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Stone ND, Parker Fiebelkorn A, Guo A, Mothershed E, Moccia L, Bell J, Yassanye D, Hall E, Duggar C, Srinivasan A, Meyer SA, Link-Gelles R. Challenges and opportunities during the COVID-19 vaccination efforts in long-term care. Vaccine 2024:S0264-410X(23)01510-4. [PMID: 38184394 DOI: 10.1016/j.vaccine.2023.12.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/03/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024]
Abstract
From December 2020 through March 2023, the COVID-19 vaccination efforts in long-term care (LTC) settings, identified many gaps and opportunities to improve public health capacity to support vaccine distribution, education, and documentation of COVID-19 vaccines administered to LTC residents and staff. Partner engagement at the local, state, and federal levels helped establish pathways for dissemination of information, improve access and delivery of vaccines, and expand reporting of vaccine administration data to monitor the impact of COVID-19 vaccination in LTC settings. Sustaining the improvements to the vaccine infrastructure in LTC settings that were created or enhanced during the COVID-19 vaccination efforts is critical for the protection of residents and staff against COVID-19 and other vaccine preventable respiratory outbreaks in the future.
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Affiliation(s)
- Nimalie D Stone
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Amy Parker Fiebelkorn
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Angela Guo
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Strategic Innovative Solutions, LLC, Clearwater, FL, USA
| | - Elizabeth Mothershed
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauren Moccia
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jeneita Bell
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diana Yassanye
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA; Parasol Health Consulting, Grand Rapids, MI, USA
| | - Elisha Hall
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chris Duggar
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Arjun Srinivasan
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah A Meyer
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ruth Link-Gelles
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Lv L, Wu XD, Yan HJ, Zhao SY, Zhang XD, Zhu KL. The disparity in hesitancy toward COVID-19 vaccination between older individuals in nursing homes and those in the community in Taizhou, China. BMC Geriatr 2023; 23:828. [PMID: 38066433 PMCID: PMC10709861 DOI: 10.1186/s12877-023-04518-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE Older individuals are priority coronavirus disease 2019 (COVID-19) vaccine recipients. Our aim was to investigate the prevalence of and factors influencing vaccine hesitancy in older individuals living in nursing homes and communities. METHODS A self-administered COVID-19 vaccine hesitancy survey was conducted from September 2021 to December 2021 among people aged ≥ 60 years in eight nursing homes (382 participants) and the community (112 participants) in Taizhou, China. The response rate was 72.1% (382/530) for older adults in nursing homes and 68.7% (112/163) for older adults in the community. RESULTS We found that 58.1% of the older individuals in nursing homes and 36.6% of those in the community were hesitant to receive the COVID-19 vaccine and that there was a statistically significant difference (P < 0.001). Multiple logistic regression results indicated that the main factors influencing hesitation among the older individuals in nursing homes were being male (Odds Ratio (OR) = 1.67, 95% Confidence Interval (CI): 1.01-2.76); their cognitive level, including having a high perceived risk of COVID-19 infection (OR = 3.06, 95% CI: 1.73-5.43) or the perception of low vaccine safety (OR = 3.08, 95% CI: 1.545- 6.145); anxiety (OR = 3.43, 95% CI: 1.96-5.99); and no previous influenza vaccination (OR = 1.82, 95% CI: 1.13-2.93); whereas those for older individuals in the community were comorbid chronic diseases (OR = 3.13, 95% CI: 1.11- 8.78) and community workers not recommending the vaccine (OR = 8.223, 95% CI: 1.77-38.27). CONCLUSION The proportion of older individuals in nursing homes who were hesitant to receive the COVID-19 vaccine was significantly higher than for older individuals in the community. Targeted measures should be implemented to reduce vaccine hesitancy and improve vaccination rates in response to the special environment of nursing homes and the characteristics of this population.
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Affiliation(s)
- Li Lv
- The Affiliated People's Hospital of Ningbo University, Ningbo, 315040, Zhejiang Province, China
| | - Xu-Dong Wu
- Hepatopancreatobiliary Surgery, People's Hospital Affiliated to Ningbo University, Ningbo University, 251 Baizhang East Road, Ningbo, 315040, Zhejiang Province, China
| | - Huan-Jun Yan
- Hepatopancreatobiliary Surgery, People's Hospital Affiliated to Ningbo University, Ningbo University, 251 Baizhang East Road, Ningbo, 315040, Zhejiang Province, China
| | - Shuang-Ying Zhao
- Hepatopancreatobiliary Surgery, People's Hospital Affiliated to Ningbo University, Ningbo University, 251 Baizhang East Road, Ningbo, 315040, Zhejiang Province, China
| | - Xiao-Dong Zhang
- Hepatopancreatobiliary Surgery, People's Hospital Affiliated to Ningbo University, Ningbo University, 251 Baizhang East Road, Ningbo, 315040, Zhejiang Province, China
| | - Ke-Lei Zhu
- Hepatopancreatobiliary Surgery, People's Hospital Affiliated to Ningbo University, Ningbo University, 251 Baizhang East Road, Ningbo, 315040, Zhejiang Province, China.
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Prusynski RA, Rundell SD, Pradhan S, Mroz TM. Some But Not Too Much: Multiparticipant Therapy and Positive Patient Outcomes in Skilled Nursing Facilities. J Geriatr Phys Ther 2023; 46:185-195. [PMID: 36103147 PMCID: PMC10008750 DOI: 10.1519/jpt.0000000000000363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Physical and occupational therapy practices in skilled nursing facilities (SNFs) were greatly impacted by the 2019 Medicare Patient-Driven Payment Model (PDPM). Under the PDPM, the practice of multiparticipant therapy-treating more than one patient per therapy provider per session-increased in SNFs, but it is unknown how substituting multiparticipant therapy for individualized therapy may impact patient outcomes. This cross-sectional study establishes baseline relationships between multiparticipant therapy and patient outcomes using pre-PDPM data. METHODS We used Minimum Data Set assessments from all short-term Medicare fee-for-service SNF stays in 2018. Using generalized mixed-effects logistic regression adjusted for therapy volume and patient factors, we examined associations between the proportion of minutes of physical and occupational therapy that were received as multiparticipant sessions during the SNF stay and 2 outcomes: community discharge and functional improvement. Multiparticipant therapy minutes as a proportion of total therapy time were categorized as none, low (below the median of 5%), medium (median to <25%), and high (≥25%) to reflect the 25% multiparticipant therapy limit required by the PDPM. RESULTS AND DISCUSSION We included 901 544 patients with complete data for functional improvement and 912 996 for the discharge outcome. Compared with patients receiving no multiparticipant therapy, adjusted models found small positive associations between low and medium multiparticipant therapy levels and outcomes. Patients receiving low levels of multiparticipant therapy had 14% higher odds of improving in function (95% CI 1.09-1.19) and 10% higher odds of community discharge (95% CI 1.05-1.15). Patients receiving medium levels of multiparticipant therapy had 18% higher odds of functional improvement (95% CI 1.13-1.24) and 44% higher odds of community discharge (95% CI 1.34-1.55). However, associations disappeared with high levels of multiparticipant therapy. CONCLUSIONS Prior to the PDPM, providing up to 25% multiparticipant therapy was an efficient strategy for SNFs that may have also benefitted patients. As positive associations disappeared with high levels (≥25%) of multiparticipant therapy, it may be best to continue delivering the majority of therapy in SNFs as individualized treatment.
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Affiliation(s)
- Rachel A Prusynski
- Department of Rehabilitation Medicine, University of Washington, Seattle
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Chambers D, Cantrell A, Preston L, Marincowitz C, Wright L, Conroy S, Lee Gordon A. Reducing unplanned hospital admissions from care homes: a systematic review. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-130. [PMID: 37916580 DOI: 10.3310/klpw6338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Background Care homes predominantly care for older people with complex health and care needs, who are at high risk of unplanned hospital admissions. While often necessary, such admissions can be distressing and provide an opportunity cost as well as a financial cost. Objectives Our objective was to update a 2014 evidence review of interventions to reduce unplanned admissions of care home residents. We carried out a systematic review of interventions used in the UK and other high-income countries by synthesising evidence of effects of these interventions on hospital admissions; feasibility and acceptability; costs and value for money; and factors affecting applicability of international evidence to UK settings. Data sources We searched the following databases in December 2021 for studies published since 2014: Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews; Cumulative Index to Nursing and Allied Health Literature; Health Management Information Consortium; Medline; PsycINFO; Science and Social Sciences Citation Indexes; Social Care Online; and Social Service Abstracts. 'Grey' literature (January 2022) and citations were searched and reference lists were checked. Methods We included studies of any design reporting interventions delivered in care homes (with or without nursing) or hospitals to reduce unplanned hospital admissions. A taxonomy of interventions was developed from an initial scoping search. Outcomes of interest included measures of effect on unplanned admissions among care home residents; barriers/facilitators to implementation in a UK setting and acceptability to care home residents, their families and staff. Study selection, data extraction and risk of bias assessment were performed by two independent reviewers. We used published frameworks to extract data on intervention characteristics, implementation barriers/facilitators and applicability of international evidence. We performed a narrative synthesis grouped by intervention type and setting. Overall strength of evidence for admission reduction was assessed using a framework based on study design, study numbers and direction of effect. Results We included 124 publications/reports (30 from the UK). Integrated care and quality improvement programmes providing additional support to care homes (e.g. the English Care Homes Vanguard initiatives and hospital-based services in Australia) appeared to reduce unplanned admissions relative to usual care. Simpler training and staff development initiatives showed mixed results, as did interventions aimed at tackling specific problems (e.g. medication review). Advance care planning was key to the success of most quality improvement programmes but do-not-hospitalise orders were problematic. Qualitative research identified tensions affecting decision-making involving paramedics, care home staff and residents/family carers. The best way to reduce end-of-life admissions through access to palliative care was unclear in the face of inconsistent and generally low-quality evidence. Conclusions Effective implementation of interventions at various stages of residents' care pathways may reduce unplanned admissions. Most interventions are complex and require adaptation to local contexts. Work at the interface between health and social care is key to successful implementation. Limitations Much of the evidence identified was of low quality because of factors such as uncontrolled study designs and small sample size. Meta-analysis was not possible. Future work We identified a need for improved economic evidence and the evaluation of integrated care models of the type delivered by hospital-based teams. Researchers should carefully consider what is realistic in terms of study design and data collection given the current context of extreme pressure on care homes. Study registration This study is registered as PROSPERO database CRD42021289418. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (award number NIHR133884) and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Louise Preston
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Carl Marincowitz
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Simon Conroy
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Adam Lee Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
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5
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Berry SD, Bakaev I, Chen H, Lipsitz LA. The balance of prescriptive and dynamic regulatory policies in nursing homes: Lessons learned from the COVID-19 pandemic. J Am Geriatr Soc 2023; 71:2672-2675. [PMID: 36959696 PMCID: PMC10517058 DOI: 10.1111/jgs.18339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 03/25/2023]
Abstract
See related Brief report by Festa et al. in this issue.
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Affiliation(s)
- Sarah D. Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Hebrew SeniorLife, Boston, MA
| | | | - Helen Chen
- San Francisco Veterans Affairs Hospital, University of California San Francisco, San Francisco, CA
| | - Lewis A. Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Hebrew SeniorLife, Boston, MA
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Urlings JHJ, Backhaus R, Verbeek H, de Boer B, Koopmans RTCM, Gerritsen DL, Hamers JPH. After COVID-19 vaccinations: what does living and working in nursing homes look like? BMC Geriatr 2023; 23:298. [PMID: 37193994 PMCID: PMC10186323 DOI: 10.1186/s12877-023-03987-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 04/21/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Nursing homes were disproportionally affected by the COVID-19 pandemic. Vaccination was considered critical for the normalization of daily live of nursing home residents. The present study investigates the impact of the prolonged COVID-19 pandemic and the effect of vaccinations on the daily lives of residents and staff in Dutch nursing homes. SETTING AND PARTICIPANTS The sample consisted of 78 nursing homes that participated in the Dutch national pilot on nursing home visits after the COVID-19 pandemic. One contact person per nursing home was approached for participation in this mixed-methods cross-sectional study. METHODS Data was collected twice through questionnaires in April and December 2021. Quantitative questions focused on recent COVID-19 outbreaks, progress of vaccination, effects of vaccination on daily living in the nursing home and burden experienced by staff. Open-ended questions addressed the prolonged effect of the pandemic on residents, family members and staff. RESULTS The overall vaccination rate of residents across nursing homes appeared to be high among both residents and staff. However, daily living in the nursing home had not returned to normal concerning personal interactions, visits, the use of facilities and work pressure. Nursing homes continued to report a negative impact of the pandemic on residents, family members and staff. CONCLUSIONS Restrictions to the daily lives of residents in nursing homes were stricter than restrictions imposed on society as a whole. Returning to a normal daily living and working was found to be complex for nursing homes. With the emergence of new variants of the virus, policies strongly focusing on risk aversion were predominantly present in nursing homes.
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Affiliation(s)
- Judith H J Urlings
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200, MD Maastricht, the Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
| | - Ramona Backhaus
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200, MD Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200, MD Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Bram de Boer
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200, MD Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
- De Waalboog "Joachim en Anna", Center for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jan P H Hamers
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Postbus 616, 6200, MD Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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Gali JH, Shah C, Keerthi BY, Thomas V. A study on clinicodemographic profile, severity, and outcome of Covid-19 in hospitalized vaccinated individuals at tertiary care centre. Lung India 2023; 40:215-221. [PMID: 37148018 PMCID: PMC10298815 DOI: 10.4103/lungindia.lungindia_28_22] [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: 01/12/2022] [Revised: 07/25/2022] [Accepted: 11/13/2022] [Indexed: 05/07/2023] Open
Abstract
Objective To evaluate the demographic profile, clinical severity, and outcome of Covid-19 infection in hospitalised vaccinated individuals. Methods An observational, cross-sectional study was conducted among Covid-19 infected hospitalised patients. Clinicodemographic profile, severity, and outcome of Covid-19 infection among the vaccinated group (VG) were recorded. These patients were also compared with unvaccinated group (UVG) with Covid-19 infection admitted during the study period. Cox proportional hazards models was used to estimate hazard ratios for mortality risk in both groups. Results Out of 580 participants, 48.2% were vaccinated with either one (71%) or two doses (28.9%). In both, VG and UVG, majority 55.8% belonged to 51-75 years. Males were predominant with 62.9% in both VG and UVGs. Day of illness at admission from symptom onset (DOI), progression of disease, ICU stay, oxygen requirement, mortality was significantly higher in UVG than in VG (p < 0.05). Steroid duration (p < 0.001) and anti-coagulation time (p < 0.001) were significantly higher in UVG than in VG. D dimer levels were significantly higher in UVG than in VG (p < 0.05). Increased age, (p < 0.0004), severity of disease, (p < 0.0052), increased oxygen requirement (p < 0.001), elevated C-reactive protein levels (Moderate: P < 0.0013; Severe P < 0.0082), and elevated IL-6 levels (p < 0.001) were the significant determinants of Covid-19-related mortality in both VG and UVGs. Conclusion Vaccinated individuals have shown milder severity, had reduced hospital stay and better outcomes as compared to unvaccinated individuals suggesting a potential vaccine efficacy against Covid-19.
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Affiliation(s)
- Jayasri Helen Gali
- Department of Pulmonary Medicine, Telangana Institute of Medical Sciences and Research, Gachibowli, Hyderabad, Telangana, India
| | - Chirali Shah
- Department of Pulmonary Medicine, Telangana Institute of Medical Sciences and Research, Gachibowli, Hyderabad, Telangana, India
| | - B. Y Keerthi
- Department of General Medicine, Telangana Institute of Medical Sciences and Research, Gachibowli, Hyderabad, Telangana, India
| | - Vimala Thomas
- Department of Preventive and Social Medicine, Director, Telangana Institute of Medical Sciences and Research, Gachibowli, Hyderabad, Telangana, India
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Sun Z, Chai L, Ma R. Long-Term Care Research in the Context of COVID-19 Pandemic: A Bibliometric Analysis. Healthcare (Basel) 2023; 11:healthcare11091248. [PMID: 37174790 PMCID: PMC10178488 DOI: 10.3390/healthcare11091248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Despite the increasing awareness of long-term care (LTC) research after the outbreak of COVID-19 pandemic, little attention was given to quantitatively describe the evolution of the research field during this period. A total of 1024 articles retrieved from the Web of Science Core Collection database were systematically analyzed using CiteSpace visualization software. The overall characteristics analysis showed that, in the context of the pandemic, attention to LTC research increased significantly-over 800 articles were published in the past two years. The USA, Canada, Italy, and England formed the leading LTC research group, which was consistent with the conclusions of existing bibliometric studies on LTC research before the outbreak. A rigorous analysis based on a dual perspective of references and keywords was applied to reveal that, compared with previous studies, in the context of the pandemic, the focus shifted from the mental and physical health status of older adults in need of LTC to the impact of the pandemic on those of older adults in LTC facilities, from the prevention of general epidemics to the prevention and response of significant public health emergencies, from providing and paying for LTC to strategies for LTC facilities to improve the quality of LTC and well-being of their residents during the pandemic. These findings can provide help and reference for academics, civil folks, and LTC practitioners, as well as help with the sustainable development of LTC research in the context of COVID-19 pandemic.
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Affiliation(s)
- Zhaohui Sun
- Department of Law and Political Science, North China Electric Power University, Baoding 071003, China
| | - Lulu Chai
- Department of Law and Political Science, North China Electric Power University, Baoding 071003, China
| | - Ran Ma
- Department of Law and Political Science, North China Electric Power University, Baoding 071003, China
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Bulgaresi M, Rivasi G, Tarantini F, Espinoza Tofalos S, Del Re LM, Salucci C, Turrin G, Barucci R, Bandinelli C, Fattorini L, Borchi D, Betti M, Checchi S, Baggiani L, Collini F, Lorini C, Bonaccorsi G, Ungar A, Mossello E, Benvenuti E. Impact of SARS-CoV2 infection on mortality and hospitalization in nursing home residents during the "Omicron era". Aging Clin Exp Res 2023; 35:1393-1399. [PMID: 37103663 PMCID: PMC10134704 DOI: 10.1007/s40520-023-02415-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/12/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Widespread vaccination and emergence of less aggressive SARS-CoV2 variants may have blunted the unfavourable outcomes of COVID-19 in nursing home (NH) residents. We analysed the course of COVID-19 epidemic in NHs of Florence, Italy, during the "Omicron era" and investigated the independent effect of SARS-CoV2 infection on death and hospitalization risk. METHODS Weekly SARS-CoV2 infection rates between November 2021 and March 2022 were calculated. Detailed clinical data were collected in a sample of NHs. RESULTS Among 2044 residents, 667 SARS-CoV2 cases were confirmed. SARS-CoV2 incidence sharply increased during the Omicron era. Mortality rates did not differ between SARS-CoV2-positive (6.9%) and SARS-CoV2-negative residents (7.3%, p = 0.71). Chronic obstructive pulmonary disease and poor functional status, but not SARS-CoV2 infection independently predicted death and hospitalization. CONCLUSIONS Despite that SARS-CoV2 incidence increased during the Omicron era, SARS-CoV2 infection was not a significant predictor of hospitalization and death in the NH setting.
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Affiliation(s)
- Matteo Bulgaresi
- Geriatric Unit, Local Health Unit "Toscana Centro", Santa Maria Annunziata Hospital, Florence, Italy
| | - Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy.
| | - Francesca Tarantini
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Sofia Espinoza Tofalos
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Lorenzo Maria Del Re
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Caterina Salucci
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Giada Turrin
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Riccardo Barucci
- Geriatric Unit, Local Health Unit "Toscana Centro", Santa Maria Annunziata Hospital, Florence, Italy
| | - Chiara Bandinelli
- Geriatric Unit, Local Health Unit "Toscana Centro", Santa Maria Annunziata Hospital, Florence, Italy
| | - Letizia Fattorini
- Department of Health Science, University of Florence, Florence, Italy
| | - Daniele Borchi
- Department of Health Science, University of Florence, Florence, Italy
| | - Marta Betti
- Department of Health Science, University of Florence, Florence, Italy
| | - Saverio Checchi
- Department of Health Science, University of Florence, Florence, Italy
| | - Lorenzo Baggiani
- Department of Community Healthcare Network, Health District "Toscana Centro", Florence, Italy
| | - Francesca Collini
- Quality and Equity Unit, Regional Health Agency of Tuscany, 50141, Florence, Italy
| | - Chiara Lorini
- Department of Health Science, University of Florence, Florence, Italy
| | | | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Enrico Mossello
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Enrico Benvenuti
- Geriatric Unit, Local Health Unit "Toscana Centro", Santa Maria Annunziata Hospital, Florence, Italy
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Abstract
BACKGROUND Despite widespread adoption of surveillance testing for coronavirus disease 2019 (Covid-19) among staff members in skilled nursing facilities, evidence is limited regarding its relationship with outcomes among facility residents. METHODS Using data obtained from 2020 to 2022, we performed a retrospective cohort study of testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among staff members in 13,424 skilled nursing facilities during three pandemic periods: before vaccine approval, before the B.1.1.529 (omicron) variant wave, and during the omicron wave. We assessed staff testing volumes during weeks without Covid-19 cases relative to other skilled nursing facilities in the same county, along with Covid-19 cases and deaths among residents during potential outbreaks (defined as the occurrence of a case after 2 weeks with no cases). We reported adjusted differences in outcomes between high-testing facilities (90th percentile of test volume) and low-testing facilities (10th percentile). The two primary outcomes were the weekly cumulative number of Covid-19 cases and related deaths among residents during potential outbreaks. RESULTS During the overall study period, 519.7 cases of Covid-19 per 100 potential outbreaks were reported among residents of high-testing facilities as compared with 591.2 cases among residents of low-testing facilities (adjusted difference, -71.5; 95% confidence interval [CI], -91.3 to -51.6). During the same period, 42.7 deaths per 100 potential outbreaks occurred in high-testing facilities as compared with 49.8 deaths in low-testing facilities (adjusted difference, -7.1; 95% CI, -11.0 to -3.2). Before vaccine availability, high- and low-testing facilities had 759.9 cases and 1060.2 cases, respectively, per 100 potential outbreaks (adjusted difference, -300.3; 95% CI, -377.1 to -223.5), along with 125.2 and 166.8 deaths (adjusted difference, -41.6; 95% CI, -57.8 to -25.5). Before the omicron wave, the numbers of cases and deaths were similar in high- and low-testing facilities; during the omicron wave, high-testing facilities had fewer cases among residents, but deaths were similar in the two groups. CONCLUSIONS Greater surveillance testing of staff members at skilled nursing facilities was associated with clinically meaningful reductions in Covid-19 cases and deaths among residents, particularly before vaccine availability.
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Affiliation(s)
- Brian E McGarry
- From the Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY (B.E.M.); the Anderson School of Management, University of California, Los Angeles, Los Angeles (A.D.G.); and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, and the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital - both in Boston (M.L.B.)
| | - Ashvin D Gandhi
- From the Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY (B.E.M.); the Anderson School of Management, University of California, Los Angeles, Los Angeles (A.D.G.); and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, and the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital - both in Boston (M.L.B.)
| | - Michael L Barnett
- From the Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, NY (B.E.M.); the Anderson School of Management, University of California, Los Angeles, Los Angeles (A.D.G.); and the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, and the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital - both in Boston (M.L.B.)
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11
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Montoya A, Wen K, Travers JL, Rivera-Hernandez M, White E, Mor V, Berry SD. Resident Factors Associated With Breakthrough SARS-CoV-2 Infections. J Am Med Dir Assoc 2023:S1525-8610(23)00225-6. [PMID: 36965506 PMCID: PMC9977610 DOI: 10.1016/j.jamda.2023.02.102] [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: 12/22/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE To examine incidence of and resident characteristics associated with breakthrough infections (BTIs) and severe illness among residents with 2 messenger RNA (mRNA) vaccinations. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Nursing home (NH) residents who completed their primary series of mRNA COVID-19 vaccination by March 31, 2021. METHODS Electronic health records and Minimum Data Set assessments from a multistate NH data consortium were used to identify BTI and severe illness (a composite measure of hospitalization and/or death within 30 days of BTI) occurring prior to November 24, 2021. A t test for differences in means was used to compare covariates for residents with and without BTI. Finally, we estimated incidence rate ratios (IRRs) for BTI with 95% CIs using a modified Poisson regression approach, comparing residents with BTI vs residents without. We adjusted for facility fixed effects in our model. RESULTS Our sample included 23,172 residents from 984 NHs who were at least 14 days past their second mRNA vaccine dose. Of those, 1173 (5%) developed an incident COVID-19 BTI (mean follow-up time: 250 days). Among residents with BTI, 8.6% were hospitalized or died within 30 days of BTI diagnosis. Factors associated with severe illness included age ≥85 years (IRR 2.08, 95% CI 1.08-4.02, reference age <65 years), bowel incontinence (IRR 1.73, 95% CI 1.01-2.99), coronary artery disease (IRR 1.96, 95% CI 1.31-2.94), chronic kidney disease (IRR 1.65, 95% CI 1.07-2.54), and schizophrenia (IRR 2.38, 95% CI 1.19-4.75). CONCLUSIONS AND IMPLICATIONS Among vaccinated NH residents, BTIs and associated severe illness are rare. Residents aged ≥85 years and with certain comorbidities appear to be the most vulnerable. Given that the pandemic continues and testing policies have relaxed, these data provide prognostic information for NH facilities faced with continued outbreaks.
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Affiliation(s)
- Ana Montoya
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Katherine Wen
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, USA
| | - Jasmine L Travers
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Maricruz Rivera-Hernandez
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Elizabeth White
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Vincent Mor
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Sarah D Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Department of Medicine & Harvard Medical Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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12
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Leung MHJ, Kung KH, Yau ISK, Fung YY, Mohammad KN, Lau CCA, Au KWA, Chuang SK. COVID-19 outbreaks in residential care homes in Hong Kong and effectiveness of vaccine against severe outcomes. INFECTIOUS MEDICINE 2023; 2:1-10. [PMID: 38013778 PMCID: PMC9839459 DOI: 10.1016/j.imj.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/03/2022] [Accepted: 01/09/2023] [Indexed: 11/26/2023]
Abstract
Background COVID-19 outbreaks in residential care homes for the elderly (RCHEs) and for persons with disability (RCHDs) have caused significant morbidity and mortality during 5th epidemic in Hong Kong. This article reviewed COVID-19 outbreaks situation and estimated the effectiveness of receiving at least two-dose of COVID-19 vaccine in preventing severe outcomes. Methods To estimate attack rates and vaccination coverage, documentation on COVID-19 infection and their vaccination records of residential care homes (RCH) residents reported between December 31, 2021 and May 31, 2022 were reviewed, and infected cases were follow-up for 4 weeks for severe outcomes or death. Correlation between vaccination coverage against attack rate by types of homes was examined. Infected RCH residents with available information were included in the analysis of vaccine effectiveness against severe outcomes and death. Results COVID-19 vaccination coverage was low in RCHDs (median 0.46, IQR: 0.24-0.76) and very low in RCHEs (median 0.08, IQR: 0.00-0.19). Higher attack rates were recorded among RCHE residents (median 0.84, IQR: 0.64-0.93) and higher case fatality rate (CFR: 28.1%) than in RCHDs (median 0.58, IQR: 0.31-0.84; CFR: 3.9%). The attack rate decreased when vaccination coverage increased for both RCHEs (ρ = -0.131, p < 0.001) and RCHDs (ρ = -0.333, p < 0.001). Comparing with infected residents who were unvaccinated/vaccinated with one-dose, receiving at least two-dose was estimated to be effective in reducing severe outcomes in 31% and 36% of infected RCHE and RCHD residents respectively; with greater reduction in mortality among RCHD than RCHE residents (54% and 38%, respectively). Vaccine effectiveness of two-dose of BNT162b2 against severe outcomes and death are higher than that of CoronaVac. Conclusions Increasing COVID-19 vaccination could have significant impact on reducing the risk of COVID-19 outbreaks in RCHs. At least two-dose of COVID-19 vaccine is still effective in reducing severe outcomes and death among infected residents in RCHs during Omicron epidemic.
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Affiliation(s)
| | - Kin Hang Kung
- Centre for Health Protection, Department of Health, Kowloon, Hong Kong, China
| | - Ian Siu-Kiu Yau
- Centre for Health Protection, Department of Health, Kowloon, Hong Kong, China
| | - Yan Yee Fung
- Centre for Health Protection, Department of Health, Kowloon, Hong Kong, China
| | | | | | - Ka Wing Albert Au
- Centre for Health Protection, Department of Health, Kowloon, Hong Kong, China
| | - Shuk Kwan Chuang
- Centre for Health Protection, Department of Health, Kowloon, Hong Kong, China
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13
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Vaccines for the Prevention of Coronavirus Disease 2019 in Older Adults. Infect Dis Clin North Am 2023; 37:27-45. [PMID: 36805013 PMCID: PMC9633624 DOI: 10.1016/j.idc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Institutionalized and community-dwelling older adults have been greatly impacted by the coronavirus disease 2019 (COVID-19) pandemic with increased morbidity and mortality. The advent of vaccines and their widespread use in this population has brought about a dramatic turnaround in COVID-19 outcomes. The immunogenicity and effectiveness of the various vaccine options worldwide are discussed. Optimization of vaccine usage will still be important to maximize protection due to reduced initial immunity, development of variant strains, and fading of immunity over time. There are also lessons learned specific to older populations for future pandemics of novel pathogens.
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14
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Mohammed I, Nauman A, Paul P, Ganesan S, Chen KH, Jalil SMS, Jaouni SH, Kawas H, Khan WA, Vattoth AL, Al-Hashimi YA, Fares A, Zeghlache R, Zakaria D. The efficacy and effectiveness of the COVID-19 vaccines in reducing infection, severity, hospitalization, and mortality: a systematic review. Hum Vaccin Immunother 2022; 18:2027160. [PMID: 35113777 PMCID: PMC8862168 DOI: 10.1080/21645515.2022.2027160] [Citation(s) in RCA: 143] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/14/2021] [Accepted: 01/02/2022] [Indexed: 02/08/2023] Open
Abstract
With the relatively rapid development of the COVID-19 pandemic, vaccine development has become crucial for limiting disease transmission. The accelerated growth in the approved COVID-19 vaccines has sparked concerns about their efficacies which have been assessed by many studies. This systematic review compares the efficacy and effectiveness of seven COVID-19 vaccines. A comprehensive systematic literature search was performed using several databases to identify studies reporting the effectiveness or the efficacy of the vaccines. Only 42 studies met our inclusion criteria, which revealed that the COVID-19 vaccines have successfully reduced the rates of infections, severity, hospitalization, and mortality among the different populations. The full-dose regimen of the Pfizer/BioNTech vaccine is the most effective against infections with the B.1.1.7 and B.1.351 variants. Despite of the high effectiveness of some of the COVID-19 vaccines, more efforts are required to test their effectiveness against the other newly emerging variants.
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Affiliation(s)
- Ibrahim Mohammed
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Areej Nauman
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Pradipta Paul
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Sanjith Ganesan
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Kuan-Han Chen
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Shahd H. Jaouni
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Hussam Kawas
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Wafa A. Khan
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | | | - Ahmed Fares
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Rached Zeghlache
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Dalia Zakaria
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
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15
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Mohseni Afshar Z, Barary M, Hosseinzadeh R, Alijanpour A, Hosseinzadeh D, Ebrahimpour S, Nazary K, Sio TT, Sullman MJM, Carson-Chahhoud K, Babazadeh A. Breakthrough SARS-CoV-2 infections after vaccination: a critical review. Hum Vaccin Immunother 2022; 18:2051412. [PMID: 35302905 PMCID: PMC9115792 DOI: 10.1080/21645515.2022.2051412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
At the beginning of the current pandemic, it was believed that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection would induce lifelong immunity and that reinfections would be unlikely. However, after several cases of reinfection were documented in previously infected patients, this was understood to be a false assumption, and this waning humoral immunity has raised significant concerns. Accordingly, long-term and durable vaccine-induced antibody protection against infection have also become a challenge, as several breakthroughs of COVID-19 infection have been identified in individuals who were fully vaccinated. This review discusses the current evidence on breakthrough COVID-19 infections occurring after vaccination.
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Affiliation(s)
- Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Barary
- Student Research Committee, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Rezvan Hosseinzadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | | | | | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Kosar Nazary
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Mark J M Sullman
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus.,Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | | | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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16
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Tobolowsky FA, Waltenburg MA, Moritz ED, Haile M, DaSilva JC, Schuh AJ, Thornburg NJ, Westbrook A, McKay SL, LaVoie SP, Folster JM, Harcourt JL, Tamin A, Stumpf MM, Mills L, Freeman B, Lester S, Beshearse E, Lecy KD, Brown LG, Fajardo G, Negley J, McDonald LC, Kutty PK, Brown AC. Longitudinal serologic and viral testing post-SARS-CoV-2 infection and post-receipt of mRNA COVID-19 vaccine in a nursing home cohort-Georgia, October 2020‒April 2021. PLoS One 2022; 17:e0275718. [PMID: 36301805 PMCID: PMC9612440 DOI: 10.1371/journal.pone.0275718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022] Open
Abstract
There are limited data describing SARS-CoV-2-specific immune responses and their durability following infection and vaccination in nursing home residents. We conducted a prospective longitudinal evaluation of 11 consenting SARS-CoV-2-positive nursing home residents to evaluate the quantitative titers and durability of binding antibodies detected after SARS-CoV-2 infection and subsequent COVID-19 vaccination. The evaluation included nine visits over 150 days from October 25, 2020, through April 1, 2021. Visits included questionnaire administration, blood collection for serology, and paired anterior nasal specimen collection for testing by BinaxNOW™ COVID-19 Ag Card (BinaxNOW), reverse transcription polymerase chain reaction (RT-PCR), and viral culture. We evaluated quantitative titers of binding SARS-CoV-2 antibodies post-infection and post-vaccination (beginning after the first dose of the primary series). The median age among participants was 74 years; one participant was immunocompromised. Of 10 participants with post-infection serology results, 9 (90%) had detectable Pan-Ig, IgG, and IgA antibodies, and 8 (80%) had detectable IgM antibodies. At first antibody detection post-infection, two-thirds (6/9, 67%) of participants were RT-PCR-positive, but none were culture- positive. Ten participants received vaccination; all had detectable Pan-Ig, IgG, and IgA antibodies through their final observation ≤90 days post-first dose. Post-vaccination geometric means of IgG titers were 10-200-fold higher than post-infection. Nursing home residents in this cohort mounted robust immune responses to SARS-CoV-2 post-infection and post-vaccination. The augmented antibody responses post-vaccination are potential indicators of enhanced protection that vaccination may confer on previously infected nursing home residents.
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Affiliation(s)
- Farrell A. Tobolowsky
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - Erin D. Moritz
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Melia Haile
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Juliana C. DaSilva
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Amy J. Schuh
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Natalie J. Thornburg
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adrianna Westbrook
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Susannah L. McKay
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Stephen P. LaVoie
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer M. Folster
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jennifer L. Harcourt
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Azaibi Tamin
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Megan M. Stumpf
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lisa Mills
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Brandi Freeman
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sandra Lester
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elizabeth Beshearse
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kristin D. Lecy
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Laura G. Brown
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Geroncio Fajardo
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Jeanne Negley
- Georgia Department of Public Health, Atlanta, Georgia, United States of America
| | - L. Clifford McDonald
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Preeta K. Kutty
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Allison C. Brown
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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17
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Crèvecoeur J, Hens N, Neyens T, Larivière Y, Verhasselt B, Masson H, Theeten H. Change in COVID19 outbreak pattern following vaccination in long-term care facilities in Flanders, Belgium. Vaccine 2022; 40:6218-6224. [PMID: 36127210 PMCID: PMC9472804 DOI: 10.1016/j.vaccine.2022.09.028] [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: 05/04/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022]
Abstract
Introduction Long term care facilities for elderly (LTCFs) in Europe encountered a high disease burden at the start of the COVID-19 pandemic. Therefore, these facilities were the first to receive COVID-19 vaccines in many European countries. A limited COVID-19 vaccine supply early 2021 resulted in a majority of residents and healthcare workers (HCWs) in LTCFs being vaccinated compared to a minority in the general population. This study exploits this imbalance to assess the efficiency of COVID-19 vaccination in containing outbreaks in LTCFs. Methods Exploratory statistics were performed using data from a COVID-19 surveillance system covering all 842 LTCFs in Flanders (the northern region of Belgium). The number and size of COVID-19 outbreaks in LTCFs were compared (1) before and after introducing vaccines and (2) with the status of the pandemic in the general population. Based on individual data from 15 LTCFs, the infection rate and symptoms of vaccinated and unvaccinated residents and HCWs were compared during a COVID-19 outbreak. Results 95.8% of the residents and 90.9% of the HCWs in Flemish LTCFs were vaccinated before May 30, 2021. Before vaccine introduction, residents in LTCFs were 10 times more likely to test positive for COVID-19 than the general population of Flanders. This ratio reversed after vaccination. Furthermore, after vaccination fewer and shorter outbreaks were observed involving fewer residents. During these outbreaks, vaccinated and unvaccinated residents were equally likely to test positive, but positive vaccinated residents were less likely to develop severe symptoms. In contrast, unvaccinated HCWs were more likely to test positive. Conclusion In the first half of 2021, two-dose vaccination was highly efficient in preventing and containing outbreaks in LTCFs, reducing COVID-19 hospitalizations and deaths. The high likelihood of unvaccinated HCWs to be involved in COVID-19 outbreaks in vaccinated LTCFs emphasizes the importance of vaccinating HCWs.
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Affiliation(s)
- Jonas Crèvecoeur
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Data Science Institute, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium; Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, building D, box 7001, 3000 Leuven, Belgium.
| | - Niel Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Data Science Institute, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium; Vaccine and Infectious Disease Institute, VAXINFECTIO, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium.
| | - Thomas Neyens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Data Science Institute, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium; Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Faculty of Medicine, KU Leuven, Kapucijnenvoer 35, building D, box 7001, 3000 Leuven, Belgium.
| | - Ynke Larivière
- Vaccine and Infectious Disease Institute, VAXINFECTIO, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium.
| | - Bruno Verhasselt
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium.
| | - Hanna Masson
- Prevention Department, Agentschap Zorg en Gezondheid Vlaanderen, 1030 Brussels, Belgium.
| | - Heidi Theeten
- Vaccine and Infectious Disease Institute, VAXINFECTIO, Faculty of Medicine and Health Sciences, University of Antwerp, 2000 Antwerpen, Belgium; Prevention Department, Agentschap Zorg en Gezondheid Vlaanderen, 1030 Brussels, Belgium.
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18
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Adams C, Chamberlain A, Wang Y, Hazell M, Shah S, Holland DP, Khan F, Gandhi NR, Fridkin S, Zelner J, Lopman BA. The Role of Staff in Transmission of SARS-CoV-2 in Long-term Care Facilities. Epidemiology 2022; 33:669-677. [PMID: 35588282 PMCID: PMC9345519 DOI: 10.1097/ede.0000000000001510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND US long-term care facilities (LTCFs) have experienced a disproportionate burden of COVID-19 morbidity and mortality. METHODS We examined SARS-CoV-2 transmission among residents and staff in 60 LTCFs in Fulton County, Georgia, from March 2020 to September 2021. Using the Wallinga-Teunis method to estimate the time-varying reproduction number, R(t), and linear-mixed regression models, we examined associations between case characteristics and R(t). RESULTS Case counts, outbreak size and duration, and R(t) declined rapidly and remained low after vaccines were first distributed to LTCFs in December 2020, despite increases in community incidence in summer 2021. Staff cases were more infectious than resident cases (average individual reproduction number, R i = 0.6 [95% confidence intervals [CI] = 0.4, 0.7] and 0.1 [95% CI = 0.1, 0.2], respectively). Unvaccinated resident cases were more infectious than vaccinated resident cases (R i = 0.5 [95% CI = 0.4, 0.6] and 0.2 [95% CI = 0.0, 0.8], respectively), but estimates were imprecise. CONCLUSIONS COVID-19 vaccines slowed transmission and contributed to reduced caseload in LTCFs. However, due to data limitations, we were unable to determine whether breakthrough vaccinated cases were less infectious than unvaccinated cases. Staff cases were six times more infectious than resident cases, consistent with the hypothesis that staff were the primary drivers of SARS-CoV-2 transmission in LTCFs.
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Affiliation(s)
- Carly Adams
- From the Emory University Rollins School of Public Health, Atlanta, GA
| | | | - Yuke Wang
- From the Emory University Rollins School of Public Health, Atlanta, GA
| | | | - Sarita Shah
- From the Emory University Rollins School of Public Health, Atlanta, GA
- Fulton County Board of Health, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
| | - David P. Holland
- From the Emory University Rollins School of Public Health, Atlanta, GA
- Fulton County Board of Health, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
| | - Fazle Khan
- Fulton County Board of Health, Atlanta, GA
| | - Neel R. Gandhi
- From the Emory University Rollins School of Public Health, Atlanta, GA
- Fulton County Board of Health, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
| | - Scott Fridkin
- From the Emory University Rollins School of Public Health, Atlanta, GA
- Emory University School of Medicine, Atlanta, GA
| | - Jon Zelner
- University of Michigan School of Public Health, Ann Arbor, MI
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19
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Dyer AH, Fallon A, Noonan C, Dolphin H, O'Farrelly C, Bourke NM, O'Neill D, Kennelly SP. Managing the Impact of COVID-19 in Nursing Homes and Long-Term Care Facilities: An Update. J Am Med Dir Assoc 2022; 23:1590-1602. [PMID: 35922016 PMCID: PMC9250924 DOI: 10.1016/j.jamda.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
Older adults in nursing homes are at greatest risk of morbidity and mortality from SARS-CoV-2 infection. Nursing home residents constituted one-third to more than half of all deaths during the early waves of the COVID-19 pandemic. Following this, widespread adaptation of infection prevention and control measures and the supply and use of personal protective equipment resulted in a significant decrease in nursing home infections and deaths. For nursing homes, the most important determinant of experiencing a SARS-CoV-2 outbreak in the first instance appears to be community-transmission levels (particularly with variants of concern), although nursing home size and quality, for-profit status, and sociodemographic characteristics are also important. Use of visitation bans, imposed to reduce the impact of COVID-19 on residents, must be delicately balanced against their impact on resident, friend or family, and staff well-being. The successful rollout of primary vaccination has resulted in a sharp decrease in morbidity and mortality from SARS-CoV-2 in nursing homes. However, emerging evidence suggests that vaccine efficacy may wane over time, and the use of a third or additional vaccine "booster" doses in nursing home residents restores protection afforded by primary vaccination. Ongoing monitoring of vaccine efficacy in terms of infection, morbidity, and mortality is crucial in this vulnerable group in informing ongoing SARS-CoV-2 vaccine boosting strategies. Here, we detail the impact of SARS-CoV-2 on nursing home residents and discuss important considerations in the management of nursing home SARS-CoV-2 outbreaks. We additionally examine the use of testing strategies, nonpharmacologic outbreak control measures and vaccination strategies in this cohort. Finally, the impact of SARS-CoV-2 on the sector is reflected on as we emphasize the need for adoption of universal standards of medical care and integration with wider public health infrastructure in nursing homes in order to provide a safe and effective long-term care sector.
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Affiliation(s)
- Adam H Dyer
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Aoife Fallon
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Claire Noonan
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Helena Dolphin
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Cliona O'Farrelly
- Comparative Immunology, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nollaig M Bourke
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland; Inflammageing Research Group, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Desmond O'Neill
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sean P Kennelly
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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20
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Rhynold ES, Quan S, Orr PH, LaBine L, Singer A, St John PD. Protective effects of prior third dose mRNA vaccination in rural nursing home residents during SARS-CoV-2 outbreaks. J Am Geriatr Soc 2022; 70:3245-3249. [PMID: 35938635 PMCID: PMC9538034 DOI: 10.1111/jgs.17996] [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: 05/30/2022] [Accepted: 07/09/2022] [Indexed: 11/28/2022]
Abstract
Background In Canada, mortality due to SARS‐CoV‐2 disproportionately impacted residents of nursing homes (NH). In November 2021, NH residents in the Canadian province of Manitoba became eligible to receive three doses of mRNA vaccine but coverage with three doses has not been universal. The objective of this study was to compare the protection from infection conferred by one, two, and three doses of COVID‐19 mRNA vaccine compared to no vaccination among residents of nursing homes experiencing SARS‐CoV‐2 outbreaks. Methods Infection Prevention and Control reports from 8 rural nursing homes experiencing outbreaks of SARS‐CoV‐2 between January 6, 2022, and March 5, 2022, were analyzed. Attack rates and the number needed to vaccinate (NNV) were calculated. Results SARS‐CoV‐2 attack rate was 65% among NH residents not vaccinated, 58% among residents who received 1–2 doses of mRNA COVID‐19 vaccine, and 28% among residents who had received 3 vaccine doses. The NNV to prevent one nursing home resident from SARS‐CoV‐2 infection during an outbreak was 3 for a vaccination with 3 doses and 14 for 1–2 doses of COVID‐19 mRNA vaccine. The superiority of receiving the third dose was statistically significant compared to 1–2 doses (Chi‐Squared, p < 0.00001). Conclusions Nursing home residents who received three doses of COVID‐19 mRNA vaccine were at lower risk of SARS‐CoV‐2 infection compared to those who received 1–2 doses. Our analyses lend support to the protective effects of the third dose of mRNA vaccine for NH residents in the event of a SARS‐CoV‐2 outbreak.
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Affiliation(s)
- Elizabeth S Rhynold
- Prairie Mountain Health, University of Manitoba Section of Geriatric Medicine, Winnipeg, Manitoba, Canada
| | - Samuel Quan
- Section of Geriatric Medicine, Max Rady School of Medicine, and the Centre on Aging, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pamela H Orr
- Max Rady School of Medicine, Departments of Community Health Sciences and Internal Medicine, Section of Geriatric Medicine, and Faculty of Graduate Studies, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa LaBine
- Max Rady School of Medicine, Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alexander Singer
- Max Rady School of Medicine, Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Philip D St John
- Max Rady School of Medicine, Departments of Internal Medicine, Medical Microbiology and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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21
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Abstract
PURPOSE OF REVIEW Despite advances in infection prevention and control and breakthroughs in vaccination development, challenges remain for long-term care facilities (LTCFs) as they face a likely future of emerging infectious diseases. To ensure the safety of LTCF residents from the current and future pandemics, we identify lessons learned from the coronavirus disease 2019 (COVID-19) experience for improving future prevention and response efforts. RECENT FINDINGS In addition to high disease susceptibility among LTCF residents, LTCF vulnerabilities include a lack of pandemic preparedness, a lack of surge capacity in human, material and testing resources, and poorly designed buildings. External sources of vulnerability include staff working in multiple LTCFs and high COVID-19 rates in surrounding communities. Other challenges include poor cooperation between LTCFs and the other components of health systems, inadequately enforced regulations, and the sometimes contradictory interests for-profit LTCFs face between protecting their residents and turning a profit. SUMMARY These challenges can be addressed in the post-COVID-19 period through systemic reforms. Governments should establish comprehensive health networks that normalize mechanisms for prediction/preparedness and response/recovery from disruptive events including pandemics. In addition, governments should facilitate cooperation among public and private sector health systems and institutions while utilizing advanced digital communication technologies. These steps will greatly reduce the threat to LTCFs posed by emerging infectious diseases in future.
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22
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Peters MD. Addressing vaccine hesitancy and resistance for COVID-19 vaccines. Int J Nurs Stud 2022; 131:104241. [PMID: 35489108 PMCID: PMC8972969 DOI: 10.1016/j.ijnurstu.2022.104241] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 01/12/2023]
Abstract
The COVID-19 vaccine rollout has had various degrees of success in different countries. Achieving high levels of vaccine coverage is key to responding to and mitigating the impact of the pandemic on health and aged care systems and the community. In many countries, vaccine hesitancy, resistance, and refusal are emerging as significant barriers to immunisation uptake and the relaxation of policies that limit everyday life. Vaccine hesitancy/ resistance/ refusal is complex and multi-faceted. Individuals and groups have diverse and often multiple reasons for delaying or refusing vaccination. These reasons include: social determinants of health, convenience, ease of availability and access, health literacy understandability and clarity of information, judgements around risk versus benefit, notions of collective versus individual responsibility, trust or mistrust of authority or healthcare, and personal or group beliefs, customs, or ideologies. Published evidence suggests that targeting and adapting interventions to particular population groups, contexts, and specific reasons for vaccine hesitancy/ resistance may enhance the effectiveness of interventions. While evidence regarding the effectiveness of interventions to address vaccine hesitancy and improve uptake is limited and generally unable to underpin any specific strategy, multi-pronged interventions are promising. In many settings, mandating vaccination, particularly for those working in health or high risk/ transmission industries, has been implemented or debated by Governments, decision-makers, and health authorities. While mandatory vaccination is effective for seasonal influenza uptake amongst healthcare workers, this evidence may not be appropriately transferred to the context of COVID-19. Financial or other incentives for addressing vaccine hesitancy may have limited effectiveness with much evidence for benefit appearing to have been translated across from other public/preventive health issues such as smoking cessation. Multicomponent, dialogue-based (i.e., communication) interventions are effective in addressing vaccine hesitancy/resistance. Multicomponent interventions that encompasses the following might be effective: (i) targeting specific groups such as unvaccinated/under-vaccinated groups or healthcare workers, (ii) increasing vaccine knowledge and awareness, (iii) enhanced access and convenience of vaccination, (iv) mandating vaccination or implementing sanctions against non-vaccination, (v) engaging religious and community leaders, (vi) embedding new vaccine knowledge and evidence in routine health practices and procedures, and (vii) addressing mistrust and improving trust in healthcare providers and institutions via genuine engagement and dialogue. It is universally important that healthcare professionals and representative groups, as often highly trusted sources of health guidance, should be closely involved in policymaker and health authority decisions regarding the establishment and implementation of vaccine recommendations and interventions to address vaccine hesitancy.
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Affiliation(s)
- Micah D.J. Peters
- University of South Australia, Clinical and Health Sciences, Rosemary Bryant AO Research Centre, City East Campus
- Centenary Building P4-32 North Terrace, Adelaide, SA 5000, Australia,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide Nursing School, Adelaide, SA, Australia,The Centre for Evidence-based Practice South Australia (CEPSA): A Joanna Briggs Institute Centre of Excellence, Australia,Australian Nursing and Midwifery Federation (ANMF) Federal Office, Australia,Correspondence to: University of South Australia, Clinical and Health Sciences, Rosemary Bryant AO Research Centre, City East Campus
- Centenary Building P4-32 North Terrace, Adelaide, SA 5000, Australia
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23
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Effect of COVID-19 Vaccination Campaign in Belgian Nursing Homes on COVID-19 Cases, Hospital Admissions, and Deaths among Residents. Viruses 2022; 14:v14071359. [PMID: 35891341 PMCID: PMC9318501 DOI: 10.3390/v14071359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/12/2022] [Accepted: 06/18/2022] [Indexed: 11/17/2022] Open
Abstract
In view of the grave situation during the first two waves of SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus-2), nursing homes (NHs) were prioritised for vaccination once vaccines became available in Belgium. The aim of this study was to assess the effect of the COVID-19 (Coronavirus Disease 2019) vaccination campaign on COVID-19 cases, hospital admissions, and deaths among residents living in Belgian NHs. All 1545 Belgian NHs were invited to participate in a COVID-19 surveillance program. In Belgium, before vaccination, COVID-19 morbidity and mortality rates were driven by the situation in the NHs. Shortly after the COVID-19 vaccination campaign, and later the booster campaign, the number of hospital admissions and deaths among NH residents dropped, while clear peaks could be observed among the general population. The impact of vaccination on virus circulation was less effective than expected. However, due to the high vaccination coverage, NH residents remain well protected against hospital admission and death due to COVID-19 more than one year after being vaccinated.
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24
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Wasserman M, Konetzka RT. Beyond Compliance: A More Integrated Public Health Approach To Outbreaks In Nursing Homes And Other Disasters. Health Aff (Millwood) 2022; 41:831-837. [PMID: 35666972 DOI: 10.1377/hlthaff.2021.01839] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Nursing home residents are vulnerable to disproportionate harm during disasters and health emergencies, as evidenced by the recent impact of COVID-19 and extreme weather events. Evaluation of these disasters shows that the nursing homes in question were often in compliance with relevant regulations around emergency planning. However, advance planning for disasters cannot anticipate every contingency, leading to the need for flexibility and quick adaptation on the part of nursing home leaders. In addition, disasters often involve larger, regional problems and situations that individual providers cannot solve. We suggest that policy makers need to prioritize development and expectations around leadership skills in nursing home management and better integrate the long-term care sector into local, state, and federal public health planning for future pandemics and other disasters.
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25
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Canaday DH, Oyebanji OA, White E, Keresztesy D, Payne M, Wilk D, Carias L, Aung H, St Denis K, Sheehan ML, Berry SD, Cameron CM, Cameron MJ, Wilson BM, Balazs AB, King CL, Gravenstein S. COVID-19 vaccine booster dose needed to achieve Omicron-specific neutralisation in nursing home residents. EBioMedicine 2022; 80:104066. [PMID: 35605428 PMCID: PMC9122310 DOI: 10.1016/j.ebiom.2022.104066] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nursing home (NH) residents have borne a disproportionate share of SARS-CoV-2 morbidity and mortality. Vaccines have limited hospitalisation and death from earlier variants in this vulnerable population. With the rise of Omicron and future variants, it is vital to sustain and broaden vaccine-induced protection. We examined the effect of boosting with BNT162b2 mRNA vaccine on humoral immunity and Omicron-specific neutralising activity among NH residents and healthcare workers (HCWs). METHODS We longitudinally enrolled 85 NH residents (median age 77) and 48 HCWs (median age 51), and sampled them after the initial vaccination series; and just before and 2 weeks after booster vaccination. Anti-spike, anti-receptor binding domain (RBD) and neutralisation titres to the original Wuhan strain and neutralisation to the Omicron strain were obtained. FINDINGS Booster vaccination significantly increased vaccine-specific anti-spike, anti-RBD, and neutralisation levels above the pre-booster levels in NH residents and HCWs, both in those with and without prior SARS-CoV-2 infection. Omicron-specific neutralisation activity was low after the initial 2 dose series with only 28% of NH residents' and 28% HCWs' titres above the assay's lower limit of detection. Omicron neutralising activity following the booster lifted 86% of NH residents and 93% of HCWs to the detectable range. INTERPRETATION With boosting, the vast majority of HCWs and NH residents developed detectable Omicron-specific neutralising activity. These data provide immunologic evidence that strongly supports booster vaccination to broaden neutralising activity and counter waning immunity in the hope it will better protect this vulnerable, high-risk population against the Omicron variant. FUNDING NIH AI129709-03S1, U01 CA260539-01, CDC 200-2016-91773, and VA BX005507-01.
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Affiliation(s)
- David H Canaday
- Case Western Reserve University School of Medicine, Cleveland, OH; Geriatric Research, Education and Clinical Center, Cleveland VA.
| | | | - Elizabeth White
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI
| | | | - Michael Payne
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Dennis Wilk
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Lenore Carias
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Htin Aung
- Case Western Reserve University School of Medicine, Cleveland, OH
| | | | | | - Sarah D Berry
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Cheryl M Cameron
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Mark J Cameron
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Brigid M Wilson
- Geriatric Research, Education and Clinical Center, Cleveland VA
| | | | | | - Stefan Gravenstein
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI; Center on Innovation in Long-Term Services and Supports, Providence Veterans Administration Medical Center, Providence, RI; Division of Geriatrics and Palliative Medicine, Alpert Medical School of Brown University, Providence, RI
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26
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Rivasi G, Bulgaresi M, Bandinelli C, Balzi D, Tarantini F, Tognelli S, Lorini C, Buscemi P, Baggiani L, Landini G, Ungar A, Bonaccorsi G, Mossello E, Benvenuti E. Long‐term effects of
SARS‐CoV
‐2 vaccination in the nursing home setting. J Am Geriatr Soc 2022; 70:1336-1341. [PMID: 35347706 PMCID: PMC9115053 DOI: 10.1111/jgs.17773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/02/2022] [Accepted: 03/12/2022] [Indexed: 12/01/2022]
Abstract
Background SARS‐CoV‐2 vaccination has significantly reduced infection, hospitalization, and lethality rates among nursing home (NH) residents, but durability of vaccine effects remains unknown. This study investigated the long‐term impact of BNT162b2 SARS‐CoV‐2 vaccine on breakthrough infection rates in the NHs of Florence, Italy. Methods Participants included residents living in Florence NHs as of April 1st, 2021, who had completed the primary SARS‐CoV2 vaccination course by February 15th, 2021. Weekly rates of breakthrough infection were calculated between April 1st and October 31st 2021, with 7‐day incidence defined as the number of new confirmed SARS‐CoV‐2‐positive residents over the vaccinated resident census. Hospital admissions and deaths were recorded from local administrative and clinical sources. Patients admitted to NHs after April 1st were excluded to avoid confounding effect of different vaccination timing. Results Among 2271 vaccinated residents (mean age 86.6, 74% female), we recorded 105 cases of breakthrough infections. Rates of breakthrough infection remained very low in the 6 months after vaccination, but started to rise over the following months, peaking at 0.94%, and then became stable around 0.2%–0.3%. Over the study period, infection rates remained low as compared to the incidence of SARS‐CoV‐2 infection during pre‐vaccination period. Overall hospitalization and lethality rates were 8%. Conclusions Among vaccinated NH residents, rates of breakthrough SARS‐CoV‐2 infection, hospitalization and lethality remained low up to 9 months following primary vaccination course. A mild resurgence of SARS‐CoV‐2 infection, after 6 months from vaccination, suggests a decline of vaccine effectiveness in preventing transmission.
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Affiliation(s)
- Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine Careggi Hospital and University of Florence Florence Italy
| | - Matteo Bulgaresi
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence Italy
| | - Chiara Bandinelli
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence Italy
| | - Daniela Balzi
- Epidemiology Unit, Health District "Toscana Centro", Florence Italy
| | - Francesca Tarantini
- Division of Geriatric and Intensive Care Medicine Careggi Hospital and University of Florence Florence Italy
| | - Silvia Tognelli
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence Italy
| | - Chiara Lorini
- Department of Health Science University of Florence Florence Italy
| | - Primo Buscemi
- Department of Health Science University of Florence Florence Italy
| | - Lorenzo Baggiani
- Department of Community Healthcare Network Health District "Toscana Centro" Florence Italy
| | - Giancarlo Landini
- Department of Internal Medicine Santa Maria Nuova Hospital, Health District "Toscana Centro," Florence Italy
| | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine Careggi Hospital and University of Florence Florence Italy
| | | | - Enrico Mossello
- Division of Geriatric and Intensive Care Medicine Careggi Hospital and University of Florence Florence Italy
| | - Enrico Benvenuti
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit "Toscana Centro", Florence Italy
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27
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COVID-19 pandemic and mortality in nursing homes across USA and Europe up to October 2021. Eur Geriatr Med 2022; 13:705-709. [PMID: 35299261 PMCID: PMC8929245 DOI: 10.1007/s41999-022-00637-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/08/2022] [Indexed: 11/10/2022]
Abstract
Purpose We compared the prevalence of COVID-19 and related mortality in nursing homes (NHs) in 14 countries until October 2021. We explored the relationship between COVID-19 mortality in NHs with the average size of NHs and with the COVID-19 deaths at a population level. Methods The total number of COVID-19 cases and COVID-19-related deaths in all NHs as well as the total number of NHs and NH beds were provided by representatives of 14 countries. The population level respective figures in each country were provided up to October 2021. Results There was a wide variation in prevalence of COVID-19 cases and deaths between countries. We observed a significant correlation between COVID-19 deaths in NHs and that of the total population and between the mean size of NHs and COVID-19 deaths. Conclusion Side-by-side comparisons between countries allow international sharing of good practice to better enable future pandemic preparedness.
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28
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Paul E, Fancourt D. Predictors of uncertainty and unwillingness to receive the COVID-19 booster vaccine: An observational study of 22,139 fully vaccinated adults in the UK. THE LANCET REGIONAL HEALTH. EUROPE 2022; 14:100317. [PMID: 35132400 PMCID: PMC8811487 DOI: 10.1016/j.lanepe.2022.100317] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The continued success of the COVID-19 vaccination programme in the UK will depend on widespread uptake of booster vaccines. However, there is evidence of hesitancy and unwillingness to receive the booster vaccine, even in fully vaccinated adults. Identifying factors associated with COVID-19 booster vaccine intentions specifically in this population is therefore critical. METHODS We used data from 22,139 fully vaccinated adults who took part in the UCL COVID-19 Social Study. Multinomial logistic regression examined predictors of uncertainty and unwillingness (versus willingness) to receive a COVID-19 booster vaccine (measured 22 November 2021 to 6 December 2021), including (i) socio-demographic factors, (ii) COVID-19 related factors (e.g., having been infected with COVID-19), and (iii) initial intent to receive a COVID-19 vaccine in the four months following the announcement in the UK that the vaccines had been approved (2 December 2020 to 31 March 2021). FINDINGS 4% of the sample reported that they were uncertain about receiving a COVID-19 booster vaccine, and a further 4% unwilling. Initial uncertainty and unwillingness to accept the first COVID-19 vaccine in 2020-21 were each associated with over five times the risk of being uncertain about and unwilling to accept a booster vaccine. Healthy adults (those without a pre-existing physical health condition) were also more likely to be uncertain or unwilling to receive a booster vaccine. In addition, low levels of current stress about catching or becoming seriously ill from COVID-19, consistently low compliance with COVID-19 government guidelines during periods of strict restrictions (e.g., lockdowns), lower levels of educational qualification, lower socio-economic position, and age below 45 years were all associated with uncertainty and unwillingness. INTERPRETATION Our findings highlight that there are a range of factors that predict booster intentions, with the strongest predictor being previous uncertainty and unwillingness. Two other concerning patterns also emerged from our results. First, administration of booster vaccinations may increase social inequalities in experiences of COVID-19 as adults from lower socio-economic backgrounds are also most likely to be uncertain or unwilling to accept a booster vaccine as well as most likely to be seriously affected by the virus. Second, some of those most likely to spread COVID-19 (i.e., those with poor compliance with guidelines) are most likely to be uncertain and unwilling. Public health messaging should be tailored specifically to these groups. FUNDING The Nuffield Foundation [WEL/FR-000022583], the MARCH Mental Health Network funded by the Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and Innovation [ES/S002588/1], and the Wellcome Trust [221400/Z/20/Z and 205407/Z/16/Z].
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Affiliation(s)
- Elise Paul
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom
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29
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Abstract
Purpose of Review This review discusses the complex relationship between COVID-19 and dementia and how the pandemic has affected the management of patients with dementia. This population resulted particularly susceptible to SARS-CoV-2 infection and its effects and also to the negative effects of the measures taken worldwide to control the spread of the virus. Recent Findings Patients with dementia were at increased risk for COVID-19 compared to patients without dementia, and diagnosis of dementia represents an independent risk factor for hospitalization in COVID-19 patients. Mortality due to SARS-CoV2 infection in subjects with dementia is 2–5 times higher than in the general population. Cognitive impairment and delirium have been described in COVID-19 survivors. SARS-COV2 pandemic exacerbates the vulnerability of dementia patients and their caregivers, due to the morbidity and mortality from COVID-19, the indirect effects of the pandemic on the social supports, and the effects on healthcare system on which they depend. Summary The COVID-19 pandemic requires people with dementia to move from traditional models of health care to innovative models for home care, to support caregivers’ burden, and to improve long term care.
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30
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Soldevila L, Prat N, Mas MÀ, Massot M, Miralles R, Bonet-Simó JM, Isnard M, Expósito-Izquierdo M, Garcia-Sanchez I, Rodoreda-Noguerola S, Moreno N, Badia E, López G, Sevilla J, Estrada O, Vallès X. The interplay between infection risk factors of SARS-CoV-2 and mortality: a cross-sectional study from a cohort of long-term care nursing home residents. BMC Geriatr 2022; 22:123. [PMID: 35164680 PMCID: PMC8842505 DOI: 10.1186/s12877-022-02779-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/13/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Covid-19 pandemic has particularly affected older people living in Long-term Care settings in terms of infection and mortality. METHODS We carried out a cross-sectional analysis within a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at least one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered. The outcomes of interest were infection (PCR positive) and death. RESULTS A total of 8021 residents were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = .03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < 0.001) whereas clinical factors were low level of functional dependence (aOR 2.42, P < .001), Complex Chronic Condition (aOR 1.29, P < .001) and dementia (aOR 1.33, P <0.001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001). CONCLUSIONS Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.
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Affiliation(s)
- Laura Soldevila
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Infectious Diseases Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain
| | - Núria Prat
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Miquel À Mas
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Mireia Massot
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Ramón Miralles
- Direcció Clínica Territorial de Cronicitat Metropolitana Nord, Institut Català de la Salut, Badalona, Spain
- Department of Geriatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Josep M Bonet-Simó
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Mar Isnard
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | | | - Irene Garcia-Sanchez
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Sara Rodoreda-Noguerola
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Nemesio Moreno
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Esther Badia
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Genís López
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Javier Sevilla
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Oriol Estrada
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Sabadell, Spain
| | - Xavier Vallès
- International Health Program, Regió Sanitària Metropolitana Nord, Institut Català de la Salut, Badalona, Spain.
- Fight AIDS and Infectious Diseases Foundation, Badalona, Spain.
- Institut per la Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.
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Watkins LKF, Mitruka K, Dorough L, Bressler SS, Kugeler KJ, Sadigh KS, Birhane MG, Nolen LD, Fischer M. Characteristics of Reported Deaths Among Fully Vaccinated Persons with COVID-19 -United States, January-April 2021. Clin Infect Dis 2022; 75:e645-e652. [PMID: 35092677 PMCID: PMC8807315 DOI: 10.1093/cid/ciac066] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Indexed: 12/19/2022] Open
Abstract
Background COVID-19 vaccines are highly efficacious, but SARS-CoV-2 infections post-vaccination occur. We characterized COVID-19 cases among fully vaccinated persons with an outcome of death. Methods We analyzed COVID-19 cases voluntarily reported to CDC by US health departments during January 1, 2021–April 30, 2021. We included cases among U.S. residents with a positive SARS-CoV-2 test ≥14 days after completion of an authorized primary vaccine series and who had a known outcome (alive or death) as of May 31, 2021. When available, specimens were sequenced for viral lineage and death certificates were reviewed for cause(s) of death. Results Of 8,084 reported COVID-19 cases among fully vaccinated persons during the surveillance period, 245 (3.0%) died. Compared with patients who remained alive, those who died were older (median age 82 years vs. 57 years, P <0.01), more likely to reside in a long-term care facility (51% vs. 18%, P <0.01), and more likely to have at least one underlying health condition associated with risk for severe disease (64% vs. 24%, P <0.01). Among 245 deaths, 191 (78%) were classified as COVID-19-related. Of 106 deaths with available death certificates, COVID-19 was listed on 81 (77%). There were no differences in the type of vaccine administered or the most common viral lineage (B.1.1.7). Conclusions COVID-19 deaths are rare in fully vaccinated persons, occurring most commonly in those with risk factors for severe disease, including older age and underlying health conditions. All eligible persons should be fully vaccinated against COVID-19 and follow other prevention measures to mitigate exposure risk.
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Affiliation(s)
| | - Kiren Mitruka
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Layne Dorough
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA; ORISE fellow, Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Sara S Bressler
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kiersten J Kugeler
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Katrin S Sadigh
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA.,COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA; ORISE fellow, Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Meseret G Birhane
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Leisha D Nolen
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Marc Fischer
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA
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Association between vaccination and preventive routines on COVID-19-related mortality in nursing home facilities: a population-based systematic retrospective chart review. Prim Health Care Res Dev 2022; 23:e75. [DOI: 10.1017/s1463423622000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Background:
Older and frail individuals are at high risk of dying from COVID-19, and residents in nursing homes (NHs) are overrepresented in death rates. We explored four different periods during the COVID-19 pandemic to analyze the effects of improved preventive routines and vaccinations, respectively, on mortality in NHs.
Methods:
We undertook a population-based systematic retrospective chart review comprising 136 NH facilities in southeast Sweden. All residents, among these facilities, who died within 30 days after a laboratory-verified COVID-19 diagnosis during four separate 92-day periods representing early pandemic (second quarter 2020), middle of the pandemic (fourth quarter 2020), early post-vaccination phase (first quarter 2021), and the following post-vaccination phase (second quarter 2021). Mortality together with electronic chart data on demographic variables, comorbidity, frailty, and cause of death was collected.
Results:
The number of deaths during the four periods was 104, 120, 34 and 4, respectively, with a significant reduction in the two post-vaccination periods (P < 0.001). COVID-19 was assessed as the dominant cause of death in 20 (19%), 19 (16%), 4 (12%) and 1 (3%) residents in each period (P < 0.01). The respective median age in the four studied periods varied between 87and 89 years, and three or more diagnoses besides COVID-19 were present in 70–90% of the respective periods’ study population. Considerable or severe frailty was found in all residents.
Conclusions:
Vaccination against COVID-19 seems associated with a reduced number of deaths in NHs. We could not demonstrate an effect on mortality merely from the protective routines that were undertaken.
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Canaday DH, Carias L, Oyebanji OA, Keresztesy D, Wilk D, Payne M, Aung H, St. Denis K, Lam EC, Rowley CF, Berry SD, Cameron CM, Cameron MJ, Wilson B, Balazs AB, Gravenstein S, King CL. Reduced BNT162b2 Messenger RNA Vaccine Response in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)-Naive Nursing Home Residents. Clin Infect Dis 2021; 73:2112-2115. [PMID: 33993265 PMCID: PMC8240817 DOI: 10.1093/cid/ciab447] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Indexed: 11/14/2022] Open
Abstract
After BNT162b2 messenger RNA vaccination, antibody levels to spike, receptor-binding domain, and virus neutralization were examined in 149 nursing home residents and 110 healthcare worker controls. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-naive nursing home residents' median post-second vaccine dose antibody neutralization titers are one-quarter that of SARS-CoV-2-naive healthcare workers.
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Affiliation(s)
- David H Canaday
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Geriatric Research, Education and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Lenore Carias
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Oladayo A Oyebanji
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Debbie Keresztesy
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Dennis Wilk
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Michael Payne
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Htin Aung
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Kerri St. Denis
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, USA
| | - Evan C Lam
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, USA
| | - Christopher F Rowley
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sarah D Berry
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Cheryl M Cameron
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Mark J Cameron
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Brigid Wilson
- Geriatric Research, Education and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Alejandro B Balazs
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, USA
| | - Stefan Gravenstein
- Division of Geriatrics and Palliative Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Center on Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
| | - Christopher L King
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio, USA
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Does infection with or vaccination against SARS-CoV-2 lead to lasting immunity? THE LANCET. RESPIRATORY MEDICINE 2021; 9:1450-1466. [PMID: 34688434 PMCID: PMC8530467 DOI: 10.1016/s2213-2600(21)00407-0] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/26/2021] [Accepted: 08/21/2021] [Indexed: 12/17/2022]
Abstract
Many nations are pursuing the rollout of SARS-CoV-2 vaccines as an exit strategy from unprecedented COVID-19-related restrictions. However, the success of this strategy relies critically on the duration of protective immunity resulting from both natural infection and vaccination. SARS-CoV-2 infection elicits an adaptive immune response against a large breadth of viral epitopes, although the duration of the response varies with age and disease severity. Current evidence from case studies and large observational studies suggests that, consistent with research on other common respiratory viruses, a protective immunological response lasts for approximately 5-12 months from primary infection, with reinfection being more likely given an insufficiently robust primary humoral response. Markers of humoral and cell-mediated immune memory can persist over many months, and might help to mitigate against severe disease upon reinfection. Emerging data, including evidence of breakthrough infections, suggest that vaccine effectiveness might be reduced significantly against emerging variants of concern, and hence secondary vaccines will need to be developed to maintain population-level protective immunity. Nonetheless, other interventions will also be required, with further outbreaks likely to occur due to antigenic drift, selective pressures for novel variants, and global population mobility.
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Rivasi G, Bulgaresi M, Mossello E, Buscemi P, Lorini C, Balzi D, Barucci R, Del Lungo I, Gangemi S, Giardini S, Piga C, Barghini E, Boni S, Bulli G, Carrai P, Crociani A, Faraone A, Lo Forte A, Martella L, Pupo S, Fortini G, Marozzi I, Bandini G, Cosma C, Stacchini L, Vaccaro G, Baggiani L, Landini G, Bonaccorsi G, Ungar A, Benvenuti E. Course and Lethality of SARS-CoV-2 Epidemic in Nursing Homes after Vaccination in Florence, Italy. Vaccines (Basel) 2021; 9:1174. [PMID: 34696282 PMCID: PMC8537408 DOI: 10.3390/vaccines9101174] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Evidence on the effectiveness of SARS-CoV-2 vaccines in nursing home (NHs) residents is limited. We examined the impact of the BNT162b2 mRNA SARS-CoV-2 vaccine on the course of the epidemic in NHs in the Florence Health District, Italy, before and after vaccination. Moreover, we assessed survival and hospitalization by vaccination status in SARS-CoV-2-positive cases occurring during the post-vaccination period. We calculated the weekly infection rates during the pre-vaccination (1 October-26 December 2020) and post-vaccination period (27 December 2020-31 March 2021). Cox analysis was used to analyze survival by vaccination status. The study involved 3730 residents (mean age 84, 69% female). Weekly infection rates fluctuated during the pre-vaccination period (1.8%-6.5%) and dropped to zero during the post-vaccination period. Nine unvaccinated (UN), 56 partially vaccinated (PV) and 35 fully vaccinated (FV) residents tested SARS-CoV-2+ during the post-vaccination period. FV showed significantly lower hospitalization and mortality rates than PV and UV (hospitalization: FV 3%, PV 14%, UV 33%; mortality: FV 6%, PV 18%, UV 56%). The death risk was 84% and 96% lower in PV (HR 0.157, 95%CI 0.049-0.491) and FV (HR 0.037, 95%CI 0.006-0.223) versus UV. SARS-CoV-2 vaccination was followed by a marked decline in infection rates and was associated with lower morbidity and mortality among infected NH residents.
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Affiliation(s)
- Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, 50134 Florence, Tuscany, Italy; (E.M.); (I.M.); (A.U.)
| | - Matteo Bulgaresi
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
| | - Enrico Mossello
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, 50134 Florence, Tuscany, Italy; (E.M.); (I.M.); (A.U.)
| | - Primo Buscemi
- Department of Health Science, University of Florence, 50134 Florence, Tuscany, Italy; (P.B.); (C.L.); (C.C.); (L.S.); (G.V.); (G.B.)
| | - Chiara Lorini
- Department of Health Science, University of Florence, 50134 Florence, Tuscany, Italy; (P.B.); (C.L.); (C.C.); (L.S.); (G.V.); (G.B.)
| | - Daniela Balzi
- Epidemiology Unit, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy;
| | - Riccardo Barucci
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
| | - Ilaria Del Lungo
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
| | - Salvatore Gangemi
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
| | - Sante Giardini
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
| | - Cecilia Piga
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
| | - Eleonora Barghini
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
| | - Serena Boni
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
| | - Giulia Bulli
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
| | - Paolo Carrai
- Department of Internal Medicine, San Giovanni di Dio Hospital, 50134 Florence, Tuscany, Italy; (P.C.); (A.C.); (A.F.); (A.L.F.)
| | - Andrea Crociani
- Department of Internal Medicine, San Giovanni di Dio Hospital, 50134 Florence, Tuscany, Italy; (P.C.); (A.C.); (A.F.); (A.L.F.)
| | - Antonio Faraone
- Department of Internal Medicine, San Giovanni di Dio Hospital, 50134 Florence, Tuscany, Italy; (P.C.); (A.C.); (A.F.); (A.L.F.)
| | - Aldo Lo Forte
- Department of Internal Medicine, San Giovanni di Dio Hospital, 50134 Florence, Tuscany, Italy; (P.C.); (A.C.); (A.F.); (A.L.F.)
| | - Letizia Martella
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
| | - Simone Pupo
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
| | - Giacomo Fortini
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
| | - Irene Marozzi
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, 50134 Florence, Tuscany, Italy; (E.M.); (I.M.); (A.U.)
| | - Giulia Bandini
- Division of Internal Medicine, Careggi Hospital, 50134 Florence, Tuscany, Italy;
| | - Claudia Cosma
- Department of Health Science, University of Florence, 50134 Florence, Tuscany, Italy; (P.B.); (C.L.); (C.C.); (L.S.); (G.V.); (G.B.)
| | - Lorenzo Stacchini
- Department of Health Science, University of Florence, 50134 Florence, Tuscany, Italy; (P.B.); (C.L.); (C.C.); (L.S.); (G.V.); (G.B.)
| | - Gabriele Vaccaro
- Department of Health Science, University of Florence, 50134 Florence, Tuscany, Italy; (P.B.); (C.L.); (C.C.); (L.S.); (G.V.); (G.B.)
| | - Lorenzo Baggiani
- Department of Territorial Health Network, 50134 Florence, Tuscany, Italy;
| | - Giancarlo Landini
- Department of Internal Medicine, Santa Maria Nuova Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy;
| | - Guglielmo Bonaccorsi
- Department of Health Science, University of Florence, 50134 Florence, Tuscany, Italy; (P.B.); (C.L.); (C.C.); (L.S.); (G.V.); (G.B.)
| | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, 50134 Florence, Tuscany, Italy; (E.M.); (I.M.); (A.U.)
| | - Enrico Benvenuti
- Geriatric Unit, Santa Maria Annunziata Hospital, Local Health Unit “Toscana Centro”, 50134 Florence, Tuscany, Italy; (M.B.); (R.B.); (I.D.L.); (S.G.); (S.G.); (C.P.); (E.B.); (S.B.); (G.B.); (L.M.); (S.P.); (G.F.); (E.B.)
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Law JLM, Logan M, Joyce MA, Landi A, Hockman D, Crawford K, Johnson J, LaChance G, Saffran HA, Shields J, Hobart E, Brassard R, Arutyunova E, Pabbaraju K, Croxen M, Tipples G, Lemieux MJ, Tyrrell DL, Houghton M. SARS-COV-2 recombinant Receptor-Binding-Domain (RBD) induces neutralizing antibodies against variant strains of SARS-CoV-2 and SARS-CoV-1. Vaccine 2021; 39:5769-5779. [PMID: 34481699 PMCID: PMC8387217 DOI: 10.1016/j.vaccine.2021.08.081] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022]
Abstract
SARS-CoV-2 is the etiological agent of COVID19. There are currently several licensed vaccines approved for human use and most of them target the spike protein in the virion envelope to induce protective immunity. Recently, variants that spread more quickly have emerged. There is evidence that some of these variants are less sensitive to neutralization in vitro, but it is not clear whether they can evade vaccine induced protection. In this study, we tested SARS-CoV-2 spike RBD as a vaccine antigen and explored the effect of formulation with Alum/MPLA or AddaS03 adjuvants. Our results show that RBD induces high titers of neutralizing antibodies and activates strong cellular immune responses. There is also significant cross-neutralization of variants B.1.1.7 and B.1.351 and to a lesser extent, SARS-CoV-1. These results indicate that recombinant RBD can be a viable candidate as a stand-alone vaccine or as a booster shot to diversify our strategy for COVID19 protection.
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Affiliation(s)
- John Lok Man Law
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada.
| | - Michael Logan
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Michael A Joyce
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Abdolamir Landi
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Darren Hockman
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Kevin Crawford
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Janelle Johnson
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Gerald LaChance
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Holly A Saffran
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Justin Shields
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Eve Hobart
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Raelynn Brassard
- Department of Biochemistry, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Elena Arutyunova
- Department of Biochemistry, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | | | | | - Graham Tipples
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada; Alberta Precision Laboratories, Edmonton, Canada
| | - M Joanne Lemieux
- Department of Biochemistry, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - D Lorne Tyrrell
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada
| | - Michael Houghton
- Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Canada.
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37
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Gallichotte EN, Nehring M, Young MC, Pugh S, Sexton NR, Fitzmeyer E, Quicke KM, Richardson M, Pabilonia KL, Ehrhart N, Fosdick BK, VandeWoude S, Ebel GD. Durable Antibody Responses in Staff at Two Long-Term Care Facilities, during and Post SARS-CoV-2 Outbreaks. Microbiol Spectr 2021; 9:e0022421. [PMID: 34287058 PMCID: PMC8552744 DOI: 10.1128/spectrum.00224-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/25/2021] [Indexed: 02/08/2023] Open
Abstract
SARS-CoV-2 has had a disproportionate impact on nonhospital health care settings, such as long-term-care facilities (LTCFs). The communal nature of these facilities, paired with the high-risk profile of residents, has resulted in thousands of infections and deaths and a high case fatality rate. To detect presymptomatic infections and identify infected workers, we performed weekly surveillance testing of staff at two LTCFs, which revealed a large outbreak at one of the sites. We collected serum from staff members throughout the study and evaluated it for binding and neutralization to measure seroprevalence, seroconversion, and type and functionality of antibodies. At the site with very few incident infections, we detected that over 40% of the staff had preexisting SARS-CoV-2 neutralizing antibodies, suggesting prior exposure. At the outbreak site, we saw rapid seroconversion following infection. Neutralizing antibody levels were stable for many weeks following infection, suggesting a durable, long-lived response. Receptor-binding domain antibodies and neutralizing antibodies were strongly correlated. The site with high seroprevalence among staff had two unique introductions of SARS-CoV-2 into the facility through seronegative infected staff during the period of study, but these did not result in workplace spread or outbreaks. Together, our results suggest that a high seroprevalence rate among staff can contribute to immunity within a workplace and protect against subsequent infection and spread within a facility. IMPORTANCE Long-term care facilities (LTCFs) have been disproportionately impacted by COVID-19 due to their communal nature and high-risk profile of residents. LTCF staff have the ability to introduce SARS-CoV-2 into the facility, where it can spread, causing outbreaks. We tested staff weekly at two LTCFs and collected blood throughout the study to measure SARS-CoV-2 antibodies. One site had a large outbreak and infected individuals rapidly generated antibodies after infection. At the other site, almost half the staff already had antibodies, suggesting prior infection. The majority of these antibodies bind to the receptor-binding domain of the SARS-CoV-2 spike protein and are potently neutralizing and stable for many months. The non-outbreak site had two unique introductions of SARS-CoV-2 into the facility, but these did not result in workplace spread or outbreaks. Our results reveal that high seroprevalence among staff can contribute to immunity and protect against subsequent infection and spread within a facility.
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Affiliation(s)
- Emily N. Gallichotte
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Mary Nehring
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Michael C. Young
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Sierra Pugh
- Department of Statistics, Colorado State University, Fort Collins, Colorado, USA
| | - Nicole R. Sexton
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Emily Fitzmeyer
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Kendra M. Quicke
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Megan Richardson
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Kristy L. Pabilonia
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Nicole Ehrhart
- Columbine Health Systems Center for Healthy Aging and Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Bailey K. Fosdick
- Department of Statistics, Colorado State University, Fort Collins, Colorado, USA
| | - Sue VandeWoude
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Gregory D. Ebel
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
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Jain VK, Iyengar KP, Ish P. Elucidating causes of COVID-19 infection and related deaths after vaccination. Diabetes Metab Syndr 2021; 15:102212. [PMID: 34284226 PMCID: PMC8280649 DOI: 10.1016/j.dsx.2021.102212] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Symptomatic or asymptomatic COVID-19 infection has been reported in vaccination. In the current article, we try to elucidate various causes behind COVID-19 infection and mortality following COVID-19 vaccination and suggest possible strategies to counteract this threat. METHODS We carried out a comprehensive review of the literature using suitable keywords such as 'COVID-19', 'Pandemics', 'Vaccines', 'Mortality', 'deaths', 'infections', and 'India' on the search engines of PubMed, SCOPUS, Google Scholar, and ResearchGate in from January to May 2021. Epidemiology, risk factors, Adverse Events Following Immunization (AEFI) and mortality after COVID-19 vaccination were assessed. RESULTS A number of factors have been associated with symptomatic or asymptomatic COVID-19 infection reported after vaccination. A high viral load, comorbidities, mutant strains, Variants of Concern (VOC) leading to Vaccine escape and casual attitude towards COVID Appropriate Behaviors appear to be the most important factors for infection and deaths after COVID-19 vaccination. CONCLUSIONS COVID-19 Infection and mortality after COVID-19 vaccination are of great concern. Application of COVID Appropriate Behaviour (CAB) before and after vaccination is essential for the population. Effective Vaccines against mutant strains and enhanced vaccination drive are key strategies to avoid this quintessential threat. Early medical intervention in high-risk groups can prevent overall mortality.
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Affiliation(s)
- Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India.
| | | | - Pranav Ish
- Department of Pulmonary, Critical Care and Sleep Medicine, VMMC and Safdarjung Hospital, New Delhi, India.
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Baltas I, Boshier FAT, Williams CA, Bayzid N, Cotic M, Guerra-Assunção JA, Irish-Tavares D, Haque T, Hart J, Roy S, Williams R, Breuer J, Mahungu TW. Post-vaccination COVID-19: A case-control study and genomic analysis of 119 breakthrough infections in partially vaccinated individuals. Clin Infect Dis 2021; 75:305-313. [PMID: 34410361 PMCID: PMC8513403 DOI: 10.1093/cid/ciab714] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Indexed: 11/29/2022] Open
Abstract
Background Post-vaccination infections challenge the control of the coronavirus disease 2019 (COVID-19) pandemic. Methods We matched 119 cases of post-vaccination severe acute respiratory syndrome coronavirus 2 infection with BNT162b2 mRNA or ChAdOx1 nCOV-19 to 476 unvaccinated patients with COVID-19 (September 2020–March 2021) according to age and sex. Differences in 60-day all-cause mortality, hospital admission, and hospital length of stay were evaluated. Phylogenetic, single-nucleotide polymorphism (SNP), and minority variant allele (MVA) full-genome sequencing analysis was performed. Results Overall, 116 of 119 cases developed COVID-19 post–first vaccination dose (median, 14 days). Thirteen of 119 (10.9%) cases and 158 of 476 (33.2%) controls died (P < .001), corresponding to the 4.5 number needed to treat (NNT). Multivariably, vaccination was associated with a 69.3% (95% confidence interval [CI]: 45.8 to 82.6) relative risk (RR) reduction in mortality. Similar results were seen in subgroup analysis for patients with infection onset ≥14 days after first vaccination and across vaccine subgroups. Hospital admissions (odds ratio, 0.80; 95% CI: .51 to 1.28) and length of stay (–1.89 days; 95% CI: –4.57 to 0.78) were lower for cases, while cycle threshold values were higher (30.8 vs 28.8, P = .053). B.1.1.7 was the predominant lineage in cases (100 of 108, 92.6%) and controls (341 of 446, 76.5%). Genomic analysis identified 1 post-vaccination case that harbored the E484K vaccine-escape mutation (B.1.525 lineage). Conclusions Previous vaccination reduces mortality when B.1.1.7 is the predominant lineage. No significant lineage-specific genomic changes during phylogenetic, SNP, and MVA analysis were detected.
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Affiliation(s)
- Ioannis Baltas
- Department of Virology, Royal Free London NHS Foundation Trust, London, United Kingdom.,Institute of Education, University College London, London, United Kingdom
| | - Florencia A T Boshier
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Charlotte A Williams
- Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Nadua Bayzid
- Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Marius Cotic
- Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - José Afonso Guerra-Assunção
- Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Dianne Irish-Tavares
- Department of Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Tanzina Haque
- Department of Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Jennifer Hart
- Department of Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Sunando Roy
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Rachel Williams
- Department of Genetics & Genomic Medicine, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Judith Breuer
- Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Department of Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Tabitha W Mahungu
- Department of Virology, Royal Free London NHS Foundation Trust, London, United Kingdom
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40
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Veronese N, Barbagallo M. Specific approaches to patients affected by dementia and covid-19 in nursing homes: the role of the geriatrician. Ageing Res Rev 2021; 69:101373. [PMID: 34051375 PMCID: PMC8152235 DOI: 10.1016/j.arr.2021.101373] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 04/29/2021] [Accepted: 05/24/2021] [Indexed: 12/13/2022]
Abstract
The coronavirus disease 19 (COVID-19) is relevant in older people. Attention was given to the nursing homes in which frailer people are usually admitted. In this review, we discuss the approaches for daily problems found in nursing home as geriatricians and potentially new research directions. We start with the problem of the older people affected by dementia and Behavioral and Psychological Symptoms of Dementia for which also the execution of a simple diagnostic test (such as nasopharyngeal swab) could be problematic. Another important problem is the management of wandering patients for which the re-organization of the spaces and vaccination could be the solutions. The relationship with families is another important problem, also from a medico-legal point of view, that can be faced using video conferencing tools. Moreover, we discussed the importance of stratifying prognosis in older nursing home residents for the best management and therapeutically approach, including palliative care, also using telemedicine and the inclusion of prognostic tools in daily clinical practice. Finally, we approached the therapeutical issues in older people that suggests the necessity of future research for finding older-friendly medications.
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Affiliation(s)
- Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy.
| | - Mario Barbagallo
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
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Tischer C, Stupp C, Janson P, Willeke K, Hung CW, Flöter J, Kirchner A, Zink K, Eder L, Hackl C, Mühle U, Weidmann M, Nennstiel U, Kuhn J, Weidner C, Liebl B, Wildner M, Keil T. Evaluation of Screening Tests in Bavarian Healthcare Facilities during the Second Wave of the SARS-CoV-2 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147371. [PMID: 34299821 PMCID: PMC8303425 DOI: 10.3390/ijerph18147371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/04/2021] [Accepted: 07/07/2021] [Indexed: 12/26/2022]
Abstract
Due to the lack of data on asymptomatic SARS-CoV-2-positive persons in healthcare institutions, they represent an inestimable risk. Therefore, the aim of the current study was to evaluate the first 1,000,000 reported screening tests of asymptomatic staff, patients, residents, and visitors in hospitals and long-term care (LTC) facilities in the State of Bavaria over a period of seven months. Data were used from the online database BayCoRei (Bavarian Corona Screening Tests), established in July 2020. Descriptive analyses were performed, describing the temporal pattern of persons that tested positive for SARS-CoV-2 by real-time polymerase chain reaction (RT-PCR) or antigen tests, stratified by facility. Until 15 March 2021, this database had collected 1,038,146 test results of asymptomatic subjects in healthcare facilities (382,240 by RT-PCR, and 655,906 by antigen tests). Of the RT-PCR tests, 2.2% (n = 8380) were positive: 3.0% in LTC facilities, 2.2% in hospitals, and 1.2% in rehabilitation institutions. Of the antigen tests, 0.4% (n = 2327) were positive: 0.5% in LTC facilities, and 0.3% in both hospitals and rehabilitation institutions, respectively. In LTC facilities and hospitals, infection surveillance using RT-PCR tests, or the less expensive but less sensitive, faster antigen tests, could facilitate the long-term management of the healthcare workforce, patients, and residents.
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Affiliation(s)
- Christina Tischer
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany
- Correspondence: ; Tel.: +49-(0)9131-6808-7220
| | - Carolin Stupp
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany
| | - Patrick Janson
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany
| | - Kristina Willeke
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany
| | - Chu-Wei Hung
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
| | - Jessica Flöter
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
| | - Anna Kirchner
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
| | - Katharina Zink
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
| | - Lisa Eder
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
| | - Christina Hackl
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
- Pettenkofer School of Public Health, Ludwig Maximilians University, Marchionistrasse 15, 81377 Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology—IBE, Ludwig Maximilians University, Marchionistrasse 15, 81377 Munich, Germany
| | - Ursula Mühle
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
| | - Manfred Weidmann
- Institute of Microbiology and Virology, Medical School Brandenburg Theodor Fontane, Universitätsplatz 1, Gebäude 14, 01968 Senftenberg, Germany;
- Midge Medical GmbH, Colditzstarße 34-36, 12099 Berlin, Germany
| | - Uta Nennstiel
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
| | - Joseph Kuhn
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
| | - Christian Weidner
- Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany;
| | - Bernhard Liebl
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
- Walther Straub Institute of Pharmacology and Toxicology, Faculty of Medicine, Ludwig Maximilians University, Pettenkoferstrasse 12, 80336 Munich, Germany
| | - Manfred Wildner
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
- Pettenkofer School of Public Health, Ludwig Maximilians University, Marchionistrasse 15, 81377 Munich, Germany
| | - Thomas Keil
- State Institute of Health, Bavarian Health and Food Safety Authority, Eggenreuther Weg 43, 91058 Erlangen, Germany; (C.S.); (P.J.); (K.W.); (C.-W.H.); (J.F.); (A.K.); (K.Z.); (L.E.); (C.H.); (U.M.); (U.N.); (J.K.); (B.L.); (M.W.); (T.K.)
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany
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42
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Canaday DH, Carias L, Oyebanji OA, Keresztesy D, Wilk D, Payne M, Aung H, St Denis K, Lam EC, Wilson B, Rowley CF, Berry SD, Cameron CM, Cameron MJ, Balazs AB, Gravenstein S, King CL. Reduced BNT162b2 mRNA vaccine response in SARS-CoV-2-naive nursing home residents. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.03.19.21253920. [PMID: 33791727 PMCID: PMC8010759 DOI: 10.1101/2021.03.19.21253920] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The SARS-CoV-2 pandemic impact on nursing home (NH) residents prompted their prioritization for early vaccination. To fill the data gap for vaccine immunogenicity in NH residents, we examined antibody levels after BNT162b2 mRNA vaccine to spike, receptor binding domain (RBD) and for virus neutralization in 149 NH residents and 111 health care worker controls. SARS-CoV-2-naive NH residents mount antibody responses with nearly 4-fold lower median neutralization titers and half the anti-spike level compared to SARS-CoV-2-naive healthcare workers. By contrast, SARS-CoV-2-recovered vaccinated NH residents had neutralization, anti-spike and anti-RBD titers similar to SARS-CoV-2-recovered vaccinated healthcare workers. NH residents' blunted antibody responses have important implications regarding the quality and durability of protection afforded by neoantigen vaccines. We urgently need better longitudinal evidence on vaccine effectiveness specific to NH resident populations to inform best practices for NH infection control measures, outbreak prevention and potential indication for a vaccine boost.
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Affiliation(s)
- David H Canaday
- Case Western Reserve University School of Medicine, Cleveland, OH
- Geriatric Research, Education and Clinical Center, Cleveland VA
| | - Lenore Carias
- Case Western Reserve University School of Medicine, Cleveland, OH
| | | | | | - Dennis Wilk
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Michael Payne
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Htin Aung
- Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Evan C Lam
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA
| | - Brigid Wilson
- Geriatric Research, Education and Clinical Center, Cleveland VA
| | - Christopher F Rowley
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sarah D Berry
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Cheryl M Cameron
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Mark J Cameron
- Case Western Reserve University School of Medicine, Cleveland, OH
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