Effectiveness of Whole-Virus COVID-19 Vaccine among Healthcare Personnel, Lima, Peru

Influenza Virus Surveillance in Healthcare Personnel in Peru: NAMRU SOUTH Experience and Perspective

Vaccinating healthcare personnel (HCP) is a top priority for public health globally. This strategy aims not only to protect HCP but also patients, reducing transmission of infections in healthcare services. However, improving vaccine coverage in HCP is still a challenge, especially because they are a risk group for acquiring influenza. Multicomponent influenza vaccination programs targeting behavioral, organizational, and administrative barriers are critical to ensure this priority population is vaccinated. Here, we describe a healthcare worker cohort study that was implemented in Peru, a middle-income country, in 2016, prior to the coronavirus disease 2019 pandemic. This cohort, which is still ongoing, has collected valuable information on influenza vaccine effectiveness, vaccine coverage, risk factors, absenteeism, and use of personal protective equipment, as well as risk of influenza disease, among others. These data can help improve knowledge not only about influenza diseases but also regarding vaccination on this specific influenza risk group in order to improve vaccine uptake.

Comparative efficacy of leading COVID-19 vaccines: A network meta-analysis

In the fight against the COVID-19 virus, various vaccines using different technologies such as mRNA, viral vectors, protein subunits, and inactivated whole viruses have become primary defence strategies. This study aims to compare their effectiveness in controlling the spread of the pandemic. Using the comprehensive resources from three major databases-PubMed, EMBASE, and the Cochrane Library-we conducted an extensive literature review up to April 30, 2023. By employing a frequentist network meta-analysis, we analysed both direct and indirect estimates of vaccine efficacy, providing a clear comparison of the leading candidates in the global fight against COVID-19. Fifteen vaccines from 26 articles were used in our network meta-analysis. The statistically significant direct estimates were obtained by Spikevax [VE: 93.29 (91.31, 95.27); P<0.05], Pfizer BioNTech [VE: 92.07 (90.03, 94.12); P<0.05], Sputnik [VE: 91.60 (85.60, 97.60); P<0.05], Novavax [VE: 88.99 (83.55, 94.42); P<0.05], Sinovac [VE: 83.50 (65.40, 101.60); P<0.05], Covifenz [VE: 77.27 (68.48, 86.06); P<0.05], Zifivax [VE: 75.94 (70.86, 81.02); P<0.05], Covishield [VE: 72.34 (67.12, 77.56); P<0.05], S-Trimer [VE: 71.61 (56.23, 86.98); P<0.05], Covaxin [VE: 70.81 (65.33, 76.29); P<0.05], Soberna [VE: 69.70 (56.50, 82.90); P<0.05], Zydus Cadila [VE: 66.60 (47.60, 85.60); P<0.05], CVnCoV [VE: 63.70 (52.20, 75.20); P<0.05], Convidecia [VE: 57.50 (39.70, 75.30); P <0.05], and Jcovden [VE : 52.42 (47.28, 57.57); P<0.05]. Spikevax emerged triumphant with an unparalleled P score of 0.95, solidifying its status as a top ranking prevention tool against the COVID-19 in our investigation. Our analysis reveals a ranking of vaccine efficacy, with Spikevax emerging as the most effective, followed closely by Comirnaty, Sputnik, and others, collectively providing strong protection against the ongoing threat of COVID-19.

Surveillance of SARS-CoV-2 in Healthcare Workers Before and After COVID-19 Vaccination: A Cohort Study in a Primary Care Unit of Brazil

INTRODUCTION

Healthcare workers (HCWs) are at higher risk of SARS-CoV-2 infection. Viral surveillance for early detection of COVID-19 is a critical strategy to understand this population's infection dynamics and prevent transmission. The study examines SARS-CoV-2 infection and reinfection among HCWs vaccinated against COVID-19 working at a primary healthcare unit serving a disenfranchised community in Brazil.

METHODS

The study was conducted in Cidade Estrutural, Federal District, Brazil, between February and October 2021. Participants were interviewed and provided samples. A prospective open cohort study was used to analyze the frequency of SARS-CoV-2 infection and reinfection, and the vaccine-induced seroconversion. Nasopharyngeal swab specimen was collected from workers presenting with flu-like symptoms and subjected to RT-qPCR. Peripheral blood samples were also collected every 30 ± 2 days for eight months, starting from the day participants received their first dose of COVID-19 vaccine, and submitted to serological testing (IgM and IgG chemiluminescence). The frequencies of infection and reinfection (RT-qPCR positive results 90 days after the infection) were calculated along with their respective confidence intervals (95% CI).

RESULTS

Of the 128 workers, 61 (47.65%; CI: 39.19-56.25) reported probable SARS-CoV-2 infection before vaccination and 50 (39.06%; CI: 31.04-47.71) had SARS-CoV-2 infection after vaccination, confirmed by molecular test. Reinfection was identified in seven workers (7/50, 14%; CI: 6.95-26.18) based on the 90-day interval between results. The serological data from the 128 workers during the cohort indicated that 68 (53.12%; CI: 44.5-61.5) had IgG antibodies and 46 had IgM antibodies (35.93%; CI: 28.14-44.54) against SARS-CoV-2. SARS-CoV-2 infection was common in 56% of the community health workers (CHWs), 50% of registered nurses, and licensed vocational nurses (33%). Following the COVID-19 vaccination, the percentage of infections among HCWs decreased from 47.83% to 4.35%.

CONCLUSION

These results demonstrate that (i) approximately 40% of the workers were infected with SARS-CoV-2 in 2021 and (ii) reinfections confirmed by RT-qPCR occurred in 14% of the HCWs after vaccination. The results provide valuable insights into the circulation of SARS-CoV-2 among HCWs in a primary care unit serving a minoritized community.

Ethnic inequalities in coverage and use of women's cancer screening in Peru

OBJECTIVE

This study aimed to assess ethnic inequalities in the coverage and utilization of cancer screening services among women in Peru.

METHODS

Data from the 2017-2023 Demographic and Family Health Survey in Peru were analyzed to evaluate ethnic disparities in screening coverage for breast and cervical cancer, including clinical breast examination (CBE), Pap smear test (PST), and mammography. Measures such as the GINI coefficient and Slope Index of Inequality (SII) were used to quantify coverage and utilization disparities among ethnic groups.

RESULTS

The study included 70,454 women aged 30-69. Among women aged 40-69, 48.31% underwent CBE, 84.06% received PST, and 41.69% underwent mammography. It was found inequalities in coverage for any cancer screening (GINI: 0.10), mammography (GINI: 0.21), CBE (GINI: 0.19), and PST (GINI: 0.06), in 25 Peruvian regions. These inequalities were more pronounced in regions with larger populations of Quechua, Aymara, and Afro-Peruvian women. In rural areas, Quechua or Aymara women (SII: -0.83, -0.95, and - 0.69, respectively) and Afro-Peruvian women (SII: -0.80, -0.92, and - 0.58, respectively) experienced heightened inequalities in the uptake of CBE, mammography, and PST, respectively. Like Quechua or Aymara women (SII: -0.50, SII: -0.52, and SII: -0.50, respectively) and Afro-Peruvian women (SII: -0.50, SII: -0.58, and SII: -0.44, respectively) with only a primary education.

CONCLUSION

Ethnic inequalities affect breast and cervical cancer screening coverage across regions in Peru. In Quechua, Aymara, and Afro-Peruvian women the uptake of mammography, CBE, and PST was less frequently than their white or mestizo counterparts. These inequalities are attributed to sociodemographic conditions such as lower education levels and residence in rural or non-capital areas.

Healthcare personnel in 2016-2019 prospective cohort infrequently got vaccinated, worked while ill, and frequently used antibiotics rather than antivirals against viral influenza illnesses

Background

Uncertainty about risk of illness and the value of influenza vaccines negatively affects vaccine uptake among persons targeted for influenza vaccination.

Methods

During 2016-2019, we followed a cohort of healthcare personnel (HCP) targeted for free-of-charge influenza vaccination in five Lima hospitals to quantify risk of influenza, workplace presenteeism (coming to work despite illness), and absenteeism (taking time off from work because of illness). The HCP who developed acute respiratory illnesses (ARI) (≥1 of acute cough, runny nose, body aches, or feverishness) were tested for influenza using reverse-transcription polymerase chain reaction (rt-PCR).

Findings

The cohort (2968 HCP) contributed 950,888 person-days. Only 36 (6%) of 605 HCP who participated every year were vaccinated. The HCP had 5750 ARI and 147 rt-PCR-confirmed influenza illnesses. The weighted incidence of laboratory-confirmed influenza was 10.0/100 person-years; 37% used antibiotics, and 0.7% used antivirals to treat these illnesses. The HCP with laboratory-confirmed influenza were present at work while ill for a cumulative 1187 hours.

Interpretation

HCP were frequently ill and often worked rather than stayed at home while ill. Our findings suggest the need for continuing medical education about the risk of influenza and benefits of vaccination and stay-at-home-while-ill policies.

Real-world effectiveness and factors associated with effectiveness of inactivated SARS-CoV-2 vaccines: a systematic review and meta-regression analysis

BACKGROUND

The two inactivated SARS-CoV-2 vaccines, CoronaVac and BBIBP-CorV, have been widely used to control the COVID-19 pandemic. The influence of multiple factors on inactivated vaccine effectiveness (VE) during long-term use and against variants is not well understood.

METHODS

We selected published or preprinted articles from PubMed, Embase, Scopus, Web of Science, medRxiv, BioRxiv, and the WHO COVID-19 database by 31 August 2022. We included observational studies that assessed the VE of completed primary series or homologous booster against SARS-CoV-2 infection or severe COVID-19. We used DerSimonian and Laird random-effects models to calculate pooled estimates and conducted multiple meta-regression with an information theoretic approach based on Akaike's Information Criterion to select the model and identify the factors associated with VE.

RESULTS

Fifty-one eligible studies with 151 estimates were included. For prevention of infection, VE associated with study region, variants, and time since vaccination; VE was significantly decreased against Omicron compared to Alpha (P = 0.021), primary series VE was 52.8% (95% CI, 43.3 to 60.7%) against Delta and 16.4% (95% CI, 9.5 to 22.8%) against Omicron, and booster dose VE was 65.2% (95% CI, 48.3 to 76.6%) against Delta and 20.3% (95% CI, 10.5 to 28.0%) against Omicron; primary VE decreased significantly after 180 days (P = 0.022). For the prevention of severe COVID-19, VE associated with vaccine doses, age, study region, variants, study design, and study population type; booster VE increased significantly (P = 0.001) compared to primary; though VE decreased significantly against Gamma (P = 0.034), Delta (P = 0.001), and Omicron (P = 0.001) compared to Alpha, primary and booster VEs were all above 60% against each variant.

CONCLUSIONS

Inactivated vaccine protection against SARS-CoV-2 infection was moderate, decreased significantly after 6 months following primary vaccination, and was restored by booster vaccination. VE against severe COVID-19 was greatest after boosting and did not decrease over time, sustained for over 6 months after the primary series, and more evidence is needed to assess the duration of booster VE. VE varied by variants, most notably against Omicron. It is necessary to ensure booster vaccination of everyone eligible for SARS-CoV-2 vaccines and continue monitoring virus evolution and VE.

TRIAL REGISTRATION

PROSPERO, CRD42022353272.