs. The cumulative incidence rates for hospital admissions and deaths were 106.40 and 13.90 per 100,000 individuals, respectively.

CONCLUSION

The study indicates that AZD1222 booster doses are safe for individuals previously vaccinated with Sinopharm BBIBP-CorV, with rare adverse events and an acceptable safety profile. This supports the use of heterologous booster strategies, though ongoing monitoring and improved pharmacovigilance are essential to detect any potential long-term effects.

How People in Eight European Countries Felt About the Safety, Effectiveness, and Necessity of COVID-19 Vaccination: A Cross-Sectional Survey

Background/objectives: Attitudes towards COVID-19 vaccination vary globally, influenced by political and cultural factors. This research aimed to assess the views of people without a healthcare qualification in Europe on COVID-19 vaccination safety, effectiveness, and necessity as well as how well informed they felt. The secondary outcomes focused on how respondents' views were affected by demographic and context factors and included a comparison by country of the level of feeling well informed. Methods: A mixed-method cross-sectional online survey in eight European countries, using convenience sampling. Results: A total of 1008 adults completed the survey, 60% of whom were female. While only 44.1% considered the vaccines safe, 43.5% effective, and 44.9% necessary, 80.0% had been vaccinated. Four in ten adults strongly agreed that they were well informed, while over a quarter did not answer the question. Younger respondents, well-informed individuals, and German respondents were more inclined to perceive COVID-19 vaccination as both effective and necessary. Conclusions: Motivations for vaccination included perceived health and social benefits, while concerns included a preference for "natural immunity", the rapid development of the vaccine, and potential unknown long-term effects. A correlation existed between respondents feeling well informed about the different COVID-19 vaccines in their country and the likelihood of having been vaccinated.

The descriptive epidemiology of adverse events following two doses of mRNA COVID-19 vaccination in Curaçao, the Caribbean

BACKGROUND

BNT162b2 and mRNA-1273 COVID-19 vaccines have been used for mass vaccinations in Curaçao, the Caribbean but information on adverse events (AEs)in this population is unavailable. This study describes the characteristics of vaccinees that incurred AEs, explores the associations between AEs by vaccine and doses, and estimates the rate of AEs.

METHODS

Vaccination and AEs data for all persons of age 5 years (range 5-105 years) and older who received two doses of COVID-19 vaccine at 71 centres in Curaçao between February 24, 2021, and April 5, 2023, were included in this retrospective observational study.

RESULTS

The vaccines differed significantly in the frequency distribution of vaccinees by age, age groups, sex, AEs, and prior COVID-19 infection. Occurrence of AEs was strongly associated with mRNA vaccine brand, sex, number of doses, but not with age, age group, and prior COVID-19 infection. Of 209,720 doses, 84 persons (0.04%) incurred AEs following two doses of mRNA vaccines (overall rate of 40.1 per 100,000 persons (95% CI 32.4-49.6). AEs were also significantly higher in females compared to males.AE rates associated with BNT162b2, and mRNA-1273 vaccines were low, but BNT162b2 vaccinees incurred substantially significantly higher AE rates (58.3 per 100,000 persons, 95% CI 45.4-74.9) than mRNA-1273 vaccinees (21.9 per 100,000 persons, 95% CI 14.6-32.8). mRNA-1273 vaccine was associated with a significantly lower risk of AEs.

CONCLUSIONS

AE reporting varied by age, sex, and vaccine used as well as the number of doses. Future studies with follow-up and longer-term reporting of AEs should be conducted.

Incidence of seroma and postoperative complications after breast surgery before and during the Covid-19 pandemic: results from a retrospective multicenter analysis

BACKGROUND

In recent years, there has been a growing number of case reports documenting delayed seroma in patients with a history of breast surgery and reconstruction. The occurrence of these seromas has been associated with prior SARS-CoV-2 infection or SARS-CoV-2 vaccination. So far, there are few systematic analyses on postoperative complications in breast surgery since the emergence of the SARS-CoV-2 pandemic.

STUDY DESIGN

We conducted a multicenter retrospective analysis to assess the incidence of postoperative complications in two major university breast care centers in Germany during the SARS-CoV-2 pandemic (August 1st, 2021, to January 31st, 2022) compared to a reference period (August 1st, 2019, to January 31st, 2020) before the pandemic.

RESULTS

A total of 987 patients were included in this retrospective analysis, with 492 patients during the SARS-CoV-2 pandemic and 495 patients in the reference period. There was no significant difference in the incidence rate of seroma after breast surgery. However, complications such as erythema, wound infection, and wound healing disorders were notably more frequent during the SARS-CoV-2 pandemic. Multivariate analysis revealed that increasing patient age, smoking, breast implant reconstruction, axillary lymph node dissection, and previous radiation were significant clinical risk factors for seroma development.

CONCLUSION

While our findings did not indicate an elevated incidence of seroma during the SARS-CoV-2 pandemic, we observed increased rates of erythema, wound healing disorders, and wound infection. Additional real-world evidence is needed for understanding both early and late complications following breast surgery in the context of the ongoing SARS-CoV-2 endemic.

Scrutinizing the COVID-19 vaccine safety debate

The controversy surrounding the safety of coronavirus disease-19 vaccinations is part of a larger historical backdrop of ongoing discussions regarding vaccine safety that have spanned several decades. The historical disputes around measles, mumps, rubella, and influenza highlight the recurring pattern in which public doubt is fueled by false information and personal stories. A 2024 multinational study in the journal Vaccine presented preexisting safety indicators for myocarditis, pericarditis, Guillain - Barré syndrome, and cerebral venous sinus thrombosis. The study had a notably large sample size and contributed to the ongoing discussion of vaccine safety. Examining this research clarifies the subtle distinctions between demonstrating causality and simple association, emphasizing the importance of thorough scientific investigation and open communication. The following recommendations should be prioritized to tackle vaccine hesitancy and ensure that politicians, healthcare practitioners, and public health officials make informed decisions. Vaccine safety data should be openly and readily provided to the public, particularly regarding potential hazards and advantages. Establishing post-marketing surveillance systems to monitor and examine adverse effects linked to vaccinations helps strengthen public confidence in the safety monitoring process and officials' dedication to addressing safety concerns with thoroughness.

Booster vaccines dose reduced mortality in hospitalized COVID-19 patients requiring oxygen supplementation: Evidence from the Beijing Omicron outbreak

To assess the impact of vaccines on clinical outcomes among hospitalized COVID-19-infected patients requiring oxygen supplementation during the Beijing Omicron outbreak. We conducted a retrospective cohort study at Beijing Chaoyang Hospital, Capital Medical University, from November 15, 2022, to March 31, 2023. Vaccination statuses were categorized into 3 doses, 2 doses, and unvaccinated (0 dose). The primary outcome was 28-day all-cause mortality. Secondary outcomes included poor outcomes, intensive care unit admission, cardiovascular thromboembolism events, and hospital readmission. Among the included patients, 117 were 2 doses, 285 received booster doses, and 503 were unvaccinated. After propensity score inverse probability weighting, the 3 doses group showed a significantly lower 28-day all-cause mortality compared to the unvaccinated group (inverse probability of treatment weighting-adjusted HR: 0.64, 95% CI: 0.50-0.81). No significant difference was observed in all-cause mortality between the 2 doses and unvaccinated groups. No significant differences were observed in secondary outcome analyses when comparing the 3 doses or 2 doses group to the unvaccinated group. Subgroup analysis revealed significant benefits of booster vaccination in patients with shorter symptom duration, lower Charlson Comorbidity Index, and without immunosuppression status. Our study highlights the significant reduction in all-cause mortality among hospitalized Omicron-infected patients who received a third dose vaccine. These findings underscore the importance of prioritizing booster vaccinations, especially among the elderly. Further research is warranted to confirm and extend these observations.

Factors influencing adverse events following COVID-19 vaccination

Various novel platform technologies have been used for the development of COVID-19 vaccines. In this nested cohort study among healthcare workers in Australia and Brazil who received three different COVID-19-specific vaccines, we (a) evaluated the incidence of adverse events following immunization (AEFI); (b) compared AEFI by vaccine type, dose and country; (c) identified factors influencing the incidence of AEFI; and (d) assessed the association between reactogenicity and vaccine anti-spike IgG antibody responses. Of 1302 participants who received homologous 2-dose regimens of ChAdOx1-S (Oxford-AstraZeneca), BNT162b2 (Pfizer-BioNTech) or CoronaVac (Sinovac), 1219 (94%) completed vaccine reaction questionnaires. Following the first vaccine dose, the incidence of any systemic reaction was higher in ChAdOx1-S recipients (374/806, 46%) compared with BNT162b2 (55/151, 36%; p = 0.02) or CoronaVac (26/262, 10%; p < 0.001) recipients. After the second vaccine dose, the incidence of any systemic reaction was higher in BNT162b2 recipients (66/151, 44%) compared with ChAdOx1-S (164/806, 20%; p < 0.001) or CoronaVac (23/262, 9%; p < 0.001) recipients. AEFI risk was higher in younger participants, females, participants in Australia, and varied by vaccine type and dose. Prior COVID-19 did not impact the risk of AEFI. Participants in Australia compared with Brazil reported a higher incidence of any local reaction (170/231, 74% vs 222/726, 31%, p < 0.001) and any systemic reaction (171/231, 74% vs 328/726, 45%, p < 0.001), regardless of vaccine type. Following a primary course of ChAdOx1-S or CoronaVac vaccination, participants who did not report AEFI seroconverted at a similar rate to those who reported local or systemic reactions. In conclusion, we found that the incidence of AEFI was influenced by participant age and COVID-19 vaccine type, and differed between participants in Australia and Brazil.

Association between mRNA COVID-19 vaccine boosters and mortality in Japan: The VENUS study

Although previous studies have shown no increased mortality risk after the primary series of COVID-19 mRNA vaccines, reports on booster doses are lacking. This study aimed to evaluate mortality risk after the mRNA vaccine boosters in addition to the primary series. This nested case-control study included two age-specific cohorts (18-64 and ≥65 years as of February 1, 2021) in two municipalities. All deaths were identified and matched five controls for each case at each date of death (index date) with risk set sampling according to municipality, age, and sex. The adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for mRNA vaccines (first to fifth doses) were estimated by comparing with no vaccination within 21 and 42 days before the index date using a conditional logistic regression model. The 18-64-years cohort comprised 431 cases (mean age, 57.0 years; men, 58.2%) and 2,155 controls (mean age, 56.0; men, 58.2%), whereas the ≥65-years cohort comprised 12,166 cases (84.0; 50.2%) and 60,830 controls (84.0, 50.2%). The aORs (95% CI) in 0-21 days after the third and fourth doses in the 18-64-years cohort were 0.62 (0.24, 1.62) and 0.38 (0.08, 1.84), respectively. The aORs (95% CI) after the third to fifth doses in the ≥65 years cohort were 0.36 (0.31, 0.43), 0.30 (0.25, 0.37), and 0.26 (0.20, 0.33), respectively. In conclusion, booster doses of mRNA vaccines do not increase mortality risk. These findings could help subsequent vaccine campaigns and alleviate vaccine hesitancy.

Vaccine Hesitancy and Associated Factors Amongst Health Professionals: A Scoping Review of the Published Literature

Background/Objectives: Healthcare professionals (HCPs) hold significant influence over public attitudes toward vaccinations. Studies suggest that HCPs are hesitant towards the coronavirus disease 2019 (COVID-19) vaccines. This hesitancy could lead to lower vaccination rates in the community. Therefore, this scoping review aimed to assess the extent of hesitancy towards COVID-19 booster doses among HCPs and identify the associated factors. Methods: A comprehensive search was conducted in the PubMed and Scopus databases from April to August 2024, using keywords related to COVID-19, vaccine hesitancy, HCPs, and booster vaccination. Studies that had been peer-reviewed, published in English after 2022, and focused on the hesitancy of the COVID-19 booster dose hesitancy among HCPs were included. Out of the 6703 studies screened, 24 studies were included. Results: Most of the HCPs have received their initial series of COVID-19 vaccinations. However, there is a lower rate of uptake for booster doses, with hesitancy rates ranging from 12% to 66.5%. Hesitancy rates varied significantly across continents, with Asia, Africa, and Europe ranging from 19.7% to 66.5%, 27% to 46.1%, 14% to 60.2%, respectively. Hesitancy was reported to be influenced by various factors, including concerns about vaccine safety, necessity, and effectiveness of these vaccines. In addition, the hesitancy regarding booster doses was also found to be influenced by factors like age, gender, profession, and previous COVID-19. Physicians, nurses, and pharmacists exhibited vaccine hesitancy rates ranging from 12.8% to 43.7%, 26% to 37%, and 26% to 34.6%, respectively. Conclusions: Our review underscores the hesitancy among HCPs towards receiving booster doses across countries around the world and explores the underlying factors. These findings provide valuable insights for the design of future pandemic vaccination programs.

The Strategic Advisory Group of Experts (SAGE) on Immunization-Past, Present and Future

BACKGROUND/OBJECTIVES

In November 1999, WHO established the Strategic Advisory Group of Experts (SAGE) on Immunization as a multidisciplinary group of experts to provide high-level recommendations on vaccines and immunization.

METHODS

This review provides an overview of SAGE's work in the past 25 years. It further outlines the processes and methods currently used by SAGE and highlights some of its major achievements.

RESULTS

SAGE's global policies have driven action toward eradication, elimination and disease control and addressed the optimization of vaccination and immunization. In total, 27 major policy positions on vaccines/vaccine-preventable diseases have guided global public health. During times of epidemics and pandemics, interim recommendations issued by SAGE have responded iteratively in real-time to provide evidence-driven response policies. SAGE is an adaptive advisory group that has modified its procedures and working approaches to meet the evolving challenges in public health and stay up-to-date with evolving scientific and guideline development standards.

CONCLUSIONS

Over the last quarter century, SAGE has significantly contributed to shaping the immunization landscape. It has achieved and maintained a high level of integrity and credibility. The advisory group continues to be an authority in global public health, and its recommendations have profound implications for the health of individuals and populations across the globe.

Immunogenicity and Protective Efficacy of Nucleic Acid-Based Vaccines Against COVID-19: A Systematic Review

To overcome the COVID-19 pandemic, the development of safe and effective vaccines is crucial. With the enormous information available on vaccine development for COVID-19, there are still grey areas to be considered when designing a potential vaccine. The rapid regulatory approval of nucleic acid-based vaccines was unique to the COVID-19; these vaccines were rapidly produced cost-effectively and with lesser risk of infectivity. Additionally, they demonstrated relative stability at room temperature (DNA). However, a comparative understanding of the immunogenic impact and efficacy of these vaccines is lacking. Immunogenicity is essential for developing and maintaining effective and long-lasting post-vaccination immunity to pathogenic microorganisms. This systematic review aims to assess and summarize the immunogenicity and protective efficacy of the nucleic acid-based vaccines against COVID-19. The Preferred Reporting Items for Systematic Reviews (PRISMA) recommendations were followed in this review. CASP tool was used for quality assessment of randomized controlled trials. All included studies employed a randomized control method, and the results demonstrated promising immune responses and effectiveness that provided high-level protection against COVID-19 infection. This study offers vital insights for advancing vaccine technology. Furthermore, it guides formulation, informs personalized vaccination strategies, and enhances global health preparedness, particularly in regions with limited vaccine access.

Nucleic acid drugs: recent progress and future perspectives

High efficacy, selectivity and cellular targeting of therapeutic agents has been an active area of investigation for decades. Currently, most clinically approved therapeutics are small molecules or protein/antibody biologics. Targeted action of small molecule drugs remains a challenge in medicine. In addition, many diseases are considered 'undruggable' using standard biomacromolecules. Many of these challenges however, can be addressed using nucleic therapeutics. Nucleic acid drugs (NADs) are a new generation of gene-editing modalities characterized by their high efficiency and rapid development, which have become an active research topic in new drug development field. However, many factors, including their low stability, short half-life, high immunogenicity, tissue targeting, cellular uptake, and endosomal escape, hamper the delivery and clinical application of NADs. Scientists have used chemical modification techniques to improve the physicochemical properties of NADs. In contrast, modified NADs typically require carriers to enter target cells and reach specific intracellular locations. Multiple delivery approaches have been developed to effectively improve intracellular delivery and the in vivo bioavailability of NADs. Several NADs have entered the clinical trial recently, and some have been approved for therapeutic use in different fields. This review summarizes NADs development and evolution and introduces NADs classifications and general delivery strategies, highlighting their success in clinical applications. Additionally, this review discusses the limitations and potential future applications of NADs as gene therapy candidates.

Determinants of COVID-19 Vaccine Acceptance and Hesitancy: A Systematic Review

Background/Objectives: COVID-19 is an infectious disease whose prevention is significantly aided by vaccination, which reduces both case severity and mortality. Despite the safety and efficacy of vaccines, acceptance is not universal, and understanding of the factors influencing vaccination decisions and hesitancy remains limited. This review aims to identify and analyze studies addressing two key questions: what influences the decision to vaccinate and what factors are associated with vaccine hesitancy. Methods: This systematic review was conducted following the PRISMA guidelines. Data collection utilized descriptors related to vaccine adherence and hesitancy, based on the PEO strategy of the Joanna Briggs Institute (JBI). Searches were conducted in Embase, Scopus, PubMed, Lilacs, and Web of Science, focusing on publications from 2021, the year the first COVID-19 vaccine was approved. After excluding duplicates and selecting articles based on eligibility criteria, the analysis involved data extraction and methodological quality assessment using JBI tools. Results: A total of 5268 publications were identified, with 30 included in this study. Factors associated with vaccine hesitancy included low education levels, social media influence, confidence in vaccine safety, and fear of side effects. In contrast, factors linked to vaccine acceptance included higher education, higher income, older age, and existing comorbidities. Conclusions: The findings highlight the urgent need for targeted health communication and education strategies, particularly for vulnerable groups. Public health policies should incorporate these factors to enhance vaccination adherence and build public confidence in vaccine safety, which is essential for mitigating future health emergencies.

A New Natural Language Processing-Inspired Methodology (Detection, Initial Characterization, and Semantic Characterization) to Investigate Temporal Shifts (Drifts) in Health Care Data: Quantitative Study

BACKGROUND

Proper analysis and interpretation of health care data can significantly improve patient outcomes by enhancing services and revealing the impacts of new technologies and treatments. Understanding the substantial impact of temporal shifts in these data is crucial. For example, COVID-19 vaccination initially lowered the mean age of at-risk patients and later changed the characteristics of those who died. This highlights the importance of understanding these shifts for assessing factors that affect patient outcomes.

OBJECTIVE

This study aims to propose detection, initial characterization, and semantic characterization (DIS), a new methodology for analyzing changes in health outcomes and variables over time while discovering contextual changes for outcomes in large volumes of data.

METHODS

The DIS methodology involves 3 steps: detection, initial characterization, and semantic characterization. Detection uses metrics such as Jensen-Shannon divergence to identify significant data drifts. Initial characterization offers a global analysis of changes in data distribution and predictive feature significance over time. Semantic characterization uses natural language processing-inspired techniques to understand the local context of these changes, helping identify factors driving changes in patient outcomes. By integrating the outcomes from these 3 steps, our results can identify specific factors (eg, interventions and modifications in health care practices) that drive changes in patient outcomes. DIS was applied to the Brazilian COVID-19 Registry and the Medical Information Mart for Intensive Care, version IV (MIMIC-IV) data sets.

RESULTS

Our approach allowed us to (1) identify drifts effectively, especially using metrics such as the Jensen-Shannon divergence, and (2) uncover reasons for the decline in overall mortality in both the COVID-19 and MIMIC-IV data sets, as well as changes in the cooccurrence between different diseases and this particular outcome. Factors such as vaccination during the COVID-19 pandemic and reduced iatrogenic events and cancer-related deaths in MIMIC-IV were highlighted. The methodology also pinpointed shifts in patient demographics and disease patterns, providing insights into the evolving health care landscape during the study period.

CONCLUSIONS

We developed a novel methodology combining machine learning and natural language processing techniques to detect, characterize, and understand temporal shifts in health care data. This understanding can enhance predictive algorithms, improve patient outcomes, and optimize health care resource allocation, ultimately improving the effectiveness of machine learning predictive algorithms applied to health care data. Our methodology can be applied to a variety of scenarios beyond those discussed in this paper.

One-year mortality and associated factors in older hospitalized COVID-19 survivors: a Nationwide Cohort Study in Korea

This study aimed to evaluate the 1-year mortality rate among older patients with COVID-19 discharged from hospital and to identify risk factors associated with this outcome. Using a COVID-19 dataset from the Korean National Health Insurance System, this study's evaluation period spanned from October 8, 2020, through December 31, 2021. The primary outcome was the 1-year mortality rate following hospital discharge. A logistic regression model was employed for multivariable analysis to estimate the odds ratios for the outcomes, and the Kaplan-Meier method was used to analyze differences in 1-year survival rates. Among the 66,810 COVID-19 patients aged 60 years or older who were hospitalized during the study period, the in-hospital mortality rate was 4.8% (n = 3219). Among the survivors (n = 63,369), the 1-year mortality rate was 4.9% (n = 3093). Non-survivors, compared to survivors, were significantly older (79.2 ± 9.5 vs. 68.9 ± 7.8, P < 0.001) and exhibited a lower rate of COVID-19 vaccination (63.0% vs. 91.7%, P < 0.001). Additionally, non-survivors experienced a higher incidence of organ dysfunction, along with a greater proportion of required mechanical ventilation (14.6% vs. 1.0%, P < 0.001) and extracorporeal membrane oxygenation (4.0% vs. 0.1%, P < 0.001). Multivariable logistic regression analysis identified older age, male sex, cardiovascular disease, immunosuppression, organ dysfunction, illness severity, and corticosteroid use during hospitalization as factors associated with death within 1 year after hospital discharge. However, vaccination was found to have a long-term protective effect against death among COVID-19 survivors. The 1-year mortality rate after hospital discharge for older COVID-19 patients was comparable to the in-hospital mortality rate for these patients in Korea. The long-term mortality rate among hospitalized older COVID-19 patients was influenced by demographic factors and the severity of illness experienced during hospitalization.

Impact of COVID-19 on Psychiatric Patients: The Role of Vaccination, Comorbidities, and Biomarkers in Clinical Outcomes

Background/Objectives: The COVID-19 pandemic has posed significant challenges, particularly for individuals residing in psychiatric facilities. This study aims to investigate the impact of COVID-19 on psychiatric patients, focusing on factors such as their vaccination status, comorbidities, medication regimens, and biomarkers like C-reactive protein (CRP) and ferritin. Methods: This retrospective study analyzed 100 patients with confirmed SARS-CoV-2 infections admitted to the private psychiatric clinic "Asclepius of Upper Volos" from March 2020 to March 2023. The data collected included sociodemographic characteristics, vaccination status, symptom severity, medication regimens, and levels of CRP and ferritin. Statistical analyses using IBM SPSS Statistics version 29 included Pearson's chi-square tests, Student's t-tests, and a survival time analysis via the log-rank test to assess associations between clinical characteristics and outcomes. Results: Among the participants, 64% were female and 74% received two doses of the COVID-19 vaccine. The majority experienced mild symptoms, with a survival rate of 74%. Statistically significant findings include a higher survival rate among vaccinated individuals (98.6%) versus unvaccinated individuals (1.4%, p < 0.001). Comorbidities like chronic obstructive pulmonary disease (COPD), coronary artery disease, and renal failure were associated with severe symptoms and higher mortality rates. Higher ferritin levels were significantly associated with poorer outcomes, with survivors having a mean ferritin level of 246.2 (SD = 150.3) compared to the 416.9 (SD = 215.9) seen in non-survivors (p < 0.001). Similarly, mean CRP levels were lower in survivors (1.58, SD = 1.96) than in non-survivors (3.46, SD = 2.92), with a p-value of 0.002. Conclusions: The findings underscore the importance of tailored health protocols and continued support for this vulnerable population. Enhanced strategies for managing comorbidities and utilizing biomarkers can aid in better predicting and improving psychiatric patient outcomes.

Impact and Effectiveness of COVID-19 Vaccines Based on Machine Learning Analysis of a Time Series: A Population-Based Study

Background: Although confirmed cases of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been declining since late 2020 due to general vaccination, little research has been performed regarding the impact of vaccines against SARS-CoV-2 in Spain in terms of hospitalizations and deaths. Objective: Our aim was to identify the reduction in severity and mortality of coronavirus disease 2019 (COVID-19) at a nationwide level due to vaccination. Methods: We designed a retrospective, population-based study to define waves of infection and to describe the characteristics of the hospitalized population. We also studied the rollout of vaccination and its relationship with the decline in hospitalizations and deaths. Finally, we developed two mathematical models to estimate non-vaccination scenarios using machine learning modeling (with the ElasticNet and RandomForest algorithms). The vaccination and non-vaccination scenarios were eventually compared to estimate the number of averted hospitalizations and deaths. Results: In total, 498,789 patients were included, with a global mortality of 14.3%. We identified six waves or epidemic outbreaks during the observed period. We established a strong relationship between the beginning of vaccination and the decline in both hospitalizations and deaths due to COVID-19 in all age groups. We also estimated that vaccination prevented 170,959 hospitalizations (CI 95% 77,844-264,075) and 24,546 deaths (CI 95% 2548-46,543) in Spain between March 2021 and December 2021. We estimated a global reduction of 9.19% in total deaths during the first year of COVID-19 vaccination. Conclusions: Demographic and clinical profiles changed over the first months of the pandemic. In Spain, patients over 80 years old and other age groups obtained clinical benefit from early vaccination. The severity of COVID-19, in terms of hospitalizations and deaths, decreased due to vaccination. Our use of machine learning models provided a detailed estimation of the averted burden of the pandemic, demonstrating the effectiveness of vaccination at a population-wide level.

Impact of cross-reactivity and herd immunity on SARS-CoV-2 pandemic severity

Public health systems reported low mortality from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in East Asia, in low-income countries, and for children during the first year of the SARS-CoV-2 pandemic. These reports led commentators to suggest that cross-reactive immunity from prior exposure to other pathogens reduced fatality risk. Resolution of initial infection waves also contributed to speculation that herd immunity prevented further waves prior to vaccination. Serology instead implied that immunity was too limited to achieve herd immunity and that there was little impact from cross-reactive protection. Paediatric deaths exceeded those from influenza, with higher age-specific fatality risk in lower-income nations and similar fatality risk in East Asia compared with demographically similar regions. Neither pre-outbreak exposure to related pathogens nor immunity induced by initial infection waves are necessarily a reliable response to future pathogen outbreaks. Preparedness for future pathogen outbreaks should instead focus on strategies such as voluntary behavioural changes, nonpharmaceutical interventions, and vaccination.

Prevalence of menstrual alterations following COVID-19 vaccination: systematic review & meta-analysis

BACKGROUND

COVID-19 vaccines can lead to diverse local and systemic side effects, but there is limited evidence concerning their association with menstrual cycle changes. This study aimed to assess the prevalence of menstrual cycle alterations after COVID-19 vaccination among adult women.

METHODS

We systematically searched the PubMed, Web of Science and Science Direct databases for observational studies that included adult women and investigated the range of menstrual alterations. The quality of the studies was evaluated via the Newcastle-Ottawa scale. All the data were analyzed via Comprehensive Meta-Analysis Software Version 4.0. Forest plots were created to calculate the individual and pooled prevalence rates of different types of menstrual changes and 95% confidence intervals (CI) via fixed-effects and random-effects models, as appropriate. Heterogeneity was assessed with Q statistics and the I2 test.

RESULTS

Eleven studies, encompassing 26,283 adult women, met our eligibility criteria. Among the selected studies, five were cohort studies, five were cross-sectional studies, and one employed a case‒control design. The menstrual changes included abnormal cycle duration, dysmenorrhea, irregular cycles, and abnormal cycle flow (heavy and light flow), with pooled percentages of 27.3% (CI: 7.2-64.6%), 22% (CI: 5.2-59.4%), 16% (CI: 5.8-37.2%), 11.7% (CI: 5.8-22%), and 5.5% (CI: 2.3-12.5%), respectively.

CONCLUSIONS

This review highlights the prevalence of menstrual changes after COVID-19 vaccination and emphasizes the importance of considering menstrual health as an integral part of postvaccination monitoring and health care interventions. However, longitudinal studies are essential for establishing a definitive causal relationship between COVID-19 vaccination and menstrual alterations.

Retinal Vascular Occlusions After COVID-19 Vaccination in South Korea: A Nation-Wide Population-Based Study

PURPOSE

To investigate the association between the retinal vascular occlusion and vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

METHODS

This nationwide population-based cohort study included 2,742,065 individuals aged ≥ 20 years who were vaccinated against SARS-CoV-2 from March 1, 2021, to December 31, 2021, and unvaccinated individuals matched at a ratio of approximately 1:10 by gender and age, all without a history of retinal vascular occlusion. The occurrence of retinal vascular occlusion was observed up to 60 days after the 1st vaccination date in the vaccination group, while 60 days from January 1, 2021, in the non-vaccination group. The risk of developing retinal vascular occlusion was compared between vaccinated and unvaccinated subjects. Risks were also compared among the different types of vaccines.

RESULTS

Vaccination lowered the risk of retinal vascular occlusion, with an odds ratio (OR) of 0.80 (95% confidence interval (CI), 0.64-0.99; p = 0.039). For individuals aged < 40 years, the vaccination lowered the risk of retinal vascular occlusion occurrence significantly compared with those over the age of 40 (OR, 0.35 for age 20-39, 0.83 for age 40-64, 0.81 for age ≥ 65; P for interaction = 0.028). There was a significant difference in the ORs for retinal vascular occlusion among the four vaccine types (p < 0.001).

CONCLUSIONS

SARS-CoV-2 vaccination did not increase the risk of retinal vascular occlusion. However, the risk levels differed depending on the type of vaccine used. Considering the ongoing evolution of SARS-CoV-2 vaccines, it is imperative to conduct additional assessments of the recently introduced vaccines.

Mortality risk of Severe Acute Respiratory Syndrome cases classified as COVID-19: A longitudinal study

BACKGROUND

The COVID-19 pandemic has significantly impacted global health, with diverse factors influencing the risk of death among reported cases. This study mainly analyzes the main characteristics that have contributed to the increase or decrease in the risk of death among Severe Acute Respiratory Syndrome (SARS) cases classified as COVID-19 reported in southeast Brazil from 2020 to 2023.

METHODS

This cohort study utilized COVID-19 notification data from the Sistema de Vigilância Epidemiológica (SIVEP) information system in the southeast region of Brazil from 2020 to 2023. Data included demographics, comorbidities, vaccination status, residence area, and survival outcomes. Classical Cox, Cox mixed effects, Prentice, Williams & Peterson (PWP), and PWP fragility models were used to assess the risk of dying over time.

RESULTS

Across 987,534 cases, 956,961 hospitalizations, and 330,343 deaths were recorded over the period. Mortality peaked in 2021. The elderly, males, black individuals, lower-educated, and urban residents faced elevated risks. Vaccination reduced death risk by around 20% and 13% in 2021 and 2022, respectively. Hospitalized individuals had lower death risks, while comorbidities increased risks by 20-26%.

CONCLUSION

The study identified demographic and comorbidity factors influencing COVID-19 mortality. Rio de Janeiro exhibited the highest risk, while São Paulo had the lowest. Vaccination significantly reduces death risk. Findings contribute to understanding regional mortality variations and guide public health policies, emphasizing the importance of targeted interventions for vulnerable groups.

Creating a Modified Version of the Cambridge Multimorbidity Score to Predict Mortality in People Older Than 16 Years: Model Development and Validation

BACKGROUND

No single multimorbidity measure is validated for use in NHS (National Health Service) England's General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR), the nationwide primary care data set created for COVID-19 pandemic research. The Cambridge Multimorbidity Score (CMMS) is a validated tool for predicting mortality risk, with 37 conditions defined by Read Codes. The GDPPR uses the more internationally used Systematized Nomenclature of Medicine clinical terms (SNOMED CT). We previously developed a modified version of the CMMS using SNOMED CT, but the number of terms for the GDPPR data set is limited making it impossible to use this version.

OBJECTIVE

We aimed to develop and validate a modified version of CMMS using the clinical terms available for the GDPPR.

METHODS

We used pseudonymized data from the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RSC), which has an extensive SNOMED CT list. From the 37 conditions in the original CMMS model, we selected conditions either with (1) high prevalence ratio (≥85%), calculated as the prevalence in the RSC data set but using the GDPPR set of SNOMED CT codes, divided by the prevalence included in the RSC SNOMED CT codes or (2) conditions with lower prevalence ratios but with high predictive value. The resulting set of conditions was included in Cox proportional hazard models to determine the 1-year mortality risk in a development data set (n=500,000) and construct a new CMMS model, following the methods for the original CMMS study, with variable reduction and parsimony, achieved by backward elimination and the Akaike information stopping criterion. Model validation involved obtaining 1-year mortality estimates for a synchronous data set (n=250,000) and 1-year and 5-year mortality estimates for an asynchronous data set (n=250,000). We compared the performance with that of the original CMMS and the modified CMMS that we previously developed using RSC data.

RESULTS

The initial model contained 22 conditions and our final model included 17 conditions. The conditions overlapped with those of the modified CMMS using the more extensive SNOMED CT list. For 1-year mortality, discrimination was high in both the derivation and validation data sets (Harrell C=0.92) and 5-year mortality was slightly lower (Harrell C=0.90). Calibration was reasonable following an adjustment for overfitting. The performance was similar to that of both the original and previous modified CMMS models.

CONCLUSIONS

The new modified version of the CMMS can be used on the GDPPR, a nationwide primary care data set of 54 million people, to enable adjustment for multimorbidity in predicting mortality in people in real-world vaccine effectiveness, pandemic planning, and other research studies. It requires 17 variables to produce a comparable performance with our previous modification of CMMS to enable it to be used in routine data using SNOMED CT.

COVID-19 vaccines are not associated with axonal injury in patients with multiple sclerosis

Objective

To evaluate the safety of COVID-19 vaccines in patients with multiple sclerosis (MS) by assessing their impact on serum neurofilament light chain (sNfL) levels as a marker of neuroaxonal damage.

Methods

Single-center observational longitudinal study including patients with MS who consecutively received their initial vaccination against SARS-CoV-2 at Hospital Universitario Ramón y Cajal, following the first national immunization program in Spain. Serum samples were collected at baseline and after receiving the second dose of the vaccine. sNfL levels were quantified using the single molecule array (SIMOA) technique. Adverse events, including clinical or radiological reactivation of the disease, were recorded.

Results

Fifty-two patients were included (median age, 39.7 years [range, 22.5-63.3]; 71.2% female). After SARS-CoV-2 vaccination, no increased inflammatory activity, either determined by the presence of relapses and/or new MRI lesions and/or high sNfL levels, was detected. Accordingly, there was no difference between median sNfL levels before and after vaccination (5.39 vs. 5.76 pg/ml, p=0.6). Despite this, when looking at baseline patient characteristics before vaccination, younger age associated with disease activity after vaccination (OR 0.87, 95% CI: 0.77-0.98, p=0.022). Larger studies are needed to validate these results.

Conclusion

COVID-19 vaccines did not cause reactivation of disease at a clinical, radiological or molecular level, thus suggesting that they are safe in MS patients.

[Symptoms and options in rehabilitation of post-COVID-19 syndrome (long-COVID)]

Manapság a járványok korát éljük. Egyre több és egyre súlyosabb járvány jelenik meg. A 2019. évi koronavírus-betegség (COVID–19) rendkívül fertőző betegség, amelyet a súlyos akut légúti szindrómát okozó új koronavírus (SARS-CoV-2) idéz elő. A vírus feltételezhetően denevérről terjedt át az emberre. A Rhinolophus sinicus egyik vírusa 80%-os, míg a Rhinolophus affinis vírustörzse 96%-os hasonlóságot mutatott a SARS-CoV-2-vel. A COVID–19-fertőzés emberről emberre történő átvitele a betegek elkülönítéséhez vezetett. A betegség a globalizált utazások következtében világszerte elterjedt, az Egészségügyi Világszervezet (WHO) világjárványnak nyilvánította, ma pedig jelentős közegészségügyi problémaként tartják számon. A fertőzés okozta akut tünetek mellett a pácienseknek és a társadalomnak szembesülnie kell a vírusfertőzés hosszú távú egészségkárosító szövődményeivel is, mely állapotot poszt-COVID–19-szindrómának (angolul: long-COVID) neveznek. A posztakut-COVID–19-szindrómán belül két szakaszt különítenek el: az akut fertőzést követő 4–12 hét közötti szubakut-COVID–19-szindrómát és a 12 héten túl is fennmaradó tünetekkel jellemzett poszt-COVID–19-szindrómát. A betegséget a tünetek sokféle skálája jellemzi, amelyek több szervrendszerre is kiterjednek. A panaszok kezelése elsősorban a tünetek kezeléséből, valamint multidiszciplináris rehabilitációból áll. A COVID–19 elleni védőoltás a világjárvány mérséklésének egyik legfontosabb eszköze. Az elmúlt évek kiterjedt kutatásai igazolják a COVID–19-vakcinák hatékonyságát. Nemzetközi tanulmányok kimutatták, hogy a vakcina protektív tényezőnek bizonyult a hosszan tartó COVID-tünetekkel szemben. Az összefoglaló tanulmányban irodalmi adatok alapján áttekintettem a COVID–19 tüneteit, epidemiológiáját, átvitelét, patogenezisét, továbbá a poszt-COVID–19-szindróma egyes szervrendszerekre gyakorolt hatásait, a rehabilitáció lehetőségeit és a vakcinák hatását a tünetek kialakulására. Orv Hetil. 2024; 165(33): 1266–1274.

Severe COVID-19 Outcomes in Five Latin American Countries in the Postvaccination Era

We conducted a multicountry retrospective study using data from COVID-19 national surveillance databases to analyze clinical profiles, hospitalization rates, intensive care unit (ICU) admissions, utilization of ventilatory support, and mortality rates in five Latin American countries in the context of COVID-19 vaccination implementation. We analyzed the sociodemographic characteristics, comorbidities, clinical outcomes, and vaccination status of laboratory-confirmed COVID-19 cases from January 2021 to December 2022. We calculated the yearly and quarterly hospitalization rates per 1000 confirmed COVID-19 cases and ICU admissions, use of mechanical ventilators, and mortality rates per 1000 hospitalized cases, with their corresponding 95% confidence interval (CI) of 38,209,397 confirmed COVID-19 cases. Rates of hospitalization, ICU admission, ventilatory support, and death were higher among males than among females (30.6 vs. 25, 275.9 vs. 218.8, 156.4 vs. 118.6, and 388.4 vs. 363.1 per 1000, respectively); higher in 2021 than in 2022 (51.6 vs. 20.2, 471.4 vs. 75.5, 230.1 vs. 46.7, and 307.9 vs. 230.3 per 1000, respectively); and higher in the gt;50 age group (range: 4.3–16.3, 35.5–149.5, 20.1–83.2, and 315–462.9, per 1000) than the lt;50 age group (range: 0.8–5.7, 3.0–49.3, 2.1–39.3, and 7.8–217.7 per 1000). Hypertension and diabetes mellitus were the most common comorbidities in Mexico and Colombia. Prevention and treatment strategies for these case profiles could bring benefits from a public health perspective.

Increased expression of miR-320b in blood plasma of patients in response to SARS-CoV-2 infection

Coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Recent research has demonstrated how epigenetic mechanisms regulate the host-virus interactions in COVID-19. It has also shown that microRNAs (miRNAs) are one of the three fundamental mechanisms of the epigenetic regulation of gene expression and play an important role in viral infections. A pilot study published by our research group identified, through next-generation sequencing (NGS), that miR-4433b-5p, miR-320b, and miR-16-2-3p are differentially expressed between patients with COVID-19 and controls. Thus, the objectives of this study were to validate the expression of these miRNAs using quantitative real-time polymerase chain reaction (qRT-PCR) and to perform in silico analyses. Patients with COVID-19 (n = 90) and healthy volunteers (n = 40) were recruited. MiRNAs were extracted from plasma samples and validated using qRT-PCR. In addition, in silico analyses were performed using mirPath v.3 software. MiR-320b was the only miRNA upregulated in the case group com-pared to the control group. The in silico analyses indicated the role of miR-320b in the regulation of the KITLG gene and consequently in the inflammatory process. This study confirmed that miR-320b can distinguish patients with COVID-19 from control participants; however, further research is needed to determine whether this miRNA can be used as a target or a biomarker.

The type of COVID-19 vaccination does not affect reproductive function and pregnancy outcomes in infertile couples

Introduction

Studies on the effect of vaccine type and two other vaccines other than inactivated vaccines approved in China on in vitro fertilization (IVF) pregnancy outcomes are rare. To complement and confirm the existing findings, this research aimed to investigate whether there are adverse effects of different vaccine types in females and males on reproductive function and clinical pregnancy.

Methods

This retrospective study enrolled 6,455 fresh embryo transfer cycles at the First Affiliated Hospital of Zhengzhou University between May 1, 2021, and October 31, 2022. The primary outcome is the clinical pregnancy rate (CPR). At the same time, the secondary results are the number of oocytes retrieved, two pronuclei (2PN) rate, blastocyst formation rate, high-quality blastocyst rate, and semen parameters (volume, density, sperm count, forward motility rate, total motility rate, immobility rate, and DNA fragment index (DFI) rate).

Results

In the comparison of ovarian stimulation indicators, no statistically significant differences (P > 0.05) were found in Gn days, endometrial thickness, 2PN rate, metaphase 2 (MII) rate, high-quality embryo rate, and blastocyst formation rate. No significant differences (P>0.05) were found in age, body mass index (BMI), education level, and semen parameters (volume, density, sperm count, forward motility rate, total motility rate, immobility rate, and DFI rate) in these four groups. The multivariate regression model showed that neither the types of vaccines nor the vaccination status of both infertile couples significantly affected clinical pregnancy.

Discussion

The type of vaccine does not appear to have an unfavorable effect on ovarian stimulation, embryo development, semen parameters, and clinical pregnancy.

Comparison of Transient and Persistent Adverse Events After COVID-19 Vaccination: A Retrospective Analysis

OBJECTIVE

Most reported adverse events following COVID-19 vaccination have been transient. However, persistent adverse events may occur with some frequency. This study aimed to analyze patient background characteristics and trends, with a focus on whether adverse events following COVID-19 vaccination were transient or persistent.

METHODS

A retrospective study was performed at a single institution in Japan.

PATIENTS

The study cohort included 47 patients who presented with symptoms after COVID-19 vaccination between May 2021 and September 2023. The patients were classified into two groups based on the duration of symptoms: transient group, less than four weeks; persistent group, greater than or equal to four weeks. Data on age, sex, body mass index, smoking history, underlying conditions, type of COVID-19 vaccination, number of doses, onset, symptoms, and treatments were collected retrospectively.

RESULTS

The median age was 51.0 years and 74.5% were females, with a particularly high proportion of women in their 40s. The use of the bivalent omicron-containing booster vaccine (BA.1) was significantly more common in the persistent group than in the transient group (p = 0.0267). Onset in the transient group was more common after the first vaccination, whereas onset in the persistent group was more common after the second and subsequent vaccinations (p = 0.003). Regarding symptoms, pain was more frequent in the persistent group than in the transient group (60% vs. 13.6%; p = 0.001).

CONCLUSIONS

This study investigated the presence of persistent symptoms, especially pain, after COVID-19 vaccination. Persistent symptoms were frequently reported after the second vaccination. It should be noted that the study does not negate the usefulness of COVID-19 vaccines.

Presenting clinical symptoms of post-COVID-19 breakthrough infection: Predictors of mortality in a Middle Eastern population

Objective

Breakthrough COVID-19 infections are common following immunisation with various types of vaccines. The patterns of infections have not been well established. We aimed to analyse the signs and symptoms of post vaccination infections in addition to the need for hospital admission, ER visit and supplemental oxygen in relation to age and gender.

Methods

A cross-sectional cohort study was conducted in JUH from March 2021 to August 2022, we interviewed 1479 individuals who are >15 years of age and got a breakthrough infection. The statistical analysis was performed using STATA statistical software.

Results

Out of the 1479 cases, 50.2 % and 69.4 % were females and less than 45 years of age respectively. Symptoms of cough, fever and headache were reported by nearly 50 % of the patients, while one-third complained of dyspnoea. We found that participants older than 45 years had worse clinical outcomes (P-value < 0.001). 13 deaths were identified in this study due to breakthrough infection, 92.3 % of them were older than 45 years (P-value < 0.001). Participants ≥45 years who experienced a breakthrough infection of COVID-19 were 0.7 times less likely to be females using adjusted logistic regression.

Conclusion

This study indicates that despite more severe symptoms reported in younger patients, the major clinical outcomes were worse among older patients, which makes age a major risk for poor outcomes regardless of symptoms. Thus, older people should be evaluated carefully when presenting with mild symptoms of COVID-19 breakthrough infection. The study also confirms that there is no difference in the incidence of COVID-19 breakthrough infections between males and females. Prospective studies are needed to risk stratify COVID-19 breakthrough infections, which should take into account variants of the virus and comorbidities.

COVID-19 Vaccine Acceptance of Pregnant Women in Thailand

Objective

This study investigated the COVID-19 vaccine acceptance rate among pregnant women in Thailand and explored factors influencing their willingness to receive the vaccine, to enhance vaccine uptake among hesitant pregnant women in the future.

Methods

A prospective study was conducted at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand, in October 2022. The data was collected using face-to-face questionnaires comprising 29 closed-end questions. Pregnant women aged 18 years old or over visiting the antenatal care clinic were included.

Results

The study included 200 participants, revealing a COVID-19 vaccine acceptance rate of 17%. Healthcare provider recommendations significantly increased vaccine acceptance by nearly two-fold (30.77%, p-value < 0.01). The major cause of vaccine hesitancy was the concern about vaccine safety that potentially harmed their babies (77.44%).

Conclusion

The COVID-19 vaccine acceptance rate among pregnant women in Thailand was low. Healthcare provider recommendations played a pivotal role in positively impacting vaccine acceptance, highlighting their importance in increasing acceptance rates in the future.

COVID-19 vaccine uptake among young adults: Influence of asthma and sociodemographic factors

Background

Asthma was initially described as a risk factor for severe coronavirus disease 2019 (COVID-19), but the uptake of COVID-19 vaccine among young adults with asthma is not well studied.

Objective

The aims were to assess COVID-19 vaccine uptake among young adults in general and to explore potential determinants including sociodemographic factors and asthma.

Methods

Participants from the population-based birth cohort BAMSE (Barn/Child, Allergy, Milieu, Stockholm, Epidemiology) were included: 4,064 in the study population, 3,064 in a follow-up at age 24 years, and 2,049 in a COVID-19 follow-up (mean age, 26.5 years). Asthma and asthma-associated characteristics were assessed through questionnaires and clinical data. Data on all COVID-19 vaccines registered between January 1, 2021, and February 15, 2023, were extracted from the National Vaccination Register.

Results

In the study population (n = 4,064), 53.9% had ≥3 COVID-19 vaccine doses registered. In the 24-year follow-up population (n = 3,064), vaccine uptake differed in relation to education (P < .001). Among the participants with university/college education, 65.7% had an uptake of ≥3 doses of vaccine, compared to 54.1% among the participants with elementary school/high school education. Participants with asthma had decreased odds of receiving ≥3 doses (adjusted odds ratio = 0.62; 95% confidence interval, 0.41-0.92) and ≥2 compared to peers without asthma. Those with uncontrolled disease also had decreased odds of receiving ≥3 doses (adjusted odds ratio = 0.30; 95% confidence interval, 0.13-0.66) and ≥2 compared to participants with controlled asthma.

Conclusions

COVID-19 vaccine uptake among young adults is lower in individuals from households with lower socioeconomic status and among those with asthma, including uncontrolled asthma.

Clinical and epidemiological risk factors associated with hospitalization and mortality rate of COVID-19 patients in Banja Luka County: A retrospective observational cohort study on 40,000 patients

Context

Since beginning of the coronavirus disease (COVID-19) it became clear that severe forms of this infection have primarily affected patients with chronic conditions.

Aims

The aim of the study was to explore clinical and epidemiological characteristics associated with COVID 19 outcomes.

Settings and Design

The retrospective observational study included 40,692 citizens of Banja Luka County, Bosnia and Herzegovina, who were confirmed as reverse transcriptase polymerase chain reaction (RT-PCR) positive on COVID-19 at a primary healthcare centre from March 2020 to September 2022.

Methods and Materials

Epidemiological data were obtained from Web-Medic medical records of patients. The COVID-19 data were obtained from COVID-19 data sheets comprised of patients' RT-PCR testing forms, surveillance forms for severe acute respiratory syndrome coronavirus-2 status, and a map of their positive and isolated contacts.

Statistical Analysis Used

Differences regarding the distributions of patients between groups were analysed using the Pearson chi-square test and Mantel-Haenszel chi-square test for trends, while differences in mean values were compared using an independent sample t-test.

Results

The average age of hospitalised patients was significantly higher compared to the age of non-hospitalised patients (P < 0.001). The average age of patients with lethal outcomes was nearly twice as high in comparison to patients with non-lethal outcomes (P < 0.001). Male patients had a higher hospitalization and mortality rate (P < 0.001). The highest hospitalization rate was in patients with chronic renal failure (CRF), diabetes and cardiovascular diseases (CVDs), while the death rate was the highest among patients with CRF and hearth comorbidities. Patients with fatigue and appetite loss had a higher percentage of lethal outcomes. Vaccinated patients had a significantly lower rate of lethal outcome.

Conclusions

Clinical symptoms, signs and outcomes, are posing as predictive parameters for further management of COVID-19. Vaccination has an important role in the clinical outcomes of COVID-19.

The impact and inflammatory characteristics of SARS-CoV-2 infection during ovarian stimulation on the outcomes of assisted reproductive treatment

Introduction

Despite the global prevalence of coronavirus disease 2019 (COVID-19), limited research has been conducted on the effects of SARS-CoV-2 infection on human reproduction. The aims of this study were to investigate the impact of SARS-CoV-2 infection during controlled ovarian stimulation (COS) on the outcomes of assisted reproductive treatment (ART) and the cytokine status of patients.

Methods

This retrospective cohort study included 202 couples who received ART treatment, 101 couples infected with SARS-CoV-2 during COS and 101 matched uninfected couples. The parameters of ovarian stimulation and pregnancy outcomes were compared between the two groups. The All-Human Inflammation Array Q3 kit was utilized to measure cytokine levels in both blood and follicular fluid.

Results

No difference was found in the number of good-quality embryos (3.3 ± 3.1 vs. 3.0 ± 2.2, P = 0.553) between the infected and uninfected groups. Among couples who received fresh embryo transfers, no difference was observed in clinical pregnancy rate (53.3% vs. 51.5%, P = 0.907). The rates of fertilization, implantation, miscarriage, ectopic pregnancy and live birth were also comparable between the two groups. After adjustments were made for confounders, regression models indicated that the quality of embryos (B = 0.16, P = 0.605) and clinical pregnancy rate (P = 0.206) remained unaffected by SARS-CoV-2 infection. The serum levels of MCP-1, TIMP-1, I-309, TNF-RI and TNF-RII were increased, while that of eotaxin-2 was decreased in COVID-19 patients. No significant difference was found in the levels of cytokines in follicular fluid between the two groups.

Conclusion

Asymptomatic or mild COVID-19 during COS had no adverse effects on ART outcomes. Although mild inflammation was present in the serum, it was not detected in the follicular fluid of these patients. The subsequent immune response needs further investigation.

How has research on the effectiveness and safety of COVID-19 vaccination been evaluated: a scope review with emphasis on CoronaVac

Introduction

The control of the COVID-19 epidemic has been focused on the development of vaccines against SARS-CoV-2. All developed vaccines have reported safety and efficacy results in preventing infection and its consequences, although the quality of evidence varies depending on the vaccine considered. Different methodological designs have been used for their evaluation, which can influence our understanding of the effects of these interventions. CoronaVac is an inactivated vaccine, and it has been assessed in various studies, including clinical trials and observational studies. Given these differences, our objective was to explore the published information to answer the question: how has the efficacy/effectiveness and safety of CoronaVac been evaluated in different studies? This is to identify potential gaps and challenges to be addressed in understanding its effect.

Methods

A scoping review was carried out following the methodology proposed by the Joanna Briggs Institute, which included studies carried out in humans as of 2020, corresponding to systematic reviews, clinical trials, analytical or descriptive observational studies, in which the effectiveness and/or safety of vaccines for COVID19 were evaluated or described. There were no age restrictions for the study participants.

Results

The efficacy/effectiveness and safety of this vaccine was assessed through 113 studies. Nineteen corresponded to experimental studies, 7 of Phase II, 5 of Phase IV, and 4 were clinical trials with random assignment. Although some clinical trials with random assignment have been carried out, these have limitations in terms of feasibility, follow-up times, and with this, the possibility of evaluating safety outcomes that occur with low frequencies. Not all studies have used homogeneous methods of analysis. Both the prevention of infection, and the prevention of outcomes such as hospitalization or death, have been valued through similar outcomes, but some through multivariate analysis of dependencies, and others through analysis that try to infer causally through different control methods of confounding.

Conclusion

Published information on the evaluation of the efficacy/effectiveness and safety of the CoronaVac is abundant. However, there are differences in terms of vaccine application schedules, population definition, outcomes evaluated, follow-up times, and safety assessment, as well as non-standardization in the reporting of results, which may hinder the generalizability of the findings. It is important to generate meetings and consensus strategies for the methods and reporting of this type of studies, which will allow to reduce the heterogeneity in their presentation and a better understanding of the effect of these vaccines.

Vaccination and Its Impact on Lung Involvement in COVID-19 Patients: A Retrospective Study in India

Background COVID-19, caused by SARS-CoV-2, led to a global pandemic necessitating urgent vaccine development and deployment. By the end of 2020, several vaccines had reached their clinical trial endpoints. India, leveraging its pharmaceutical prowess, developed two primary vaccines: CoviShield® and Covaxin®. Despite the availability of these vaccines, vaccine hesitancy became a notable challenge. This study aimed to assess the correlation between vaccination status and lung involvement in COVID-19 patients, aiming to fortify trust in vaccines and enhance vaccine uptake in India. Methods This retrospective cross-sectional study analyzed data from 272 patients treated at a designated COVID-19 Care Center in Chennai, India, from May to July 2021. Patients were divided into vaccinated and unvaccinated groups, with vaccinated individuals further categorized based on the type and dose of vaccine received (CoviShield® or Covaxin®). Lung involvement was assessed through CT chest scans, and statistical analyses were performed to compare the severity of lung involvement across different groups. Results The vaccinated group demonstrated significantly lower mean lung involvement (28%) compared to the unvaccinated group (34.8%). Within vaccinated individuals, no significant differences were observed between different vaccine types and doses, suggesting a generalized protective effect of COVID-19 vaccination against severe lung involvement. Conclusion Vaccination against COVID-19 significantly reduces the severity of lung involvement among patients, irrespective of the vaccine brand or dose. This study reinforces the importance of vaccination in mitigating the impact of COVID-19 and supports ongoing vaccination efforts.

Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework

INTRODUCTION

The mRNA vaccines mRNA-1273 and BNT162b2 demonstrated high efficacy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in phase 3 clinical trials, including among older adults. To inform coronavirus disease 2019 (COVID-19) vaccine selection, this systematic literature review (SLR) and meta-analysis assessed the comparative effectiveness of mRNA-1273 versus BNT162b2 in older adults.

METHODS

We systematically searched for relevant studies reporting COVID-19 outcomes with mRNA vaccines in older adults aged ≥ 50 years by first cross-checking relevant published SLRs. Based on the cutoff date from a previous similar SLR, we then searched the WHO COVID-19 Research Database for relevant articles published between April 9, 2022, and June 2, 2023. Outcomes of interest were SARS-CoV-2 infection, symptomatic SARS-CoV-2 infection, severe SARS-CoV-2 infection, COVID-19-related hospitalization, and COVID-19-related death following ≥ 2 vaccine doses. Random effects meta-analysis models were used to pool risk ratios (RRs) across studies. Heterogeneity was evaluated using chi-square testing. Evidence certainty was assessed per GRADE framework.

RESULTS

Twenty-four non-randomized real-world studies reporting clinical outcomes with mRNA vaccines in individuals aged ≥ 50 years were included in the meta-analysis. Vaccination with mRNA-1273 was associated with significantly lower risk of SARS-CoV-2 infection (RR 0.72 [95% confidence interval (CI) 0.64‒0.80]), symptomatic SARS-CoV-2 infection (RR 0.72 [95% CI 0.62‒0.83]), severe SARS-CoV-2 infection (RR 0.67 [95% CI 0.57‒0.78]), and COVID-19-related hospitalization (RR 0.65 [95% CI 0.53‒0.79]) but not COVID-19-related death (RR 0.80 [95% CI 0.64‒1.00]) compared with BNT162b2. There was considerable heterogeneity between studies for all outcomes (I2 > 75%) except death (I2 = 0%). Multiple subgroup and sensitivity analyses excluding specific studies generally demonstrated consistent results. Certainty of evidence across outcomes was rated as low (type 3) or very low (type 4), reflecting the lack of randomized controlled trial data.

CONCLUSION

Meta-analysis of 24 observational studies demonstrated significantly lower risk of asymptomatic, symptomatic, and severe infections and hospitalizations with the mRNA-1273 versus BNT162b2 vaccine in older adults aged ≥ 50 years.

Current Progress, Challenges and Prospects in the Development of COVID-19 Vaccines

The COVID-19 pandemic has resulted in over 772 million confirmed cases, including nearly 7 million deaths, according to the World Health Organization (WHO). Leveraging rapid development, accelerated vaccine approval processes, and large-scale production of various COVID-19 vaccines using different technical platforms, the WHO declared an end to the global health emergency of COVID-19 on May 5, 2023. Current COVID-19 vaccines encompass inactivated, live attenuated, viral vector, protein subunit, nucleic acid (DNA and RNA), and virus-like particle (VLP) vaccines. However, the efficacy of these vaccines is diminishing due to the constant mutation of SARS-CoV-2 and the heightened immune evasion abilities of emerging variants. This review examines the impact of the COVID-19 pandemic, the biological characteristics of the virus, and its diverse variants. Moreover, the review underscores the effectiveness, advantages, and disadvantages of authorized COVID-19 vaccines. Additionally, it analyzes the challenges, strategies, and future prospects of developing a safe, broad-spectrum vaccine that confers sufficient and sustainable immune protection against new variants of SARS-CoV-2. These discussions not only offer insight for the development of next-generation COVID-19 vaccines but also summarize experiences for combating future emerging viruses.