1
|
Stirrup O, Tut G, Krutikov M, Bone D, Lancaster T, Azmi B, Monakhov I, Moss P, Hayward A, Copas A, Shallcross L. Anti-nucleocapsid antibody levels following initial and repeat SARS-CoV-2 infections in a cohort of long-term care facility residents in England (VIVALDI). Wellcome Open Res 2024; 9:45. [PMID: 38818129 PMCID: PMC11137476 DOI: 10.12688/wellcomeopenres.20750.1] [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] [Accepted: 01/11/2024] [Indexed: 06/01/2024] Open
Abstract
Background We have previously demonstrated that older residents of long-term care facilities (LTCF) in the UK show levels of anti-spike antibodies that are comparable to the general population following primary series and booster vaccination for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, data on the humoral response to other SARS-CoV-2 proteins associated with natural infection are scarce in this vulnerable population. Methods We measured quantitative levels of anti-nucleocapsid antibodies in blood samples taken from LTCF residents and staff after initial and repeat SARS-CoV-2 infections, between December 2020 and March 2023. Data on SARS-CoV-2 infection and vaccination were obtained through linkage to national datasets. Linear mixed effects models were used to investigate anti-nucleocapsid antibody levels, using log10 scale, in relation to time from most recent infection. This included evaluation of associations between repeat infection, staff/resident status, age, sex, Omicron infection and vaccination history and peak antibody level and slope of decline with time. Results We analysed 405 antibody observations from 220 residents and 396 observations from 215 staff. Repeat infection was associated with 8.5-fold (95%CI 4.9-14.8-fold) higher initial (peak) median anti-nucleocapsid antibody level, with steeper subsequent slope of decline. There were no significant differences in antibody level associated with resident (vs. staff) status or age, but Omicron infection was associated with 3.6-fold (95%CI 2.4-5.4-fold) higher levels. There was stronger evidence of waning of antibody levels over time in a sensitivity analysis in which observations were censored in cases with suspected undetected repeat infection. Conclusions We found similar levels of anti-nucleocapsid antibody in residents and staff of LTCFs. Repeat infection and infection with an Omicron strain were associated with higher peak values. There was evidence of waning of anti-nucleocapsid antibody levels over time.
Collapse
Affiliation(s)
- Oliver Stirrup
- Institute for Global Health, University College London, London, England, UK
| | - Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, England, UK
| | - Maria Krutikov
- Institute of Health Informatics, University College London, London, England, UK
| | - David Bone
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, England, UK
| | - Tara Lancaster
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, England, UK
| | - Borscha Azmi
- Institute of Health Informatics, University College London, London, England, UK
| | | | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, England, UK
| | - Andrew Hayward
- Institute of Epidemiology & Health Care, University College London, London, England, UK
- Health Data Research UK, London, England, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, England, UK
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, England, UK
| |
Collapse
|
2
|
Krutikov M, Stirrup O, Fuller C, Adams N, Azmi B, Irwin-Singer A, Sethu N, Hayward A, Altamirano H, Copas A, Shallcross L. Built Environment and SARS-CoV-2 Transmission in Long-Term Care Facilities: Cross-Sectional Survey and Data Linkage. J Am Med Dir Assoc 2024; 25:304-313.e11. [PMID: 38065220 PMCID: PMC11139658 DOI: 10.1016/j.jamda.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES To describe the built environment in long-term care facilities (LTCF) and its association with introduction and transmission of SARS-CoV-2 infection. DESIGN Cross-sectional survey with linkage to routine surveillance data. SETTING AND PARTICIPANTS LTCFs in England caring for adults ≥65 years old, participating in the VIVALDI study (ISRCTN14447421) were eligible. Data were included from residents and staff. METHODS Cross-sectional survey of the LTCF built environment with linkage to routinely collected asymptomatic and symptomatic SARS-CoV-2 testing and vaccination data between September 1, 2020, and March 31, 2022. We used individual and LTCF level Poisson and Negative Binomial regression models to identify risk factors for 4 outcomes: incidence rate of resident infections and outbreaks, outbreak size, and duration. We considered interactions with variant transmissibility (pre vs post Omicron dominance). RESULTS A total of 134 of 151 (88.7%) LTCFs participated in the survey, contributing data for 13,010 residents and 17,766 staff. After adjustment and stratification, outbreak incidence (measuring infection introduction) was only associated with SARS-CoV-2 incidence in the community [incidence rate ratio (IRR) for high vs low incidence, 2.84; 95% CI, 1.85-4.36]. Characteristics of the built environment were associated with transmission outcomes and differed by variant transmissibility. For resident infection incidence, factors included number of storeys (0.64; 0.43-0.97) and bedrooms (1.04; 1.02-1.06), and purpose-built vs converted buildings (1.99; 1.08-3.69). Air quality was associated with outbreak size (dry vs just right 1.46; 1.00-2.13). Funding model (0.99; 0.99-1.00), crowding (0.98; 0.96-0.99), and bedroom temperature (1.15; 1.01-1.32) were associated with outbreak duration. CONCLUSIONS AND IMPLICATIONS We describe previously undocumented diversity in LTCF built environments. LTCFs have limited opportunities to prevent SARS-CoV-2 introduction, which was only driven by community incidence. However, adjusting the built environment, for example by isolating infected residents or improving airflow, may reduce transmission, although data quality was limited by subjectivity. Identifying LTCF built environment modifications that prevent infection transmission should be a research priority.
Collapse
Affiliation(s)
- Maria Krutikov
- Institute of Health Informatics, University College London, London, UK.
| | - Oliver Stirrup
- Institute for Global Health, University College London, London, UK
| | - Chris Fuller
- Institute of Health Informatics, University College London, London, UK
| | - Natalie Adams
- Institute of Health Informatics, University College London, London, UK
| | - Borscha Azmi
- Institute of Health Informatics, University College London, London, UK
| | - Aidan Irwin-Singer
- Surveillance Testing and Immunity, UK Health Security Agency, London, UK
| | - Niyathi Sethu
- Institute for Environmental Design and Engineering, University College London, London, UK
| | - Andrew Hayward
- Institute of Epidemiology and Health Care, University College London, London, UK
| | - Hector Altamirano
- Institute for Environmental Design and Engineering, University College London, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
| |
Collapse
|
3
|
Adams N, Stirrup O, Blackstone J, Krutikov M, Cassell JA, Cadar D, Henderson C, Knapp M, Goscé L, Leiser R, Regan M, Cullen-Stephenson I, Fenner R, Verma A, Gordon A, Hopkins S, Copas A, Freemantle N, Flowers P, Shallcross L. Shaping care home COVID-19 testing policy: a protocol for a pragmatic cluster randomised controlled trial of asymptomatic testing compared with standard care in care home staff (VIVALDI-CT). BMJ Open 2023; 13:e076210. [PMID: 37963697 PMCID: PMC10649600 DOI: 10.1136/bmjopen-2023-076210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Care home residents have experienced significant morbidity, mortality and disruption following outbreaks of SARS-CoV-2. Regular SARS-CoV-2 testing of care home staff was introduced to reduce transmission of infection, but it is unclear whether this remains beneficial. This trial aims to investigate whether use of regular asymptomatic staff testing, alongside funding to reimburse sick pay for those who test positive and meet costs of employing agency staff, is a feasible and effective strategy to reduce COVID-19 impact in care homes. METHODS AND ANALYSIS The VIVALDI-Clinical Trial is a multicentre, open-label, cluster randomised controlled, phase III/IV superiority trial in up to 280 residential and/or nursing homes in England providing care to adults aged >65 years. All regular and agency staff will be enrolled, excepting those who opt out. Homes will be randomised to the intervention arm (twice weekly asymptomatic staff testing for SARS-CoV-2) or the control arm (current national testing guidance). Staff who test positive for SARS-CoV-2 will self-isolate and receive sick pay. Care providers will be reimbursed for costs associated with employing temporary staff to backfill for absence arising directly from the trial.The trial will be delivered by a multidisciplinary research team through a series of five work packages.The primary outcome is the incidence of COVID-19-related hospital admissions in residents. Secondary outcomes include the number and duration of outbreaks and home closures. Health economic and modelling analyses will investigate the cost-effectiveness and cost consequences of the testing intervention. A process evaluation using qualitative interviews will be conducted to understand intervention roll out and identify areas for optimisation to inform future intervention scale-up, should the testing approach prove effective and cost-effective. Stakeholder engagement will be undertaken to enable the sector to plan for results and their implications and to coproduce recommendations on the use of testing for policy-makers. ETHICS AND DISSEMINATION The study has been approved by the London-Bromley Research Ethics Committee (reference number 22/LO/0846) and the Health Research Authority (22/CAG/0165). The results of the trial will be disseminated regardless of the direction of effect. The publication of the results will comply with a trial-specific publication policy and will include submission to open access journals. A lay summary of the results will also be produced to disseminate the results to participants. TRIAL REGISTRATION NUMBER ISRCTN13296529.
Collapse
Affiliation(s)
- Natalie Adams
- Institute of Health informatics, University College London, London, UK
| | - Oliver Stirrup
- Institute for Global Health, University College London, London, UK
| | - James Blackstone
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Maria Krutikov
- Institute of Health informatics, University College London, London, UK
| | - Jackie A Cassell
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
- UK Health Security Agency, London, UK
| | - Dorina Cadar
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
- Centre for Dementia Studies, Department of Neuroscience, Brighton and Sussex Medical School, Brighton, UK
| | - Catherine Henderson
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, UK
| | - Lara Goscé
- Institute for Global Health, University College London, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth Leiser
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Martyn Regan
- UK Health Security Agency, London, UK
- Division of Population Health, Health Services Research & Primary Care, School of Health Sciences & Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Iona Cullen-Stephenson
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Robert Fenner
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Arpana Verma
- Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Adam Gordon
- Academic Unit of Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
- Applied Research Collaboration-East Midlands (ARC-EM), NIHR, Nottingham, UK
| | | | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Nick Freemantle
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Paul Flowers
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Laura Shallcross
- Institute of Health informatics, University College London, London, UK
| |
Collapse
|
4
|
Friedrich B, Forbes G, Jhass A, Lorencatto F, Shallcross L, Antonopoulou V. Factors influencing staff attitudes to COVID-19 vaccination in care homes in England: a qualitative study. BMC Health Serv Res 2023; 23:1066. [PMID: 37798753 PMCID: PMC10557274 DOI: 10.1186/s12913-023-10031-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic disproportionately affected people living and working in UK care homes causing high mortality rates. Vaccinating staff members and residents is considered the most effective intervention to reduce infection and its transmission rates. However, uptake of the first dose of the COVID-19 vaccine in care homes was variable. We sought to investigate factors influencing uptake of COVID-19 vaccination in care home staff to inform strategies to increase vaccination uptake and inform future preparedness. METHODS Twenty care home staff including managerial and administrative staff, nurses, healthcare practitioners and support staff from nine care homes across England participated in semi-structured telephone interviews (March-June 2021) exploring attitudes towards the COVID-19 vaccine and factors influencing uptake. We used thematic analysis to generate themes which were subsequently deductively mapped to the Capability, Opportunity, Motivation-Behaviour (COM-B) model. The Behavioural Change Wheel (BCW) was used to identify potential intervention strategies to address identified influences. RESULTS Enablers to vaccine uptake included the willingness to protect care home residents, staff and family/friends from infection and the belief that vaccination provided a way back to normality (reflective motivation); convenience of vaccination and access to accurate information (physical opportunity); and a supporting social environment around them favouring vaccination (social opportunity). Barriers included fears about side-effects (automatic motivation); a lack of trust due to the quick release of the vaccine (reflective motivation); and feeling pressurised to accept vaccination if mandatory (automatic motivation). CONCLUSIONS We identified influences on COVID-19 vaccine uptake by care home staff that can inform the implementation of future vaccination programmes. Strategies likely to support uptake include information campaigns and facilitating communication between staff and managers to openly discuss concerns regarding possible vaccination side effects. Freedom of choice played an important role in the decision to be vaccinated suggesting that the decision to mandate vaccination may have unintended behavioural consequences.
Collapse
Affiliation(s)
- Bettina Friedrich
- Institute of Health Informatics, Faculty of Population Sciences, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Gillian Forbes
- Centre for Behaviour Change, Department of Clinical, Education and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Arnoupe Jhass
- Institute of Health Informatics, Faculty of Population Sciences, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Fabiana Lorencatto
- Centre for Behaviour Change, Department of Clinical, Education and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- NIHR Policy Research Unit in Behavioural Science, Population Health Sciences Institute, Newcastle University, Newcastle, NE2 4AX, UK
| | - Laura Shallcross
- Institute of Health Informatics, Faculty of Population Sciences, University College London, 222 Euston Road, London, NW1 2DA, UK
| | - Vivi Antonopoulou
- Centre for Behaviour Change, Department of Clinical, Education and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
- NIHR Policy Research Unit in Behavioural Science, Population Health Sciences Institute, Newcastle University, Newcastle, NE2 4AX, UK.
| |
Collapse
|
5
|
Tessier E, Webster H, Aziz NA, Flannagan J, Zaidi A, Charlett A, Dabrera G, Lamagni T. The impact of COVID-19 on residents of long-term care facilities with learning disabilities and/or autism. Influenza Other Respir Viruses 2023; 17:e13139. [PMID: 37123814 PMCID: PMC10133727 DOI: 10.1111/irv.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023] Open
Abstract
Background The COVID-19 pandemic has had disproportionate impact on vulnerable populations including those with learning disabilities. Assessing the incidence and risk of death in such settings can improve the prevention of COVID-19. We describe individuals who tested positive for SARS-CoV-2 while residing in care homes for learning disabilities and/or autism and investigate the risk of death compared with individuals living in their own homes. Methods Surveillance records for COVID-19 infections in England from 02 February 2020 to 31 March 2022 were extracted. Data on property type, variant wave, vaccination, hospitalisation and death were derived through data linkage and enrichment. Care home residents with learning disabilities and/or autism and diagnosed with COVID-19 were identified and analysed, and logistic regression analyses compared the risk of death of individuals living in private residence. We assessed interaction parameters by post-estimation analyses. Results A total of 3501 individuals were identified as diagnosed with SARS-CoV-2 whilst living in 632 care home properties for learning disabilities and/or autism. Of the 3686 episodes of infection, 80.4% were part of an outbreak. The crude case fatality rate was 2.6% and 0.6% among care home residents with autism and/or learning disabilities and their counterparts in households, respectively.The post-estimation analyses found over eight times the odds of death among care home residents in 60 years old compared with their counterparts living in private homes. Conclusions Care home residents with learning disabilities and/or autism have a greater risk of death from COVID-19. Optimising guidance to meet their needs is of great importance.
Collapse
Affiliation(s)
- Elise Tessier
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| | - Harriet Webster
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| | - Nurin Abdul Aziz
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| | - Joe Flannagan
- All Hazards and Intelligence DivisionUK Health Security AgencyLondonUK
| | - Asad Zaidi
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| | - Andre Charlett
- Statistics, Modelling and Economic DivisionUK Health Security AgencyLondonUK
| | - Gavin Dabrera
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| | - Theresa Lamagni
- COVID‐19 Vaccine and Epidemiology DivisionUK Health Security AgencyLondonUK
| |
Collapse
|
6
|
Foulkes S, Monk EJM, Sparkes D, Hettiarachchi N, Milligan ID, Munro K, Taylor-Kerr A, Platt N, Howells A, Kyaw JYA, Adaji E, Gallagher E, Khawam J, Wellington E, Price L, Crossman D, Norman C, de Lacy E, Cromey L, Corrigan D, Lackenby A, Barbero P, Elegunde B, Zambon M, Chand MA, Brown CS, Islam J, Atti A, Hopkins S, Hall VJ, Cole MJ. Early Warning Surveillance for SARS-CoV-2 Omicron Variants, United Kingdom, November 2021-September 2022. Emerg Infect Dis 2023; 29:184-188. [PMID: 36454718 PMCID: PMC9796219 DOI: 10.3201/eid2901.221293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Since June 2020, the SARS-CoV-2 Immunity and Reinfection Evaluation (SIREN) study has conducted routine PCR testing in UK healthcare workers and sequenced PCR-positive samples. SIREN detected increases in infections and reinfections and delected Omicron subvariant waves emergence contemporaneous with national surveillance. SIREN's sentinel surveillance methods can be used for variant surveillance.
Collapse
|
7
|
Duration of vaccine effectiveness against SARS-CoV-2 infection, hospitalisation, and death in residents and staff of long-term care facilities in England (VIVALDI): a prospective cohort study. THE LANCET. HEALTHY LONGEVITY 2022; 3:e470-e480. [PMID: 35813279 PMCID: PMC9252508 DOI: 10.1016/s2666-7568(22)00147-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
|
8
|
Krutikov M, Stirrup O, Nacer-Laidi H, Azmi B, Fuller C, Tut G, Palmer T, Shrotri M, Irwin-Singer A, Baynton V, Hayward A, Moss P, Copas A, Shallcross L. Outcomes of SARS-CoV-2 omicron infection in residents of long-term care facilities in England (VIVALDI): a prospective, cohort study. THE LANCET. HEALTHY LONGEVITY 2022; 3:e347-e355. [PMID: 35531432 PMCID: PMC9067940 DOI: 10.1016/s2666-7568(22)00093-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background The SARS-CoV-2 omicron variant (B.1.1.529) is highly transmissible, but disease severity appears to be reduced compared with previous variants such as alpha and delta. We investigated the risk of severe outcomes following infection in residents of long-term care facilities. Methods We did a prospective cohort study in residents of long-term care facilities in England who were tested regularly for SARS-CoV-2 between Sept 1, 2021, and Feb 1, 2022, and who were participants of the VIVALDI study. Residents were eligible for inclusion if they had a positive PCR or lateral flow device test during the study period, which could be linked to a National Health Service (NHS) number, enabling linkage to hospital admissions and mortality datasets. PCR or lateral flow device test results were linked to national hospital admission and mortality records using the NHS-number-based pseudo-identifier. We compared the risk of hospital admission (within 14 days following a positive SARS-CoV-2 test) or death (within 28 days) in residents who had tested positive for SARS-CoV-2 in the period shortly before omicron emerged (delta-dominant) and in the omicron-dominant period, adjusting for age, sex, primary vaccine course, past infection, and booster vaccination. Variants were confirmed by sequencing or spike-gene status in a subset of samples. Results 795 233 tests were done in 333 long-term care facilities, of which 159 084 (20·0%) could not be linked to a pseudo-identifier and 138 012 (17·4%) were done in residents. Eight residents had two episodes of infection (>28 days apart) and in these cases the second episode was excluded from the analysis. 2264 residents in 259 long-term care facilities (median age 84·5 years, IQR 77·9-90·0) were diagnosed with SARS-CoV-2, of whom 253 (11·2%) had a previous infection and 1468 (64·8%) had received a booster vaccination. About a third of participants were male. Risk of hospital admissions was markedly lower in the 1864 residents infected in the omicron-period (4·51%, 95% CI 3·65-5·55) than in the 400 residents infected in the pre-omicron period (10·50%, 7·87-13·94), as was risk of death (5·48% [4·52-6·64] vs 10·75% [8·09-14·22]). Adjusted hazard ratios (aHR) also indicated a reduction in hospital admissions (0·64, 95% CI 0·41-1·00; p=0·051) and mortality (aHR 0·68, 0·44-1·04; p=0·076) in the omicron versus the pre-omicron period. Findings were similar in residents with a confirmed variant. Interpretation Observed reduced severity of the omicron variant compared with previous variants suggests that the wave of omicron infections is unlikely to lead to a major surge in severe disease in long-term care facility populations with high levels of vaccine coverage or natural immunity. Continued surveillance in this vulnerable population is important to protect residents from infection and monitor the public health effect of emerging variants. Funding UK Department of Health and Social Care.
Collapse
Affiliation(s)
- Maria Krutikov
- Institute of Health Informatics, University College London, London, UK
| | - Oliver Stirrup
- Institute for Global Health, University College London, London, UK
| | | | - Borscha Azmi
- Institute of Health Informatics, University College London, London, UK
| | - Chris Fuller
- Institute of Health Informatics, University College London, London, UK
| | - Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Tom Palmer
- Institute for Global Health, University College London, London, UK
| | - Madhumita Shrotri
- Institute of Health Informatics, University College London, London, UK
| | | | | | - Andrew Hayward
- UCL Institute of Epidemiology & Health Care, University College London, London, UK
- Health Data Research UK, London, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
| |
Collapse
|
9
|
Aggarwal D, Myers R, Hamilton WL, Bharucha T, Tumelty NM, Brown CS, Meader EJ, Connor T, Smith DL, Bradley DT, Robson S, Bashton M, Shallcross L, Zambon M, Goodfellow I, Chand M, O'Grady J, Török ME, Peacock SJ, Page AJ. The role of viral genomics in understanding COVID-19 outbreaks in long-term care facilities. THE LANCET. MICROBE 2022; 3:e151-e158. [PMID: 34608459 PMCID: PMC8480962 DOI: 10.1016/s2666-5247(21)00208-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We reviewed all genomic epidemiology studies on COVID-19 in long-term care facilities (LTCFs) that had been published to date. We found that staff and residents were usually infected with identical, or near identical, SARS-CoV-2 genomes. Outbreaks usually involved one predominant cluster, and the same lineages persisted in LTCFs despite infection control measures. Outbreaks were most commonly due to single or few introductions followed by a spread rather than a series of seeding events from the community into LTCFs. The sequencing of samples taken consecutively from the same individuals at the same facilities showed the persistence of the same genome sequence, indicating that the sequencing technique was robust over time. When combined with local epidemiology, genomics allowed probable transmission sources to be better characterised. The transmission between LTCFs was detected in multiple studies. The mortality rate among residents was high in all facilities, regardless of the lineage. Bioinformatics methods were inadequate in a third of the studies reviewed, and reproducing the analyses was difficult because sequencing data were not available in many facilities.
Collapse
Affiliation(s)
- Dinesh Aggarwal
- Department of Medicine, University of Cambridge, Cambridge, UK
- Public Health England, London, UK
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
- Wellcome Sanger Institute, Hinxton, Cambridge, UK
| | | | - William L Hamilton
- Department of Medicine, University of Cambridge, Cambridge, UK
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Tehmina Bharucha
- Public Health England, London, UK
- Oxford Glycobiology Institute, Department of Biochemistry, University of Oxford, Oxford, UK
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Niamh M Tumelty
- Cambridge University Libraries, University of Cambridge, Cambridge, UK
| | - Colin S Brown
- Public Health England, London, UK
- Oxford Glycobiology Institute, Department of Biochemistry, University of Oxford, Oxford, UK
- Lao-Oxford-Mahosot Hospital, Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Emma J Meader
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Tom Connor
- Organisms and Environment Division, School of Biosciences, Cardiff University, Cardiff, Wales, UK
- Public Health Wales, University Hospital of Wales, Cardiff, UK
- Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| | - Darren L Smith
- Hub for Biotechnology in the Built Environment, Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Declan T Bradley
- Public Health Agency, Belfast, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Samuel Robson
- University of Portsmouth, Centre for Enzyme Innovation, Portsmouth, UK
| | - Matthew Bashton
- Hub for Biotechnology in the Built Environment, Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, UK
| | | | - Ian Goodfellow
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Meera Chand
- Public Health England, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Justin O'Grady
- Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| | - M Estée Török
- Department of Medicine, University of Cambridge, Cambridge, UK
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Sharon J Peacock
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Sanger Institute, Hinxton, Cambridge, UK
| | - Andrew J Page
- Quadram Institute Bioscience, Norwich Research Park, Norwich, UK
| |
Collapse
|
10
|
Krutikov M, Palmer T, Tut G, Fuller C, Azmi B, Giddings R, Shrotri M, Kaur N, Sylla P, Lancaster T, Irwin-Singer A, Hayward A, Moss P, Copas A, Shallcross L. Prevalence and duration of detectable SARS-CoV-2 nucleocapsid antibodies in staff and residents of long-term care facilities over the first year of the pandemic (VIVALDI study): prospective cohort study in England. THE LANCET HEALTHY LONGEVITY 2022; 3:e13-e21. [PMID: 34935001 PMCID: PMC8676418 DOI: 10.1016/s2666-7568(21)00282-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Long-term care facilities (LTCFs) have reported high SARS-CoV-2 infection rates and related mortality, but the proportion of infected people among those who have survived, and duration of the antibody response to natural infection, is unknown. We determined the prevalence and stability of nucleocapsid antibodies (the standard assay for detection of previous infection) in staff and residents in LTCFs in England. Methods This was a prospective cohort study of residents 65 years or older and of staff 65 years or younger in 201 LTCFs in England between March 1, 2020, and May 7, 2021. Participants were linked to a unique pseudo-identifier based on their UK National Health Service identification number. Serial blood samples were tested for IgG antibodies against SARS-CoV-2 nucleocapsid protein using the Abbott ARCHITECT i-system (Abbott, Maidenhead, UK) immunoassay. Primary endpoints were prevalence and cumulative incidence of antibody positivity, which were weighted to the LTCF population. Incidence rate of loss of antibodies (seroreversion) was estimated from Kaplan-Meier curves. Findings 9488 samples were included, 8636 (91·0%) of which could be individually linked to 1434 residents and 3288 staff members. The cumulative incidence of nucleocapsid seropositivity was 34·6% (29·6–40·0) in residents and 26·1% (23·0–29·5) in staff over 11 months. 239 (38·6%) residents and 503 women (81·3%) were included in the antibody-waning analysis, and median follow-up was 149 days (IQR 107–169). The incidence rate of seroreversion was 2·1 per 1000 person-days at risk, and median time to reversion was 242·5 days. Interpretation At least a quarter of staff and a third of surviving residents were infected with SAR-CoV-2 during the first two waves of the pandemic in England. Nucleocapsid-specific antibodies often become undetectable within the first year following infection, which is likely to lead to marked underestimation of the true proportion of people with previous infection. Given that natural infection might act to boost vaccine responses, better assays to identify natural infection should be developed. Funding UK Government Department of Health and Social Care.
Collapse
|
11
|
Giddings R, Krutikov M, Palmer T, Fuller C, Azmi B, Shrotri M, Irwin-Singer A, Tut G, Moss P, Copas A, Shallcross L. Changes in COVID-19 outbreak severity and duration in long-term care facilities following vaccine introduction, England, November 2020 to June 2021. Euro Surveill 2021; 26. [PMID: 34794537 PMCID: PMC8603404 DOI: 10.2807/1560-7917.es.2021.26.46.2100995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
We describe the impact of changing epidemiology and vaccine introduction on characteristics of COVID-19 outbreaks in 330 long-term care facilities (LTCF) in England between November 2020 and June 2021. As vaccine coverage in LTCF increased and national incidence declined, the total number of outbreaks and outbreak severity decreased across the LTCF. The number of infected cases per outbreak decreased by 80.6%, while the proportion of outbreaks affecting staff only increased. Our study supports findings of vaccine effectiveness in LTCF.
Collapse
Affiliation(s)
| | - Maria Krutikov
- UCL Institute of Health Informatics, London, United Kingdom
| | - Tom Palmer
- UCL Institute for Global Health, London, United Kingdom
| | | | - Borscha Azmi
- UCL Institute of Health Informatics, London, United Kingdom
| | | | | | - Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Andrew Copas
- UCL Institute for Global Health, London, United Kingdom
| | | |
Collapse
|
12
|
Shrotri M, Krutikov M, Palmer T, Giddings R, Azmi B, Subbarao S, Fuller C, Irwin-Singer A, Davies D, Tut G, Lopez Bernal J, Moss P, Hayward A, Copas A, Shallcross L. Vaccine effectiveness of the first dose of ChAdOx1 nCoV-19 and BNT162b2 against SARS-CoV-2 infection in residents of long-term care facilities in England (VIVALDI): a prospective cohort study. THE LANCET. INFECTIOUS DISEASES 2021; 21:1529-1538. [PMID: 34174193 PMCID: PMC8221738 DOI: 10.1016/s1473-3099(21)00289-9] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The effectiveness of SARS-CoV-2 vaccines in older adults living in long-term care facilities is uncertain. We investigated the protective effect of the first dose of the Oxford-AstraZeneca non-replicating viral-vectored vaccine (ChAdOx1 nCoV-19; AZD1222) and the Pfizer-BioNTech mRNA-based vaccine (BNT162b2) in residents of long-term care facilities in terms of PCR-confirmed SARS-CoV-2 infection over time since vaccination. METHODS The VIVALDI study is a prospective cohort study that commenced recruitment on June 11, 2020, to investigate SARS-CoV-2 transmission, infection outcomes, and immunity in residents and staff in long-term care facilities in England that provide residential or nursing care for adults aged 65 years and older. In this cohort study, we included long-term care facility residents undergoing routine asymptomatic SARS-CoV-2 testing between Dec 8, 2020 (the date the vaccine was first deployed in a long-term care facility), and March 15, 2021, using national testing data linked within the COVID-19 Datastore. Using Cox proportional hazards regression, we estimated the relative hazard of PCR-positive infection at 0-6 days, 7-13 days, 14-20 days, 21-27 days, 28-34 days, 35-48 days, and 49 days and beyond after vaccination, comparing unvaccinated and vaccinated person-time from the same cohort of residents, adjusting for age, sex, previous infection, local SARS-CoV-2 incidence, long-term care facility bed capacity, and clustering by long-term care facility. We also compared mean PCR cycle threshold (Ct) values for positive swabs obtained before and after vaccination. The study is registered with ISRCTN, number 14447421. FINDINGS 10 412 care home residents aged 65 years and older from 310 LTCFs were included in this analysis. The median participant age was 86 years (IQR 80-91), 7247 (69·6%) of 10 412 residents were female, and 1155 residents (11·1%) had evidence of previous SARS-CoV-2 infection. 9160 (88·0%) residents received at least one vaccine dose, of whom 6138 (67·0%) received ChAdOx1 and 3022 (33·0%) received BNT162b2. Between Dec 8, 2020, and March 15, 2021, there were 36 352 PCR results in 670 628 person-days, and 1335 PCR-positive infections (713 in unvaccinated residents and 612 in vaccinated residents) were included. Adjusted hazard ratios (HRs) for PCR-positive infection relative to unvaccinated residents declined from 28 days after the first vaccine dose to 0·44 (95% CI 0·24-0·81) at 28-34 days and 0·38 (0·19-0·77) at 35-48 days. Similar effect sizes were seen for ChAdOx1 (adjusted HR 0·32, 95% CI 0·15-0·66) and BNT162b2 (0·35, 0·17-0·71) vaccines at 35-48 days. Mean PCR Ct values were higher for infections that occurred at least 28 days after vaccination than for those occurring before vaccination (31·3 [SD 8·7] in 107 PCR-positive tests vs 26·6 [6·6] in 552 PCR-positive tests; p<0·0001). INTERPRETATION Single-dose vaccination with BNT162b2 and ChAdOx1 vaccines provides substantial protection against infection in older adults from 4-7 weeks after vaccination and might reduce SARS-CoV-2 transmission. However, the risk of infection is not eliminated, highlighting the ongoing need for non-pharmaceutical interventions to prevent transmission in long-term care facilities. FUNDING UK Government Department of Health and Social Care.
Collapse
Affiliation(s)
- Madhumita Shrotri
- UCL Institute of Health Informatics, UCL, London, UK; Public Health England, London, UK
| | | | - Tom Palmer
- UCL Institute for Global Health, UCL, London, UK
| | | | - Borscha Azmi
- UCL Institute of Health Informatics, UCL, London, UK
| | | | | | | | | | - Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Andrew Hayward
- UCL Institute of Epidemiology & Healthcare, UCL, London, UK; Health Data Research UK, London, UK
| | - Andrew Copas
- UCL Institute for Global Health, UCL, London, UK
| | | |
Collapse
|
13
|
Shrotri M, Krutikov M, Palmer T, Giddings R, Azmi B, Subbarao S, Fuller C, Irwin-Singer A, Davies D, Tut G, Lopez Bernal J, Moss P, Hayward A, Copas A, Shallcross L. Vaccine effectiveness of the first dose of ChAdOx1 nCoV-19 and BNT162b2 against SARS-CoV-2 infection in residents of long-term care facilities in England (VIVALDI): a prospective cohort study. THE LANCET. INFECTIOUS DISEASES 2021. [PMID: 34174193 DOI: 10.1101/2021.03.26.21254391] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND The effectiveness of SARS-CoV-2 vaccines in older adults living in long-term care facilities is uncertain. We investigated the protective effect of the first dose of the Oxford-AstraZeneca non-replicating viral-vectored vaccine (ChAdOx1 nCoV-19; AZD1222) and the Pfizer-BioNTech mRNA-based vaccine (BNT162b2) in residents of long-term care facilities in terms of PCR-confirmed SARS-CoV-2 infection over time since vaccination. METHODS The VIVALDI study is a prospective cohort study that commenced recruitment on June 11, 2020, to investigate SARS-CoV-2 transmission, infection outcomes, and immunity in residents and staff in long-term care facilities in England that provide residential or nursing care for adults aged 65 years and older. In this cohort study, we included long-term care facility residents undergoing routine asymptomatic SARS-CoV-2 testing between Dec 8, 2020 (the date the vaccine was first deployed in a long-term care facility), and March 15, 2021, using national testing data linked within the COVID-19 Datastore. Using Cox proportional hazards regression, we estimated the relative hazard of PCR-positive infection at 0-6 days, 7-13 days, 14-20 days, 21-27 days, 28-34 days, 35-48 days, and 49 days and beyond after vaccination, comparing unvaccinated and vaccinated person-time from the same cohort of residents, adjusting for age, sex, previous infection, local SARS-CoV-2 incidence, long-term care facility bed capacity, and clustering by long-term care facility. We also compared mean PCR cycle threshold (Ct) values for positive swabs obtained before and after vaccination. The study is registered with ISRCTN, number 14447421. FINDINGS 10 412 care home residents aged 65 years and older from 310 LTCFs were included in this analysis. The median participant age was 86 years (IQR 80-91), 7247 (69·6%) of 10 412 residents were female, and 1155 residents (11·1%) had evidence of previous SARS-CoV-2 infection. 9160 (88·0%) residents received at least one vaccine dose, of whom 6138 (67·0%) received ChAdOx1 and 3022 (33·0%) received BNT162b2. Between Dec 8, 2020, and March 15, 2021, there were 36 352 PCR results in 670 628 person-days, and 1335 PCR-positive infections (713 in unvaccinated residents and 612 in vaccinated residents) were included. Adjusted hazard ratios (HRs) for PCR-positive infection relative to unvaccinated residents declined from 28 days after the first vaccine dose to 0·44 (95% CI 0·24-0·81) at 28-34 days and 0·38 (0·19-0·77) at 35-48 days. Similar effect sizes were seen for ChAdOx1 (adjusted HR 0·32, 95% CI 0·15-0·66) and BNT162b2 (0·35, 0·17-0·71) vaccines at 35-48 days. Mean PCR Ct values were higher for infections that occurred at least 28 days after vaccination than for those occurring before vaccination (31·3 [SD 8·7] in 107 PCR-positive tests vs 26·6 [6·6] in 552 PCR-positive tests; p<0·0001). INTERPRETATION Single-dose vaccination with BNT162b2 and ChAdOx1 vaccines provides substantial protection against infection in older adults from 4-7 weeks after vaccination and might reduce SARS-CoV-2 transmission. However, the risk of infection is not eliminated, highlighting the ongoing need for non-pharmaceutical interventions to prevent transmission in long-term care facilities. FUNDING UK Government Department of Health and Social Care.
Collapse
Affiliation(s)
- Madhumita Shrotri
- UCL Institute of Health Informatics, UCL, London, UK; Public Health England, London, UK
| | | | - Tom Palmer
- UCL Institute for Global Health, UCL, London, UK
| | | | - Borscha Azmi
- UCL Institute of Health Informatics, UCL, London, UK
| | | | | | | | | | - Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Andrew Hayward
- UCL Institute of Epidemiology & Healthcare, UCL, London, UK; Health Data Research UK, London, UK
| | - Andrew Copas
- UCL Institute for Global Health, UCL, London, UK
| | | |
Collapse
|
14
|
Tut G, Lancaster T, Krutikov M, Sylla P, Bone D, Kaur N, Spalkova E, Bentley C, Amin U, Jadir AT, Hulme S, Butler MS, Ayodele M, Bruton R, Shrotri M, Azmi B, Fuller C, Irwin-Singer A, Hayward A, Copas A, Shallcross L, Moss P. Profile of humoral and cellular immune responses to single doses of BNT162b2 or ChAdOx1 nCoV-19 vaccines in residents and staff within residential care homes (VIVALDI): an observational study. THE LANCET. HEALTHY LONGEVITY 2021; 2:e544-e553. [PMID: 34430954 PMCID: PMC8376213 DOI: 10.1016/s2666-7568(21)00168-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Residents of long-term care facilities (LTCFs) have been prioritised for COVID-19 vaccination because of the high COVID-19 mortality in this population. Several countries have implemented an extended interval of up to 12 weeks between the first and second vaccine doses to increase population coverage of single-dose vaccination. We aimed to assess the magnitude and quality of adaptive immune responses following a single dose of COVID-19 vaccine in LTCF residents and staff. METHODS From the LTCFs participating in the ongoing VIVALDI study (ISRCTN14447421), staff and residents who had received a first dose of COVID-19 vaccine (BNT162b2 [tozinameran] or ChAdOx1 nCoV-19), had pre-vaccination and post-vaccination blood samples (collected between Dec 11, 2020, and Feb 16, 2021), and could be linked to a pseudoidentifier in the COVID-19 Data Store were included in our cohort. Past infection with SARS-CoV-2 was defined on the basis of nucleocapsid-specific IgG antibodies being detected through a semiquantitative immunoassay, and participants who tested positive on this assay after but not before vaccination were excluded from the study. Processed blood samples were assessed for spike-specific immune responses, including spike-specific IgG antibody titres, T-cell responses to spike protein peptide mixes, and inhibition of ACE2 binding by spike protein from four variants of SARS-CoV-2 (the original strain as well as the B.1.1.7, B.1.351, and P.1 variants). Responses before and after vaccination were compared on the basis of age, previous infection status, role (staff or resident), and time since vaccination. FINDINGS Our cohort comprised 124 participants from 14 LTCFs: 89 (72%) staff (median age 48 years [IQR 35·5-56]) and 35 (28%) residents (87 years [77-90]). Blood samples were collected a median 40 days (IQR 25-47; range 6-52) after vaccination. 30 (24%) participants (18 [20%] staff and 12 [34%] residents) had serological evidence of previous SARS-CoV-2 infection. All participants with previous infection had high antibody titres following vaccination that were independent of age (r s=0·076, p=0·70). In participants without evidence of previous infection, titres were negatively correlated with age (r s=-0·434, p<0·0001) and were 8·2-times lower in residents than in staff. This effect appeared to result from a kinetic delay antibody generation in older infection-naive participants, with the negative age correlation disappearing only in samples taken more than 42 days post-vaccination (r s=-0·207, p=0·20; n=40), in contrast to samples taken after 0-21 days (r s=-0·774, p=0·0043; n=12) or 22-42 days (r s=-0·437, p=0·0034; n=43). Spike-specific cellular responses were similar between older and younger participants. In infection-naive participants, antibody inhibition of ACE2 binding by spike protein from the original SARS-CoV-2 strain was negatively correlated with age (r s=-0·439, p<0·0001), and was significantly lower against spike protein from the B.1.351 variant (median inhibition 31% [14-100], p=0·010) and the P.1 variant (23% [14-97], p<0·0001) than against the original strain (58% [27-100]). By contrast, a single dose of vaccine resulted in around 100% inhibition of the spike-ACE2 interaction against all variants in people with a history of infection. INTERPRETATION History of SARS-CoV-2 infection impacts the magnitude and quality of antibody response after a single dose of COVID-19 vaccine in LTCF residents. Residents who are infection-naive have delayed antibody responses to the first dose of vaccine and should be considered for an early second dose where possible. FUNDING UK Government Department of Health and Social Care.
Collapse
Affiliation(s)
- Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Tara Lancaster
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Maria Krutikov
- UCL Institute of Health Informatics, University College London, London, UK
| | - Panagiota Sylla
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - David Bone
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Nayandeep Kaur
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Eliska Spalkova
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Christopher Bentley
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Umayr Amin
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Azar T Jadir
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Samuel Hulme
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Megan S Butler
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Morenike Ayodele
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Rachel Bruton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Madhumita Shrotri
- UCL Institute of Health Informatics, University College London, London, UK
| | - Borscha Azmi
- UCL Institute of Health Informatics, University College London, London, UK
| | - Chris Fuller
- UCL Institute of Health Informatics, University College London, London, UK
| | | | | | - Andrew Copas
- UCL Institute for Global Health, University College London, London, UK
| | - Laura Shallcross
- UCL Institute of Health Informatics, University College London, London, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| |
Collapse
|
15
|
Chen Y, Atchison C, Atkinson B, Barber C, Bennett A, Brickley E, Cooke J, Dabrera G, Fishwick D, Fletcher T, Graham A, Higgins H, Keen C, Morgan D, Noakes C, Pearce N, Raja A, Sandys V, Stocks J, van Tongeren M, van Veldhoven K, Verma A, Curran A. The COVID-OUT study protocol: COVID-19 outbreak investigation to understand workplace SARS-CoV-2 transmission in the United Kingdom. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.17015.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Preventing SARS-CoV-2 transmission and protecting people from COVID-19 is the most significant public health challenge faced in recent years. COVID-19 outbreaks are occurring in workplaces and evidence is needed to support effective strategies to prevent and control these outbreaks. Investigations into these outbreaks are routinely undertaken by public health bodies and regulators in the United Kingdom (UK); however, such investigations are typically disparate in nature with a lack of consistency across all investigations, preventing meaningful analysis of the data collected. The COVID-OUT (COVID-19 Outbreak investigation to Understand Transmission) study aims to collect a consistent set of data in a systematic way from workplaces that are experiencing outbreaks, to understand SARS-CoV-2 transmission risk factors, transmission routes, and the role they play in the COVID-19 outbreaks. Suitable outbreak sites are identified from public health bodies. Following employer consent to participate, the study will recruit workers from workplaces where there are active outbreaks. The study will utilise data already collected as part of routine public health outbreak investigations and collect additional data through a comprehensive questionnaire, viral and serologic testing of workers, surface sampling, viral genome sequencing, and an environmental assessment of building plans, ventilation and current control measures. At each site, a detailed investigation will be carried out to evaluate transmission routes. A case-control approach will be used to compare workers who have and have not had SARS-CoV-2 infections during the outbreak period to assess transmission risk factors. Data from different outbreaks will be combined for pooled analyses to identify common risk factors, as well as factors that differ between outbreaks. The COVID-OUT study can contribute to a better understanding of why COVID-19 outbreaks associated with workplaces occur and how to prevent these outbreaks from happening in the future.
Collapse
|
16
|
Krutikov M, Palmer T, Tut G, Fuller C, Shrotri M, Williams H, Davies D, Irwin-Singer A, Robson J, Hayward A, Moss P, Copas A, Shallcross L. Incidence of SARS-CoV-2 infection according to baseline antibody status in staff and residents of 100 long-term care facilities (VIVALDI): a prospective cohort study. THE LANCET. HEALTHY LONGEVITY 2021; 2:e362-e370. [PMID: 34104901 DOI: 10.1101/2021.03.08.21253110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND SARS-CoV-2 infection represents a major challenge for long-term care facilities (LTCFs) and many residents and staff are seropositive following persistent outbreaks. We aimed to investigate the association between the SARS-CoV-2 antibody status at baseline and subsequent infection in this population. METHODS We did a prospective cohort study of SARS-CoV-2 infection in staff (aged <65 years) and residents (aged >65 years) at 100 LTCFs in England between Oct 1, 2020, and Feb 1, 2021. Blood samples were collected between June and November, 2020, at baseline, and 2 and 4 months thereafter and tested for IgG antibodies to SARS-CoV-2 nucleocapsid and spike proteins. PCR testing for SARS-CoV-2 was done weekly in staff and monthly in residents. Cox regression was used to estimate hazard ratios (HRs) of a PCR-positive test by baseline antibody status, adjusted for age and sex, and stratified by LTCF. FINDINGS 682 residents from 86 LCTFs and 1429 staff members from 97 LTCFs met study inclusion criteria. At baseline, IgG antibodies to nucleocapsid were detected in 226 (33%) of 682 residents and 408 (29%) of 1429 staff members. 93 (20%) of 456 residents who were antibody-negative at baseline had a PCR-positive test (infection rate 0·054 per month at risk) compared with four (2%) of 226 residents who were antibody-positive at baseline (0·007 per month at risk). 111 (11%) of 1021 staff members who were antibody-negative at baseline had PCR-positive tests (0·042 per month at risk) compared with ten (2%) of 408 staff members who were antibody-positive staff at baseline (0·009 per month at risk). The risk of PCR-positive infection was higher for residents who were antibody-negative at baseline than residents who were antibody-positive at baseline (adjusted HR [aHR] 0·15, 95% CI 0·05-0·44, p=0·0006), and the risk of a PCR-positive infection was also higher for staff who were antibody-negative at baseline compared with staff who were antibody-positive at baseline (aHR 0·39, 0·19-0·82; p=0·012). 12 of 14 reinfected participants had available data on symptoms, and 11 of these participants were symptomatic. Antibody titres to spike and nucleocapsid proteins were comparable in PCR-positive and PCR-negative cases. INTERPRETATION The presence of IgG antibodies to nucleocapsid protein was associated with substantially reduced risk of reinfection in staff and residents for up to 10 months after primary infection. FUNDING UK Government Department of Health and Social Care.
Collapse
Affiliation(s)
- Maria Krutikov
- UCL Institute of Health Informatics, University College London, London, UK
| | - Tom Palmer
- UCL Institute for Global Health, University College London, London, UK
| | - Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Chris Fuller
- UCL Institute of Health Informatics, University College London, London, UK
| | - Madhumita Shrotri
- UCL Institute of Health Informatics, University College London, London, UK
- Public Health England, London, UK
| | | | | | | | | | - Andrew Hayward
- UCL Institute of Epidemiology and Healthcare, University College London, London, UK
- Health Data Research UK, London, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Andrew Copas
- UCL Institute for Global Health, University College London, London, UK
| | - Laura Shallcross
- UCL Institute of Health Informatics, University College London, London, UK
| |
Collapse
|
17
|
Krutikov M, Palmer T, Tut G, Fuller C, Shrotri M, Williams H, Davies D, Irwin-Singer A, Robson J, Hayward A, Moss P, Copas A, Shallcross L. Incidence of SARS-CoV-2 infection according to baseline antibody status in staff and residents of 100 long-term care facilities (VIVALDI): a prospective cohort study. THE LANCET. HEALTHY LONGEVITY 2021; 2:e362-e370. [PMID: 34104901 PMCID: PMC8175048 DOI: 10.1016/s2666-7568(21)00093-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND SARS-CoV-2 infection represents a major challenge for long-term care facilities (LTCFs) and many residents and staff are seropositive following persistent outbreaks. We aimed to investigate the association between the SARS-CoV-2 antibody status at baseline and subsequent infection in this population. METHODS We did a prospective cohort study of SARS-CoV-2 infection in staff (aged <65 years) and residents (aged >65 years) at 100 LTCFs in England between Oct 1, 2020, and Feb 1, 2021. Blood samples were collected between June and November, 2020, at baseline, and 2 and 4 months thereafter and tested for IgG antibodies to SARS-CoV-2 nucleocapsid and spike proteins. PCR testing for SARS-CoV-2 was done weekly in staff and monthly in residents. Cox regression was used to estimate hazard ratios (HRs) of a PCR-positive test by baseline antibody status, adjusted for age and sex, and stratified by LTCF. FINDINGS 682 residents from 86 LCTFs and 1429 staff members from 97 LTCFs met study inclusion criteria. At baseline, IgG antibodies to nucleocapsid were detected in 226 (33%) of 682 residents and 408 (29%) of 1429 staff members. 93 (20%) of 456 residents who were antibody-negative at baseline had a PCR-positive test (infection rate 0·054 per month at risk) compared with four (2%) of 226 residents who were antibody-positive at baseline (0·007 per month at risk). 111 (11%) of 1021 staff members who were antibody-negative at baseline had PCR-positive tests (0·042 per month at risk) compared with ten (2%) of 408 staff members who were antibody-positive staff at baseline (0·009 per month at risk). The risk of PCR-positive infection was higher for residents who were antibody-negative at baseline than residents who were antibody-positive at baseline (adjusted HR [aHR] 0·15, 95% CI 0·05-0·44, p=0·0006), and the risk of a PCR-positive infection was also higher for staff who were antibody-negative at baseline compared with staff who were antibody-positive at baseline (aHR 0·39, 0·19-0·82; p=0·012). 12 of 14 reinfected participants had available data on symptoms, and 11 of these participants were symptomatic. Antibody titres to spike and nucleocapsid proteins were comparable in PCR-positive and PCR-negative cases. INTERPRETATION The presence of IgG antibodies to nucleocapsid protein was associated with substantially reduced risk of reinfection in staff and residents for up to 10 months after primary infection. FUNDING UK Government Department of Health and Social Care.
Collapse
Affiliation(s)
- Maria Krutikov
- UCL Institute of Health Informatics, University College London, London, UK
| | - Tom Palmer
- UCL Institute for Global Health, University College London, London, UK
| | - Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Chris Fuller
- UCL Institute of Health Informatics, University College London, London, UK
| | - Madhumita Shrotri
- UCL Institute of Health Informatics, University College London, London, UK
- Public Health England, London, UK
| | | | | | | | | | - Andrew Hayward
- UCL Institute of Epidemiology and Healthcare, University College London, London, UK
- Health Data Research UK, London, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Andrew Copas
- UCL Institute for Global Health, University College London, London, UK
| | - Laura Shallcross
- UCL Institute of Health Informatics, University College London, London, UK
| |
Collapse
|
18
|
Maple PAC. Population (Antibody) Testing for COVID-19-Technical Challenges, Application and Relevance, an English Perspective. Vaccines (Basel) 2021; 9:vaccines9060550. [PMID: 34073985 PMCID: PMC8225097 DOI: 10.3390/vaccines9060550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 01/08/2023] Open
Abstract
In the UK, population virus or antibody testing using virus swabs, serum samples, blood spots or oral fluids has been performed to a limited extent for several diseases including measles, mumps, rubella and hepatitis and HIV. The collection of population-based infection and immunity data is key to the monitoring of disease prevalence and assessing the effectiveness of interventions such as behavioural modifications and vaccination. In particular, the biological properties of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and its interaction with the human host have presented several challenges towards the development of population-based immunity testing. Measuring SARS-CoV-2 immunity requires the development of antibody assays of acceptable sensitivity and specificity which are capable of accurately detecting seroprevalence and differentiating protection from non-protective responses. Now that anti-COVID-19 vaccines are becoming available there is a pressing need to measure vaccine efficacy and the development of herd immunity. The unprecedented impact of the SARS-CoV-2 pandemic in the UK in terms of morbidity, mortality, and economic and social disruption has mobilized a national scientific effort to learn more about this virus. In this article, the challenges of testing for SARS-CoV-2 infection, particularly in relation to population-based immunity testing, will be considered and examples given of relevant national level studies.
Collapse
Affiliation(s)
- Peter A. C. Maple
- Clinical Neurology Research Group, Department of Neurology, Division of Clinical Neuroscience, University of Nottingham School of Medicine, Queen’s Medical Centre, Nottingham NG7 2UH, UK;
- Molecular (COVID) Department, UK Lighthouse Laboratory, Cheshire SK10 4TG, UK
| |
Collapse
|