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Erbaş İC, Keleş YE, Erdeniz EH, Yılmaz AT, Yeşil E, Çakıcı Ö, Akça M, Ulu NK, Dinç F, Çiftdoğan DY, Öncel S, Kuyucu N, Tapısız A, Belet N. Evaluation of possible COVID-19 reinfection in children: A multicenter clinical study. Arch Pediatr 2023; 30:187-191. [PMID: 36804354 PMCID: PMC9902289 DOI: 10.1016/j.arcped.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/17/2022] [Accepted: 01/07/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Although it was originally unknown whether there would be cases of reinfection of coronavirus disease 2019 (COVID-19) as seen with other coronaviruses, cases of reinfection were reported from various regions recently. However, there is little information about reinfection in children. METHODS In this study, we aimed to investigate the incidence and clinical findings of reinfection in pediatric patients who had recovered from COVID-19. We retrospectively evaluated all patients under 18 years of age with COVID-19 infection from a total of eight healthcare facilities in Turkey, between March 2020 and July 2021. Possible reinfection was defined as a record of confirmed COVID-19 infection based on positive reverse transcription-polymerase chain reaction (RT-PCR) test results at least 3 months apart. RESULTS A possible reinfection was detected in 11 out of 8840 children, which yielded an incidence of 0.12%. The median duration between two episodes of COVID-19 was 196 (92-483) days. When initial and second episodes were compared, the rates of symptomatic and asymptomatic disease were similar for both, as was the severity of the disease (p = 1.000). Also, there was no significant difference in duration of symptoms (p = 0.498) or in hospitalization rates (p = 1.000). Only one patient died 15 days after PCR positivity, which resulted in a 9.1% mortality rate for cases of reinfection in pediatric patients. CONCLUSION We observed that children with COVID-19 were less likely to be exposed to reinfection when compared with adults. Although the clinical spectrum of reinfection was mostly similar to the first episode, we reported death of a healthy child during the reinfection.
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Affiliation(s)
- İrem Ceren Erbaş
- Division of Pediatric Infectious Disease, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey.
| | - Yıldız Ekemen Keleş
- Division of Pediatric Infectious Disease, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Emine Hafize Erdeniz
- Division of Pediatric Infectious Disease, Faculty of Medicine, On Dokuz Mayıs University, Samsun, Turkey
| | - Ayşe Tekin Yılmaz
- Division of Pediatric Infectious Disease, Eskişehir State Hospital, Eskişehir, Turkey
| | - Edanur Yeşil
- Division of Pediatric Infectious Disease, Mersin State Hospital, Mersin, Turkey
| | - Özlem Çakıcı
- Division of Pediatric Infectious Disease, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Mehtap Akça
- Division of Pediatric Infectious Disease, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Nursel Kara Ulu
- Division of Pediatric Infectious Disease, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Fatih Dinç
- Division of Virology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Dilek Yılmaz Çiftdoğan
- Division of Pediatric Infectious Disease, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Selim Öncel
- Division of Pediatric Infectious Disease, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Necdet Kuyucu
- Division of Pediatric Infectious Disease, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Anıl Tapısız
- Division of Pediatric Infectious Disease, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Nurşen Belet
- Division of Pediatric Infectious Disease, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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Sk T, Biswas S, Sardar T. The impact of a power law-induced memory effect on the SARS-CoV-2 transmission. CHAOS, SOLITONS, AND FRACTALS 2022; 165:112790. [PMID: 36312209 PMCID: PMC9595307 DOI: 10.1016/j.chaos.2022.112790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
It is well established that COVID-19 incidence data follows some power law growth pattern. Therefore, it is natural to believe that the COVID-19 transmission process follows some power law. However, we found no existing model on COVID-19 with a power law effect only in the disease transmission process. Inevitably, it is not clear how this power law effect in disease transmission can influence multiple COVID-19 waves in a location. In this context, we developed a completely new COVID-19 model where a force of infection function in disease transmission follows some power law. Furthermore, different realistic epidemiological scenarios like imperfect social distancing among home-quarantined individuals, disease awareness, vaccination, treatment, and possible reinfection of the recovered population are also considered in the model. Applying some recent techniques, we showed that the proposed system converted to a COVID-19 model with fractional order disease transmission, where order of the fractional derivative ( α ) in the force of infection function represents the memory effect in disease transmission. We studied some mathematical properties of this newly formulated model and determined the basic reproduction number (R 0 ). Furthermore, we estimated several epidemiological parameters of the newly developed fractional order model (including memory index α ) by fitting the model to the daily reported COVID-19 cases from Russia, South Africa, UK, and USA, respectively, for the time period March 01, 2020, till December 01, 2021. Variance-based Sobol's global sensitivity analysis technique is used to measure the effect of different important model parameters (including α ) on the number of COVID-19 waves in a location (W C ). Our findings suggest that α along with the average transmission rate of the undetected (symptomatic and asymptomatic) cases in the community (β 1 ) are mainly influencing multiple COVID-19 waves in those four locations. Numerically, we identified the regions in the parameter space of α andβ 1 for which multiple COVID-19 waves are occurring in those four locations. Furthermore, our findings suggested that increasing memory effect in disease transmission ( α → 0) may decrease the possibility of multiple COVID-19 waves and as well as reduce the severity of disease transmission in those four locations. Based on all the results, we try to identify a few non-pharmaceutical control strategies that may reduce the risk of further SARS-CoV-2 waves in Russia, South Africa, UK, and USA, respectively.
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Affiliation(s)
- Tahajuddin Sk
- Department of Mathematics, Dinabandhu Andrews College, Kolkata, India
| | - Santosh Biswas
- Department of Mathematics, Jadavpur University, Kolkata, India
| | - Tridip Sardar
- Department of Mathematics, Dinabandhu Andrews College, Kolkata, India
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Sardar T, Nadim SS, Rana S. Detection of multiple waves for COVID-19 and its optimal control through media awareness and vaccination: study based on some Indian states. NONLINEAR DYNAMICS 2022; 111:1903-1920. [PMID: 36246667 PMCID: PMC9540085 DOI: 10.1007/s11071-022-07887-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED COVID-19 is a highly infectious disease, and in very recent times, it has shown a massive impact throughout the globe. Several countries faced the COVID-19 infection waves multiple times. These later waves are more aggressive than the first wave and drastically impact social and economic factors. We developed a mechanistic model with imperfect lockdown effect, reinfection, transmission variability between symptomatic & asymptomatic, and media awareness to focus on the early detection of multiple waves and their control measures. Using daily COVID-19 cases data from six states of India, we estimated several important model parameters. Moreover, we estimated the home quarantine, community, and basic reproduction numbers. We developed an algorithm to carry out global sensitivity analysis (Sobol) of the parameters that influence the number of COVID-19 waves ( W C ) and the average number of COVID-19 cases in a wave ( A W ). We have identified some critical controlling parameters that mainly influenced W C and A W . Our study also revealed the best COVID-19 control strategy/strategies among vaccination, media awareness, and their combination using an optimal cost-effective study. The detailed analysis suggests that the severity of asymptomatic transmission is around 10% to 29% of that of symptomatic transmission in all six locations. About 1% to 4% of the total population under lockdown may contribute to new COVID-19 infection in all six locations. Optimal cost-effective analysis based on interventions, namely only vaccination (VA), only media awareness (ME), and a combination of vaccination & media (VA+ME), are projected for the period March 14, 2020, to August 31, 2021, for all the six locations. We have found that a large percentage of the population (26% to 45%) must be vaccinated from February 13 to August 31, 2021, to avert an optimal number of COVID-19 cases in these six locations. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s11071-022-07887-5.
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Affiliation(s)
- Tridip Sardar
- Department of Mathematics, Dinabandhu Andrews College, Kolkata, India
| | - Sk Shahid Nadim
- Odum School of Ecology, University of Georgia, Athens, USA
- Department of Mathematics, Indian Institute of Technology, Roorkee, India
| | - Sourav Rana
- Department of Statistics, Visva-Bharati University, Santiniketan, West Bengal India
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Marinov GK, Mladenov M, Rangachev A, Alexiev I. SARS-CoV-2 reinfections during the first three major COVID-19 waves in Bulgaria. PLoS One 2022; 17:e0274509. [PMID: 36084070 PMCID: PMC9462809 DOI: 10.1371/journal.pone.0274509] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a devastating impact on the world over the past two years (2020-2021). One of the key questions about its future trajectory is the protection from subsequent infections and disease conferred by a previous infection, as the SARS-CoV-2 virus belongs to the coronaviruses, a group of viruses the members of which are known for their ability to reinfect convalescent individuals. Bulgaria, with high rates of previous infections combined with low vaccination rates and an elderly population, presents a somewhat unique context to study this question. METHODS We use detailed governmental data on registered COVID-19 cases to evaluate the incidence and outcomes of COVID-19 reinfections in Bulgaria in the period between March 2020 and early December 2021. RESULTS For the period analyzed, a total of 4,106 cases of individuals infected more than once were observed, including 31 cases of three infections and one of four infections. The number of reinfections increased dramatically during the Delta variant-driven wave of the pandemic towards the end of 2021. We observe a moderate reduction of severe outcomes (hospitalization and death) in reinfections relative to primary infections, and a more substantial reduction of severe outcomes in breakthrough infections in vaccinated individuals. CONCLUSIONS In the available datasets from Bulgaria, prior infection appears to provide some protection from severe outcomes, but to a lower degree than the reduction in severity of breakthrough infections in the vaccinated compared to primary infections in the unvaccinated.
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Affiliation(s)
- Georgi K. Marinov
- Department of Genetics, Stanford University, Stanford, CA, United States of America
| | | | - Antoni Rangachev
- Institute of Mathematics and Informatics, Bulgarian Academy of Sciences, Sofia, Bulgaria
- International Center for Mathematical Sciences-Sofia, Sofia, Bulgaria
| | - Ivailo Alexiev
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
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Hasan DA, Maulud SQ, Jalal PJ, Priyanka, Choudhary OP. SARS-CoV-2 vaccine breakthrough reinfection in a health-care worker of Iraq: a case report. Hum Vaccin Immunother 2022; 18:2055947. [PMID: 35417318 PMCID: PMC9248933 DOI: 10.1080/21645515.2022.2055947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The COVID-19 pandemic has severely affected the entire globe since the first isolation of SARS-CoV-2 from patients with severe respiratory illness in Wuhan, China. Although the global vaccination drive is in full swing, many cases of reinfection have also been reported after vaccination. Currently, there is a scarcity of data available on the reinfection and vaccine breakthrough infections in Iraq. In this letter, we have presented a case report on the SARS-CoV-2 vaccine breakthrough reinfection in a health-care worker after completion of the double-dose vaccination. An increased symptom severity was reported on the second infection, which was confirmed to be of Delta variant. Such vaccine breakthrough infection reports have raised important questions regarding the duration of vaccine-mediated immunity and vaccine effectiveness against all circulating variants. These have further emphasized the importance of following non-pharmaceutical interventions by fully vaccinated individuals, especially at health-care settings.
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Affiliation(s)
| | - Sazan Qadir Maulud
- Department of Biology, College of Education, Salahaddin University-Erbil, Erbil, Kurdistan Region of Iraq
| | - Paywast Jamal Jalal
- Department of Biology, College of Science, University of Sulaimani, Sulymani, Kurdistan Region of Iraq
| | - Priyanka
- Department of Veterinary Microbiology, Mahatma Jyotiba Fule College of Veterinary and Animal Sciences, Jaipur, India
| | - Om Prakash Choudhary
- Department of Veterinary Anatomy and Histology, College of Veterinary Sciences and Animal Husbandry, Central Agricultural University (I), Selesih, Aizawl, India
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Akpan GE, Bawo L, Amo-Addae M, Kennedy J, Wesseh CS, Whesseh F, Adewuyi P, Sanvee-Blebo L, Babalola J, Sesay HWW, Yeabah TO, Jackson D, Shannon F, Umeokonkwo CD, Nyenswah AW, Macauley J, Jallah W. COVID-19 reinfection in Liberia: Implication for improving disease surveillance. PLoS One 2022; 17:e0265768. [PMID: 35324956 PMCID: PMC8947140 DOI: 10.1371/journal.pone.0265768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
COVID-19 remains a serious disruption to human health, social, and economic existence. Reinfection with the virus intensifies fears and raises more questions among countries, with few documented reports. This study investigated cases of COVID-19 reinfection using patients’ laboratory test results between March 2020 and July 2021 in Liberia. Data obtained from Liberia’s Ministry of Health COVID-19 surveillance was analyzed in Excel 365 and ArcGIS Pro 2.8.2. Results showed that with a median interval of 200 days (Range: 99–415), 13 out of 5,459 cases were identified and characterized as reinfection in three counties during the country’s third wave of the outbreak. Eighty-six percent of the COVID-19 reinfection cases occurred in Montserrado County within high clusters, which accounted for over 80% of the randomly distributed cases in Liberia. More cases of reinfection occurred among international travelers within populations with high community transmissions. This study suggests the need for continued public education and surveillance to encourage longer-term COVID-19 preventive practices even after recovery.
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Affiliation(s)
- Godwin E. Akpan
- Division of Field Epidemiology Training Program, African Field Epidemiology Network, Monrovia, Liberia
- * E-mail:
| | - Luke Bawo
- Department of Planning, Research and Development, Ministry of Health, Monrovia, Liberia
| | - Maame Amo-Addae
- Division of Field Epidemiology Training Program, African Field Epidemiology Network, Monrovia, Liberia
| | - Jallah Kennedy
- Office of the Executive Director, Roads To Health (Roads to Rural and Vulnerable Population Health), Galloway, New Jersey, United States of America
| | - C. Sanford Wesseh
- Department of Planning, Research and Development, Ministry of Health, Monrovia, Liberia
| | - Faith Whesseh
- Division of Field Epidemiology Training Program, African Field Epidemiology Network, Monrovia, Liberia
| | - Peter Adewuyi
- Division of Field Epidemiology Training Program, African Field Epidemiology Network, Monrovia, Liberia
| | - Lily Sanvee-Blebo
- Division of Field Epidemiology Training Program, African Field Epidemiology Network, Monrovia, Liberia
| | - Joseph Babalola
- Division of Field Epidemiology Training Program, African Field Epidemiology Network, Monrovia, Liberia
| | - Himiede W. W. Sesay
- Division of Field Epidemiology Training Program, African Field Epidemiology Network, Monrovia, Liberia
| | - Trokon O. Yeabah
- Division of Infectious Disease and Epidemiology, National Public Health Institute of Liberia, Monrovia, Liberia
| | - Dikena Jackson
- Department of Planning, Research and Development, Ministry of Health, Monrovia, Liberia
| | - Fulton Shannon
- Department of Planning, Research and Development, Ministry of Health, Monrovia, Liberia
| | - Chukwuma David Umeokonkwo
- Division of Field Epidemiology Training Program, African Field Epidemiology Network, Monrovia, Liberia
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Abraham W. Nyenswah
- Division of Infectious Disease and Epidemiology, National Public Health Institute of Liberia, Monrovia, Liberia
| | - Jane Macauley
- Office of the Director General, National Public Health Institute of Liberia, Monrovia, Liberia
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Clinical and Epidemiological Characteristics of COVID-19 Patients with SARS-CoV-2 Re-Detected on PCR Test after Discharge from Isolation. Clin Pract 2021; 11:954-960. [PMID: 34940009 PMCID: PMC8699873 DOI: 10.3390/clinpract11040110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
There have been multiple reports of patients with coronavirus disease (COVID-19) testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after discharge; however, information on the characteristics of such cases is limited. In this case report, we aimed to identify clinical and epidemiological characteristics of patients who had a repeat positive polymerase chain reaction (PCR) test for SARS-CoV-2. We analyzed data of 22 COVID-19 patients who tested positive for SARS-CoV-2 on polymerase chain reaction (PCR) testing after two consecutive negative PCR results following discharge from hospitals. The interval between the two positive tests in the episodes of COVID-19 ranged from 4 to 117 days. More than one-third of the cases were healthcare workers (HCWs) and one-third of them had comorbidities. The main symptoms were cough and fever, and we noticed that males experienced more symptoms and signs of COVID-19 than females. Individuals with repeat SARS-CoV-2 positivity tend to experience milder illness during the second episode than the first episode. To confirm the reinfection of SARS-CoV-2, the results of other tests, such as viral culture and immunological assays of immunoglobulin G (IgG) and immunoglobulin M (IgM), need to be considered. Recovered COVID-19 patients should continue social distancing, using face masks, and practicing hand hygiene, especially HCWs who are more likely to be exposed to SARS-CoV-2.
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Lo Muzio L, Ambosino M, Lo Muzio E, Quadri MFA. SARS-CoV-2 Reinfection Is a New Challenge for the Effectiveness of Global Vaccination Campaign: A Systematic Review of Cases Reported in Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11001. [PMID: 34682746 PMCID: PMC8535385 DOI: 10.3390/ijerph182011001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/03/2021] [Accepted: 10/09/2021] [Indexed: 12/28/2022]
Abstract
Reinfection with SARS-CoV-2 seems to be a rare phenomenon. The objective of this study is to carry out a systematic search of literature on the SARS-CoV-2 reinfection in order to understand the success of the global vaccine campaigns. A systematic search was performed. Inclusion criteria included a positive RT-PCR test of more than 90 days after the initial test and the confirmed recovery or a positive RT-PCR test of more than 45 days after the initial test that is accompanied by compatible symptoms or epidemiological exposure, naturally after the confirmed recovery. Only 117 articles were included in the final review with 260 confirmed cases. The severity of the reinfection episode was more severe in 92/260 (35.3%) with death only in 14 cases. The observation that many reinfection cases were less severe than initial cases is interesting because it may suggest partial protection from disease. Another interesting line of data is the detection of different clades or lineages by genome sequencing between initial infection and reinfection in 52/260 cases (20%). The findings are useful and contribute towards the role of vaccination in response to the COVID-19 infections. Due to the reinfection cases with SARS-CoV-2, it is evident that the level of immunity is not 100% for all individuals. These data highlight how it is necessary to continue to observe all the prescriptions recently indicated in the literature in order to avoid new contagion for all people after healing from COVID-19 or becoming asymptomatic positive.
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Affiliation(s)
- Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, 70122 Foggia, Italy;
- Consorzio Interuniversitario Nazionale per la Bio-Oncologia (C.I.N.B.O.), 66100 Chieti, Italy
| | - Mariateresa Ambosino
- Department of Clinical and Experimental Medicine, University of Foggia, 70122 Foggia, Italy;
| | - Eleonora Lo Muzio
- Department of Translational Medicine and for Romagna, University of Ferrara, 44121 Ferrara, Italy;
| | - Mir Faeq Ali Quadri
- Department of Preventive Dental Sciences, Jazan University, Jazan 82511, Saudi Arabia;
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Fathizadeh H, Afshar S, Masoudi MR, Gholizadeh P, Asgharzadeh M, Ganbarov K, Köse Ş, Yousefi M, Kafil HS. SARS-CoV-2 (Covid-19) vaccines structure, mechanisms and effectiveness: A review. Int J Biol Macromol 2021; 188:740-750. [PMID: 34403674 PMCID: PMC8364403 DOI: 10.1016/j.ijbiomac.2021.08.076] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022]
Abstract
The world has been suffering from COVID-19 disease for more than a year, and it still has a high mortality rate. In addition to the need to minimize transmission of the virus through non-pharmacological measures such as the use of masks and social distance, many efforts are being made to develop a variety of vaccines to prevent the disease worldwide. So far, several vaccines have reached the final stages of safety and efficacy in various phases of clinical trials, and some, such as Moderna/NIAID and BioNTech/Pfizer, have reported very high safety and protection. The important point is that comparing different vaccines is not easy because there is no set standard for measuring neutralization. In this study, we have reviewed the common platforms of COVID-19 vaccines and tried to present the latest reports on the effectiveness of these vaccines.
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Affiliation(s)
- Hadis Fathizadeh
- Department of laboratory sciences, Sirjan School of Medical Sciences, Sirjan, Iran
| | - Saman Afshar
- Department of Animal Biology, Faculty of Natural Science, University of Tabriz, Tabriz, Iran
| | - Mahmood Reza Masoudi
- Department of Internal Medicine, Sirjan School of Medical Sciences, Sirjan, Iran
| | - Pourya Gholizadeh
- Research Center for Pharmaceutical Nanotechnology, Tabriz University of Medical Sciences, Iran
| | | | | | - Şükran Köse
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Mehdi Yousefi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Iran.
| | - Hossein Samadi Kafil
- Drug Applied Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Iran.
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