The effectiveness of COVID-19 vaccines in reducing the incidence, hospitalization, and mortality from COVID-19: A systematic review and meta-analysis

Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Adults with Underlying Medical Conditions: Systematic Literature Review and Pairwise Meta-Analysis Using GRADE

INTRODUCTION

This systematic literature review and pairwise meta-analysis evaluated the comparative effectiveness of mRNA-1273 versus BNT162b2 in patients with at least one underlying medical condition at high risk for severe COVID-19.

METHODS

MEDLINE, Embase, and Cochrane databases were searched for relevant articles from January 1, 2019 to February 9, 2024. Studies reporting effectiveness data from at least two doses of mRNA-1273 and BNT162b2 vaccination in adults with medical conditions at high risk of developing severe COVID-19 according to the US Centers for Disease Control and Prevention were included. Outcomes of interest were SARS-CoV-2 infection (overall, symptomatic, and severe), hospitalization due to COVID-19, and death due to COVID-19. Risk ratios (RRs) were calculated with random effects models. Subgroup analyses by specific medical conditions, number of vaccinations, age, and SARS-CoV-2 variant were conducted. Heterogeneity between studies was estimated with chi-square testing. The certainty of evidence was assessed using the Grading of Recommendations, Assessments, Development, and Evaluations framework.

RESULTS

Sixty-five observational studies capturing the original/ancestral-containing primary series to Omicron-containing bivalent original-BA4-5 vaccinations were included in the meta-analysis. mRNA-1273 was associated with significantly lower risk of SARS-CoV-2 infection (RR, 0.85 [95% CI, 0.79-0.92]; I2 = 92.5%), symptomatic SARS-CoV-2 infection (RR, 0.75 [95% CI, 0.65-0.86]; I2 = 62.3%), severe SARS-CoV-2 infection (RR, 0.83 [95% CI, 0.78-0.89]; I2 = 38.0%), hospitalization due to COVID-19 (RR, 0.88 [95% CI, 0.82-0.94]; I2 = 38.7%), and death due to COVID-19 (RR, 0.84 [95% CI, 0.76-0.93]; I2 = 1.3%) than BNT162b2. Findings were generally consistent across subgroups. Evidence certainty was low or very low because sufficiently powered randomized controlled trials are impractical in this heterogeneous population.

CONCLUSION

Meta-analysis of 65 observational studies showed that vaccination with mRNA-1273 was associated with a significantly lower risk of SARS-CoV-2 infection and COVID-19-related hospitalization and death than BNT162b2 in patients with medical conditions at high risk of severe COVID-19.

Association between obstructive sleep apnea (OSA) and COVID-19 severity

Obstructive sleep apnea and sleep-related hypoxia have been associated with higher rates of hospitalization and mortality among patients with Coronavirus disease 2019 (COVID-19). We further explored the association between obstructive sleep apnea, COVID-19 severity and related mortality. In addition, we examined the effects of clinical and demographic parameters on COVID-19. In this retrospective study, we included adult patients who were diagnosed with COVID-19 prior to the Omicron variant identification. We compared the severity of COVID-19 and mortality with the diagnosis of obstructive sleep apnea. The study population included 44,275 patients who tested positive for COVID-19. Of these, 97% had mild or asymptomatic disease, 1.2% had moderate disease, and 1.8% had severe disease. Obstructive sleep apnea was diagnosed in 980 (2.2%) patients. In a multivariate analysis, obstructive sleep apnea diagnosis increased the risk of severe COVID-19 by 1.6 (95% confidence interval: 1.1-2.4) compared with mild disease. However, no increase in mortality was associated with obstructive sleep apnea. Interestingly, patients with moderate and high socioeconomic status had a 1.6 times higher risk for severe COVID-19 than patients from the low socioeconomic status group (95% confidence interval: 1.2-2.1 and 95% confidence interval: 1.1-2.3, respectively). The risk of dying due to COVID-19 was 1.6 (95% confidence interval: 1.1-2.5) and 3.1 (95% confidence interval: 1.8-5.3) times higher in patients with medium and high socioeconomic status, respectively, compared with patients with low socioeconomic status. Diagnosis of obstructive sleep apnea was found to be an independent risk factor for severe COVID-19. The higher the socioeconomic status, the higher the risk of severe COVID-19 morbidity and mortality.

COVID-19 Vaccination and Cardiovascular Events: A Systematic Review and Bayesian Multivariate Meta-Analysis of Preventive Benefits and Risks

Background

To provide a detailed understanding and apply a comprehensive strategy, this study examines the association between COVID-19 vaccination and cardiovascular events. We conducted a Bayesian multivariate meta-analysis using summary data across multiple outcomes including myocardial infarction, stroke, arrhythmia, and CAD, considering potential dependencies in the data. Markov chain Monte Carlo (MCMC) methods were detected for easy implementation of the Bayesian approach. Also, the sensitivity analysis of the model was done by using different priors.

Methods

Fifteen studies were included in the systematic review, with eleven studies comparing the results between the vaccine group and the unvaccinated group. Additionally, six studies were used for further analysis to compare mRNA COVID-19 Vaccines (Pfizer-BioNTech and Moderna).

Results

Bayesian meta-analysis revealed a link between vaccines and CAD risk (OR, 1.70; 95% CrI: 1.11-2.57), particularly after BNT162b2 (OR, 1.64; 95% CrI: 1.06-2.55) and second dose (OR, 3.44; 95% CrI: 1.99-5.98). No increased risk of heart attack, arrhythmia, or stroke was observed post-COVID-19 vaccination. As the only noteworthy point, a protective effect on stroke (OR, 0.19; 95% CrI: 0.10-0.39) and myocardial infarction (OR, 0.003; 95% CrI: 0.001-0.006) was observed after the third dose of the vaccine.

Conclusions

Secondary analysis showed no notable disparity in cardiovascular outcomes between BNT162b2 and mRNA vaccines. The association of COVID-19 vaccination with the risk of coronary artery disease should be considered in future vaccine technologies for the next pandemic.

Intention and potential determinants of COVID-19 vaccination among healthcare workers at a single university hospital in Japan, 2024-2025 pre-season

BACKGROUND

Financial accessibility has emerged as a significant barrier to vaccine uptake following the cessation of universal public funding for coronavirus disease 2019 (COVID-19) vaccination programs. This investigation assessed the intention and determinant factors of COVID-19 vaccination among healthcare workers in Japan in the 2024-2025 pre-season.

METHODS

A retrospective survey was conducted utilizing data collected from hospital staff at Okayama University Hospital, Japan, to inform the COVID-19 vaccination strategy in October 2024. The analysis evaluated demographic characteristics, vaccine intention, perceived barriers to vaccination, and maximum acceptable out-of-pocket expenditure.

RESULTS

The study population of 3417 respondents comprised 843 medical doctors (24.7 %), 1131 nurses (33.1 %), 320 other medical staff (9.4 %), 286 dental doctors (8.4 %), and 627 administrative officers (18.3 %). At full cost, 2109 (61.7 %) indicated no intention to receive vaccination, while only 4.4 % expressed willingness to be vaccinated and 33.9 % remained undecided. With total self-payment, the vaccination acceptance rates were the highest and lowest among medical doctors (11.4 %) and nurses (1.0 %), respectively. Cost (38.1 %), followed by safety issues (29.5 %) and concerns regarding efficacy or medical necessity (20.3 %), emerged as the primary barrier. The projected vaccination intention increased to 43.9 % and 54.9 % at reduced self-pay costs of 3000 JPY and 5000 JPY, respectively.

CONCLUSIONS

Addressing financial constraints through policy interventions could be effective strategies in increasing overall vaccination coverage among healthcare workers. In addition, providing tailored education on vaccine safety, efficacy, and necessity may further facilitate increased vaccine uptake within this critical population.

Predictors of COVID-19 Vaccination Intention and Behavior Among Young People in a European Union Country With Low COVID-19 Vaccination Rates: Cross-Sectional Study

BACKGROUND

Vaccination against COVID-19 is a critical measure for managing the pandemic and achieving herd immunity. In 2021, Slovenia had a significantly lower COVID-19 vaccination rate compared to the average rate in the European Union, with individuals aged younger than 37 years showing the highest hesitancy. Previous studies primarily explored vaccination willingness before vaccines were available to young people, leaving a gap in understanding the factors influencing vaccination behavior and differences within the population of young people.

OBJECTIVE

This study aimed to investigate a wide set of predictors influencing COVID-19 vaccination intention and behavior among young people in Slovenia. Specifically, we aimed to compare vaccinated and unvaccinated young people, further categorizing the unvaccinated group into those who were hesitant, those who intended to vaccinate in the near future, and those who refused vaccination.

METHODS

An integrated model, based on the health belief model and theory of planned behavior, was developed, and it included additional contextual factors (such as trust in science, trust in vaccines, conspiracy theory tendencies, etc) and health-related and sociodemographic characteristics. Data were collected in August 2021 via the online access survey panel JazVem (Valicon), targeting individuals aged 15-30 years in Slovenia. Quotas ensured that the sample (n=507) was quasi-representative according to age, gender, education, and region. Bivariate analyses and multinomial logistic regression were performed to explore the determinants of vaccination intention and behavior.

RESULTS

Among respondents, 45.8% (232/507) were vaccinated, 30.0% (152/507) refused vaccination, 12.4% (63/507) were hesitant, and 11.8% (60/507) intended to undergo vaccination in the near future. Vaccinated individuals were predominantly aged 23-26 years, had higher education, and reported above-average material status. Refusers were more common among the youngest (15-18 years) and oldest (27-30 years) groups, had lower education, and showed higher conspiracy theory tendencies. Multinomial regression analysis revealed that unvaccinated respondents who perceived greater COVID-19-related health consequences were more likely to delay vaccination (adjusted odds ratio [aOR] 2.0, 95% CI 1.2-3.3) or exhibit hesitancy (aOR 1.9, 95% CI 1.1-3.2) compared with vaccinated respondents. Subjective norms were less influential among hesitant individuals (aOR 0.4, 95% CI 0.2-0.7) and refusers (aOR 0.3, 95% CI 0.2-0.7) than among vaccinated individuals. Self-efficacy in managing health problems was less evident among those who delayed vaccination to the near future (aOR 0.5, 95% CI 0.3-0.9) than among vaccinated individuals.

CONCLUSIONS

This study underscores the complexity of vaccination intentions and behaviors among young people, emphasizing the necessity for public health strategies promoting vaccination to be tailored to the specific reasons for nonvaccination within different subgroups. Interventions aimed at addressing vaccine hesitancy and delays should particularly focus on individuals with lower education and material disadvantages. By fostering trust and enhancing self-efficacy, these interventions could more effectively promote vaccine uptake.

Estimates of SARS-CoV-2 Infections and Population Immunity After the COVID-19 Pandemic in Austria: Analysis of National Wastewater Data

BACKGROUND

Postpandemic surveillance data on coronavirus disease 2019 (COVID-19) infections may help inform future public health policies regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, vaccinations, or other COVID-19 measures. We estimate the total SARS-CoV-2 infections in Austria after the end of the pandemic from wastewater data and utilize these estimates to calculate the average national levels of SARS-CoV-2 infection protection and COVID-19 death protection.

METHODS

We estimated the total SARS-CoV-2 infections in Austria after the end of the pandemic (5 May 2023, per World Health Organization) up to May 2024 from wastewater data using a previously published model. These estimates were used in an agent-based model (ABM) to estimate average national levels of SARS-CoV-2 infection protection and COVID-19 death protection, based on waning immunity estimates of infections and vaccination in previous literature.

RESULTS

We estimate approximately 3.2 million infections between 6 May 2023 and 23 May 2024, with a total of 17.8 million infections following 12 May 2020. The ABM estimates that the national average death protection was approximately 82% higher in May 2024 than before the pandemic. This represents a relative decrease of 8% since May 2023. It also shows that 95% of people in Austria were infected with SARS-CoV-2 at least once by May 2024. National infection protection remained relatively low after the onset of Omicron.

CONCLUSIONS

These findings should be considered for public health decisions on SARS-CoV-2 testing practices and vaccine booster administrations.

Boost your health (Refuerza tu Salud): Design of a randomized controlled trial of a community health worker intervention to reduce inequities in COVID-19 and influenza vaccinations

INTRODUCTION

Low-income and underserved populations, especially racial and ethnic minorities, experience health disparities linked to social determinants. The COVID-19 pandemic amplified these disparities, necessitating effective strategies to address structural racism and related factors. Vaccination, crucial for mitigating infectious diseases, including COVID-19 and influenza, remains challenging among underserved populations. Community health worker (CHW) interventions show promise in addressing these disparities but have not undergone rigorous evaluation with a randomized controlled trial to increase vaccination uptake among underserved populations. This study develops and evaluates a CHW vaccination behavior (CHW-VB) intervention to increase COVID-19 and influenza vaccination among adult patients in primary care settings.

METHODS

Tailoring of the Boost Your Health (Refuerza tu Salud) intervention is grounded in behavior change theory and integrates input from a Community Advisory Board. The study employs a patient randomized controlled trial design to test the effectiveness the CHW-VB intervention compared with usual care across six Federally Qualified Health Centers (FQHCs) in New York. Patients are being screened for eligibility (vaccinated but not up to date with the COVID-19 vaccine and have at least one of seven common chronic illnesses) and 800 are assessed at baseline and three months. Outcomes include COVID-19 vaccine (primary) and influenza vaccine (secondary) uptake. The study also evaluates intervention implementation using the RE-AIM model.

CONCLUSION

Boost Your Health aims to increase COVID-19 and influenza vaccination among racially/ethnically diverse, underserved populations with chronic illness through the CHW-VB intervention, targeting critical gaps in vaccination uptake to reduce health disparities and increase health equity.

TRIAL REGISTRATION

(ClinicalTrials.govNCT06156254).

Temporal trends in the incidence and case severity of COVID-19 cases among the Syrian refugees in Azraq camp in Jordan: A retrospective observational study

BACKGROUND

Azraq Syrian refugee camp, located in Jordan, is where the challenges of managing the COVID-19 epidemic meet the vulnerabilities of displaced people. This study aimed to investigate the epidemiological characteristics, incidence, risk factors, and outcomes of COVID-19 among Azraq camp residents.

METHODS

COVID-19 data from Azraq camp were collected by International Medical Corps clinics and analyzed retrospectively from August 1, 2020, to August 31, 2022. Data included demographics, risk factors, testing history, contact tracing, and vaccination profiles. We estimated COVID-19 incidence and analyzed risk factors using Poisson and multilevel logistic regression.

RESULTS

A total of 2,468 confirmed COVID-19 cases were identified, with a prevalence of 5.6 per 100 residents. The camp's monthly incidence rate was more than 50% lower than the national rate, with a 1.7% monthly decrease. Females had a higher incidence than males (6.4% vs. 4.9%, p < 0.001), while the elderly bore the greatest disease burden. Home-based isolation was the main strategy, except during the second wave. Vaccination coverage reached 31.6%, primarily with Pfizer (49.8%). Symptomatic cases made up 44.0% of confirmed cases, with 10.4% requiring hospitalization. Factors independently associated with hospitalization included age, comorbidity, and vaccination status.

CONCLUSION

The study highlights the need for robust surveillance, targeted healthcare interventions, equitable resource allocation, and vaccination campaigns to manage COVID-19 and future epidemics in refugee camps.

Impact of vaccination against SARS-CoV-2 on mortality risk, ICU admission rate, and hospitalization length in hospitalized COVID-19 patients: a cross-sectional study

BACKGROUND

Vaccination against SARS-CoV-2 has been crucial in impeding virus spread and preventing fatal complications. Despite growing evidence of vaccine efficacy, data on its impact on hospitalized patients remain limited. We aimed to estimate the risk of mortality, ICU admission, and hospitalization length among hospitalized COVID-19 patients based on vaccination status.

METHODS

In this single-center cross-sectional study, we included patients above 16 years old hospitalized due to COVID-19. Patients were categorized as unvaccinated, partially vaccinated (single dose), or fully vaccinated (at least one booster dose). We performed logistic and linear regression analyses, including both bivariable and multivariable models, to evaluate the association between vaccination status, demographic characteristics, and study outcomes.

RESULTS

Of 299 participants, 21.7%, 15.7%, and 62.5% were unvaccinated, partially vaccinated, and fully vaccinated, respectively. Full vaccination was associated with significantly reduced mortality risk (OR: 0.235, 95%CI: 0.103-0.538) and lower ICU admission rates (OR: 0.252, 95%CI: 0.131-0.484). Vaccinated patients had shorter hospital stays (fully vaccinated: 6.38 ± 1.65 days; unvaccinated: 9.22 ± 2.84 days, p < 0.001). Older age independently predicted higher mortality (OR: 1.062, 95%CI: 1.030-1.095), ICU admission (OR: 1.047, 95%CI: 1.027-1.068), and longer hospital stays (estimate: 0.027, 95%CI: 0.012-0.043). Multiple comorbidities were associated with higher mortality and longer hospitalization (OR: 1.794, 95%CI: 1.244-2.587; estimate: 0.395, 95%CI: 0.142-0.648).

CONCLUSION

Full vaccination against SARS-CoV-2 is associated with significantly improved clinical outcomes in hospitalized COVID-19 patients, including reduced mortality, lower ICU admission rates, and shorter hospital stays.

COVID-19 Vaccines Effectiveness and Safety in Trinidad and Tobago: A Systematic Review and Meta-Analysis

This systematic review evaluated the effectiveness and side effects of various COVID-19 vaccines, with a focus on Trinidad and Tobago. The Pfizer-BioNTech and Moderna vaccines demonstrated the highest efficacy, particularly against COVID-19 variants, while Janssen and Sinopharm were comparatively less effective. mRNA vaccines, such as Pfizer-BioNTech and Oxford-AstraZeneca, were associated with more frequent and severe side effects, including soreness, fever, and cardiovascular issues. The review also identified significant gaps in the current scientific literature regarding COVID-19 vaccination issues in Trinidad and Tobago. These gaps highlight the need for comprehensive research to address vaccination challenges, including public health communication, equitable access, and local perceptions of vaccine safety. This analysis provides a foundation for developing targeted strategies to improve vaccine effectiveness in the region.

Recognition and cleavage of human tRNA methyltransferase TRMT1 by the SARS-CoV-2 main protease

The SARS-CoV-2 main protease (Mpro or Nsp5) is critical for production of viral proteins during infection and, like many viral proteases, also targets host proteins to subvert their cellular functions. Here, we show that the human tRNA methyltransferase TRMT1 is recognized and cleaved by SARS-CoV-2 Mpro. TRMT1 installs the N2,N2-dimethylguanosine (m2,2G) modification on mammalian tRNAs, which promotes cellular protein synthesis and redox homeostasis. We find that Mpro can cleave endogenous TRMT1 in human cell lysate, resulting in removal of the TRMT1 zinc finger domain. Evolutionary analysis shows the TRMT1 cleavage site is highly conserved in mammals, except in Muroidea, where TRMT1 is likely resistant to cleavage. TRMT1 proteolysis results in reduced tRNA binding and elimination of tRNA methyltransferase activity. We also determined the structure of an Mpro-TRMT1 peptide complex that shows how TRMT1 engages the Mpro active site in an uncommon substrate binding conformation. Finally, enzymology and molecular dynamics simulations indicate that kinetic discrimination occurs during a later step of Mpro-mediated proteolysis following substrate binding. Together, these data provide new insights into substrate recognition by SARS-CoV-2 Mpro that could help guide future antiviral therapeutic development and show how proteolysis of TRMT1 during SARS-CoV-2 infection impairs both TRMT1 tRNA binding and tRNA modification activity to disrupt host translation and potentially impact COVID-19 pathogenesis or phenotypes.

Comparing COVID-19 literacy and vaccine hesitancy among health care workers, including oral health professionals, in Japan

BACKGROUND

Oral health professionals should have good COVID-19 vaccine literacy as should physicians and nurses. However, little is known about COVID-19 literacy and vaccine hesitancy among oral health professionals in Japan.

AIMS

This study aimed to investigate the status of COVID-19 literacy and vaccine hesitancy among oral health professionals by comparing them with other healthcare workers (HCWs).

METHODS

To compare these differences, a self-administered questionnaire-based survey of 596 staff members was conducted in March 2023 at schools, an affiliated hospital, and elderly care facilities after the staff who wished to receive it completed the fifth dose of COVID-19 vaccinations. Comparison between the recognition levels and number of vaccine doses among the HCWs were examined using the Kruskal-Wallis tests. Defining the third or lower doses of COVID-19 vaccine as vaccine hesitancy, factors associated with the hesitancy were examined using logistic regression analysis.

RESULTS

In total, 408 (68.5%) participants were enrolled for the study. Dental hygienists' COVID-19 literacy levels were lower compared to those of nurses and physicians. Dentists received a significantly lower number of vaccine doses than did physicians. Vaccine hesitancy was positively associated with younger age and higher concern about the adverse effects of the vaccine, but it was not associated with occupation.

CONCLUSION

Interventions to improve the low COVID-19 literacy and high COVID-19 vaccine hesitancy among oral health professionals, particularly young ones, are needed for COVID-19 and future pandemics.

Effectiveness of AstraZeneca vaccine against SARS-CoV-2 (ChAdox1-S) in reducing in-hospital mortality in individuals with COVID-19 and schizophrenia: A retrospective cohort study

ChAdOx1-S is a viral vector vaccine developed by AstraZeneca. We aimed to assess the effectiveness of 1 and 2 doses of the ChAdOx1-S vaccine in reducing COVID-19-related in-hospital mortality in individuals with schizophrenia. This is a retrospective cohort study using a nationwide hospital database in Brazil. Individuals diagnosed with COVID-19 and schizophrenia were included in the study. The exposures were 0, 1, and 2 doses of ChAdOx1-S. The outcome of mortality was measured in hazard ratios (HR), calculated using multivariable Cox regression models. The study included 1,929 positive cases of COVID-19 in schizophrenia patients. After adjusting for age, socioeconomic factors, and comorbidities, we observed a significant 55% decrease in the hazard of mortality in the 2-dose vaccination group (HR 0.45, 95% CI: 0.310-0.652) compared to the unvaccinated. Surprisingly, our results did not show any significant reduction in the hazard of mortality in the 1 dose vaccination group (HR 1.278, 95% CI: 0.910-1.795). The effectiveness of two doses of ChAdOx1-S in individuals with schizophrenia aligns with findings from studies on the general population. That one dose was insignificant. Overall, these findings are important for informing public health decisions - prioritizing individuals with schizophrenia for vaccinations and managing acceptance of vaccines.

Flares and Predicting Factors of Flares in Patients with Systemic Lupus Erythematosus Associated with Different Doses and Types of COVID-19 Vaccines

Objectives: To compare disease activity and flares among different doses and types of COVID-19 vaccines in systemic lupus erythematosus (SLE) patients. Methods: SLE patients in a lupus cohort, who received at least one dose of a COVID-19 vaccine (inactivated virus, adenovirus-vectored, or mRNA vaccines) between March and October 2022 joined this study. The data regarding disease activity and flares after each dose were reviewed and compared. Results: Two hundred and one SLE patients (524 total doses) were included in this study, with 201, 199, and 124 of them receiving 1, 2, and 3 doses of a vaccine, respectively, which comprised 183, 128, and 213 doses of inactivated virus, adenovirus-vectored, and mRNA vaccines, respectively. Regardless of vaccine dose or type, there were no significant changes in SLE disease activity pre- or post-vaccination. Flares were significantly more common after the 2nd and 3rd doses than after the 1st one (20.10% and 17.74% vs. 8.96%, p = 0.001, and p = 0.010, respectively), and after inactivated virus, adenovirus-vectored and mRNA vaccinations in 11.48%, 14.84%, and 17.84% of the patients (p = ns), respectively. However, the incidence rate of flares/100 patient-months was not different. The majority of flares were severe, with renal flares being the most frequent. Renal and mucocutaneous involvement and high SLE disease activity prior to the 1st vaccine dose were independent factors that predicted flares. Conclusions: Flares after COVID-19 vaccination were not uncommon. Most of the flares were severe, mainly due to renal flares. SLE patients should have stable low disease activity prior to receiving COVID-19 vaccine in order to avoid flares.

Effect of the COVID-19 vaccination on feto-maternal outcomes: A prospective cohort study among Indian pregnant women

Background & objectives Studies on the effects of COVID-19 vaccination among pregnant women in Asian settings, more specifically in India, are scarce. The present study evaluated the feto-maternal outcomes among Indian pregnant women who received the COVID-19 vaccine. Methods A prospective cohort study was undertaken among 430 pregnant women from two primary health centres (PHC) in Chandigarh, India during 2021-2022. The feto-maternal outcomes evaluated in the study included abortions, live birth/stillbirth, term/pre-term/post-term delivery, mode of delivery (normal vaginal/caesarean section/forceps), birth weight and intrauterine growth retardation. Results Of the 430 study participants, 295 pregnant women received COVID-19 vaccines, with an uptake rate of 68.6 per cent. Majority of vaccinated women (280- who completed the study) were in their second trimester (133, 47.5%), while 92 (32.9%) were in their third, and 55 (19.6%) were in their first trimester when they were enrolled in the study. Neonatal intensive care unit (NICU) admission was significantly lower among the vaccinated pregnant women, while other feto-maternal and neonatal outcomes were similar between vaccinated and unvaccinated pregnant women. Interpretation & conclusions The findings of this study suggest COVID-19 vaccination in pregnant women in India might be safe, in terms of feto-maternal outcomes.

The Effectiveness of COVID-19 Vaccination on Post-Acute Sequelae of SARS-CoV-2 Infection Among Geriatric Patients

This study aims to evaluate the effectiveness of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in preventing the post-acute sequelae of SARS-CoV-2 infection (PASC), commonly known as long COVID, and reducing all-cause mortality among older patients. A retrospective cohort study was conducted using the TriNetX database. The study cohort consisted of older patients (age ≥ 65 years) with their first COVID-19 illness between January 1, 2022, and May 31, 2024. Participants were divided into vaccinated and unvaccinated groups based on their vaccination status. Propensity score matching (PSM) was used to balance baseline characteristics. Cox regression models and log-rank tests were applied to estimate the hazard ratio (HR) for PASC and all-cause mortality during 30-180 days of follow-up. The study included 189 059 geriatric patients who contracted SARS-CoV-2, with 5615 vaccinated and 183 444 unvaccinated. After PSM, each group contained 5615 patients. Vaccinated patients exhibited a significantly lower incidence of PASC symptoms (HR = 0.852, 95% CI: 0.778-0.933, p = 0.0005), particularly anxiety and depression, with a HR of 0.710 (95% CI: 0.575-0.878, p = 0.0015). Vaccination was also significantly associated with reduced all-cause mortality (HR = 0.231, 95% CI: 0.136-0.394, p < 0.0001). The findings highlight the effectiveness of COVID-19 vaccination in mitigating the development of PASC and decreasing mortality among older patients.

Association between vaccination and persistent COVID-19-related symptoms among patients with mild Omicron infection: A prospective cohort study

Background

While COVID-19 vaccination has been shown to reduce the risk of severe illness, its impact on the occurrence of persistent symptoms in patients with mild Omicron infection remains uncertain. Our objective was to investigate whether COVID-19 vaccination reduces the occurrence of persistent COVID-19-related symptoms 3 months after mild Omicron infection.

Methods

Multicenter prospective cohort study was conducted in Brazil between January 2022 and June 2023 when Omicron was predominant. Participants ≥ 18 years seeking outpatient care for symptomatic SARS-CoV-2 infection were enrolled. Complete vaccination included individuals who received the full primary series and any booster dose, while incomplete vaccination included those with incomplete primary series or no vaccination. The primary outcome was any persistent symptoms at 3 months. Secondary outcomes were organ system-specific persistent symptoms and the EQ-5D-3L utility score. All outcomes were assessed by means of structured telephone interviews 3 months after enrollment.

Results

1,067 patients were enrolled (median age, 39 years), of which 914 (871 completely vaccinated and 43 unvaccinated or incompletely vaccinated). Among the vaccinated participants the median time since the last vaccine dose was 145 (interquartile range, 106-251) days. A total of 388/1067 (36.9 %) had a prior infection at the time of study entry. The occurrence of overall persistent COVID-19-related symptoms at 3 months was 41.6 % (n = 362) among completely vaccinated and 44.2 % (n = 19) among unvaccinated or incompletely vaccinated patients (adjusted risk ratio [aRR], 0.87; 95 % confidence interval [CI], 0.61-1.23; p = 0.43). Complete vaccination was associated with lower occurrence of mental health symptoms (aRR, 0.44; 95 % CI, 0.24-0.81; p = 0.01). No differences were found in the occurrence of persistent symptoms in other specific domains, nor in EQ-5D-3L utility scores.

Conclusions

This study was not able to identify a statistically significant protection of complete COVID-19 vaccination against any overall persistent symptoms at 3 months. Nevertheless, complete vaccination was associated with a lower occurrence of persistent mental health symptoms.

Understanding the COVID-19 vaccine uptake, acceptance, and hesitancy in Ethiopia and Tanzania: a scoping review

Background

The development and implementation of COVID-19 vaccines have been a breakthrough in controlling the pandemic. However, the vaccination coverage in most low-income countries remains very low due to critical vaccine shortage and profound hesitancy. In this scoping review, we aimed to assess COVID-19 vaccine uptake, acceptance, and hesitancy in Ethiopia and Tanzania.

Methods

The search was made in PubMed, Scopus, Embase, and Web of Science. Only original research articles focusing on vaccine acceptance and hesitancy were included. The studies selected for a full read were analysed using a thematic analysis approach.

Findings

A total of 76 articles were included in the study, with 74 of them coming from Ethiopia. The study found an increasing trend in vaccine uptake over time. However, there was also an increase in hesitancy and a decline in willingness to receive the vaccine. The willingness to receive the COVID-19 vaccine in Ethiopia ranged from 18.5 to 88%. The main reasons for "vaccine hesitancy" included fear of side effects, concerns about long-term safety, doubts about vaccine effectiveness, lack of information, vaccine fast-tracking, and religious beliefs. The study also found that younger individuals, females, and pregnant women were less willing to receive the vaccine. The adverse events reported among vaccinated individuals were mostly mild. Most of the studies operationalised vaccine acceptance-hesitancy as dichotomous variables. However, the historical, political, and socio-cultural context in which vaccine acceptance and hesitancy occur was not given any attention. While there is a good amount of data from Ethiopia describing patterns of vaccine acceptance and hesitancy among different populations over time, there is limited information from Tanzania due to the late arrival of the vaccine and limited published articles.

Conclusion

We have observed a paradox involving two seemingly conflicting trends: an increase in vaccination rates/coverage and "anti-vax." Most studies have simplified vaccine acceptance-hesitancy as an "either-or" incident, without considering its dynamic nature and occurrence within a broader political, social, and cultural context. Therefore, it is crucial to explore approaches that can enhance our understanding of the vaccine acceptance-hesitancy phenomenon, in order to improve vaccine trust and uptake.

In vivo evaluation of Andrographis paniculata and Boesenbergia rotunda extract activity against SARS-CoV-2 Delta variant in Golden Syrian hamsters: Potential herbal alternative for COVID-19 treatment

The ongoing COVID-19 pandemic has triggered extensive research, mainly focused on identifying effective therapeutic agents, specifically those targeting highly pathogenic SARS-CoV-2 variants. This study aimed to investigate the in vivo antiviral efficacy and anti-inflammatory activity of herbal extracts derived from Andrographis paniculata and Boesenbergia rotunda, using a Golden Syrian hamster model infected with Delta, a representative variant associated with severe COVID-19. Hamsters were intranasally inoculated with the SARS-CoV-2 Delta variant and orally administered either vehicle control, B. rotunda, or A. paniculata extract at a dosage of 1000 mg/kg/day. Euthanasia was conducted on days 1, 3, and 7 post-inoculation, with 4 animals per group. The results demonstrated that oral administration of A. paniculata extract significantly alleviated both lethality and infection severity compared with the vehicle control and B. rotunda extract. However, neither extract exhibited direct antiviral activity in terms of reducing viral load in the lungs. Nonetheless, A. paniculata extract treatment significantly reduced IL-6 protein levels in the lung tissue (7278 ± 868.4 pg/g tissue) compared to the control (12,495 ± 1118 pg/g tissue), indicating there was a decrease in local inflammation. This finding is evidenced by the ability of A. paniculata extract to reduce histological lesions in the lungs of infected hamsters. Furthermore, both extracts significantly decreased IL-6 and IP-10 mRNA expression in peripheral blood mononuclear cells of infected hamsters compared to the control group, suggesting systemic anti-inflammatory effects occurred. In conclusion, A. paniculata extract's potential therapeutic application for SARS-CoV-2 arises from its observed capacity to lessen inflammatory cytokine concentrations and mitigate lung pathology.

Levels of high-sensitive troponin T and mid-regional pro-adrenomedullin after COVID-19 vaccination in vulnerable groups: monitoring cardiovascular safety of COVID-19 vaccination

Background

COVID-19 vaccines are well tolerated and effective but may have adverse effects on the cardiovascular system. Vaccine-associated myocardial injury was analysed by measuring high-sensitive troponin T (hsTnT); mid-regional pro-adrenomedullin (MR-proADM) levels were evaluated to assess endothelial dysfunction.

Methods

This was a prospective study with a vulnerable population of healthcare workers (HCWs) and elderly patients (>70 years) who were vaccinated with either one dose of ChAdOx1 nCov-19 adenoviral vector vaccine (AZ) followed by one dose of the BNT162b2 messenger RNA vaccine (BNT), or with two doses of BNT (12th of January - 30th of November 2021). HsTnT and MR-proADM were measured in blood samples at three visits (V1: 1st immediately before vaccination; V2, 3: 3-4 weeks after 1st and 2nd vaccination). HsTnT of HCWs was compared to a healthy reference population.

Results

N = 162 volunteers were included (V1 = 161; V2, V3 = 162 each). N = 74 (45.7%) received AZ/BNT and n = 88 (54.3%) received BNT/BNT [elderly: n = 20 (12.3%), HCWs: n = 68 (42.0%)]. Median hsTnT levels were 4 ng/L, 5 ng/L and 4 ng/L (V1-V3) for AZ/BNT and at 5 ng/L, 6 ng/L and 6 ng/L (V1-V3) for BNT/BNT. Compared to the reference population (n = 300), hsTnT was significantly higher at all visits for both vaccination groups (p < 0.01), without differences between the AZ/BNT and BNT/BNT cohort. Median MR-proADM values were 0.43 nmol/L, 0.45 nmol/L, 0.44 nmol/L (V1-V3) in the AZ/BNT cohort and 0.49 nmol/L, 0.44 nmol/L, 0.47 nmol/L for BNT/BNT, respectively. Change of median hsTnT and MR-proADM between visits did not show significant increases. One HCW experienced a permanent and three a transient hsTnT increase ≥14 ng/L.

Conclusion

No overall subtle, persistent cardiovascular involvement was observed after the 2nd COVID-19 vaccination. Elevated cardiovascular biomarkers in clinically asymptomatic individuals need further investigations.

Nationwide Cohort observational study on the safety and efficacy of COVID-19 vaccination in patients with Moyamoya disease

The safety and efficacy of coronavirus disease 2019 (COVID-19) vaccination in patients diagnosed with Moyamoya disease (MMD) have not been established. Using National Health Insurance Service data, this study analyzed the occurrence of stroke-related events and mortality following COVID-19 vaccination among patients diagnosed with MMD from 2008 to 2020. Among 10,297 MMD patients, 296 (2.9%) experienced events and 175 (1.7%) died in 2021. Significant risk factors for events included ages 50-59 (Odds Ratio [OR] 3.29; P = 0.022) and 60 or above (OR 5.20; P = 0.001) (reference group: age in 20s), low BMI (OR 2.00; P = 0.011), previous stroke (OR 1.96; P < 0.001), and COVID-19 infection (OR 2.28; P = 0.034). Female (OR 0.64 [95% CI 0.50-0.82]; p = 0.011), revascularization surgery (RS) (OR 0.38 [95% CI 0.21-0.70]; p < 0.001), and vaccination (OR 0.17 [95% CI 0.13-0.22]; p < 0.001) were associated with reduced odds of stroke-related events. For mortality, significant risks were age over 60 (OR 7.09; P = 0.008), low BMI (OR 3.87; P = 0.001), and prior stroke (OR 1.74; p = 0.004), while being female, RS (OR 0.41; P = 0.022), and vaccination (OR 0.12; P < 0.001) were associated with a lower frequency of mortality. mRNA vaccines were associated with a significantly lower incidence of events, mortality, and COVID-19 infections compared to vector vaccines. COVID-19 vaccination is linked to reduced stroke-related events and mortality in MMD patients, with mRNA vaccines showing a significantly lower incidence compared to vector vaccines. COVID-19 infection raises the risk of events, underscoring the benefit of vaccination.

Recognition and Cleavage of Human tRNA Methyltransferase TRMT1 by the SARS-CoV-2 Main Protease

The SARS-CoV-2 main protease (Mpro, or Nsp5) is critical for the production of functional viral proteins during infection and, like many viral proteases, can also target host proteins to subvert their cellular functions. Here, we show that the human tRNA methyltransferase TRMT1 can be recognized and cleaved by SARS-CoV-2 Mpro. TRMT1 installs the N 2,N 2-dimethylguanosine (m2,2G) modification on mammalian tRNAs, which promotes global protein synthesis and cellular redox homeostasis. We find that Mpro can cleave endogenous TRMT1 in human cell lysate, resulting in removal of the TRMT1 zinc finger domain. TRMT1 proteolysis results in elimination of TRMT1 tRNA methyltransferase activity and reduced tRNA binding affinity. Evolutionary analysis shows that the TRMT1 cleavage site is highly conserved in mammals, except in Muroidea, where TRMT1 is likely resistant to cleavage. In primates, regions outside the cleavage site with rapid evolution could indicate adaptation to ancient viral pathogens. Furthermore, we determined the structure of a TRMT1 peptide in complex with Mpro, revealing a substrate binding conformation distinct from the majority of available Mpro-peptide complexes. Kinetic parameters for peptide cleavage show that the TRMT1(526-536) sequence is cleaved with comparable efficiency to the Mpro-targeted nsp8/9 viral cleavage site. Mutagenesis studies and molecular dynamics simulations together indicate that kinetic discrimination occurs during a later step of Mpro-mediated proteolysis that follows substrate binding. Our results provide new information about the structural basis for Mpro substrate recognition and cleavage, the functional roles of the TRMT1 zinc finger domain in tRNA binding and modification, and the regulation of TRMT1 activity by SARS-CoV-2 Mpro. These studies could inform future therapeutic design targeting Mpro and raise the possibility that proteolysis of human TRMT1 during SARS-CoV-2 infection suppresses protein translation and oxidative stress response to impact viral pathogenesis.

Significance Statement

Viral proteases can strategically target human proteins to manipulate host biochemistry during infection. Here, we show that the SARS-CoV-2 main protease (Mpro) can specifically recognize and cleave the human tRNA methyltransferase enzyme TRMT1, and that cleavage of TRMT1 cripples its ability to install a key modification on human tRNAs that is critical for protein translation. Our structural and functional analysis of the Mpro-TRMT1 interaction shows how the flexible Mpro active site engages a conserved sequence in TRMT1 in an uncommon binding mode to catalyze its cleavage and inactivation. These studies provide new insights into substrate recognition by SARS-CoV-2 Mpro that could help guide future antiviral therapeutic development and show how proteolysis of TRMT1 during SARS-CoV-2 infection impairs both TRMT1 tRNA binding and tRNA modification activity to disrupt host translation and potentially impact COVID-19 pathogenesis or phenotypes.

Kaposi Sarcoma as a Possible Cutaneous Adverse Effect of ChAdOx1 nCov-19 Vaccine: A Case Report

The COVID-19 pandemic prompted the rapid development of vaccines, including the ChAdOx1 nCov-19 (AstraZeneca) vaccine. While effective, adverse effects have been reported, including cutaneous manifestations. Kaposi sarcoma (KS), a vascular tumor linked to Kaposi sarcoma herpesvirus/human herpesvirus 8 (HHV-8), has seen increased detection during the pandemic. This study reports a case of classic cutaneous KS in a 79-year-old male following the first dose of the ChAdOx1 nCov-19 vaccine, without prior SARS-CoV-2 infection. The patient developed multiple reddish-blue papules on his legs and feet, confirmed as KS through histopathology. Treatment included radiotherapy and sequential chemotherapy with Doxorubicin. The potential reactivation of latent HHV-8 by the vaccine is explored through mechanisms involving the SARS-CoV-2 spike protein and adenovirus vector, which may induce immune responses and inflammatory pathways. Although establishing a direct causal link remains challenging, the case highlights the need for vigilance regarding KS reactivation post-vaccination. Further large-scale studies are warranted to elucidate the relationship between COVID-19 vaccines and latent virus reactivation, ensuring comprehensive safety assessments and informed public health decisions.

Analytical Performance of a Multiplexed Microarray Assay for Rapid Identification and Quantification of a Multivalent mRNA Vaccine

mRNA vaccines were highly effective in response to the COVID-19 pandemic, making them an attractive platform to address cancers and other infectious diseases. Many new mRNA vaccines in development are multivalent, which represents a difficulty for the standard assays commonly used to characterize the critical quality attributes of monovalent formulations. Here, we present a multiplexed analytical tool with nucleic acid microarray technology using the VaxArray platform that measures the identity and quantity of mono- and multivalent mixtures of naked mRNA and mRNA encapsulated in lipid nanoparticle formulations in under 2 h without any additional preparation steps, such as extraction or RT-PCR. Using a quadrivalent mixture of encapsulated mRNA constructs that encode for four unique proteins in a vaccine formulation, the VaxArray mRNA assay was demonstrated to be highly specific for each mRNA with sensitivity < 1 µg/mL. The quantification of individual mRNAs within the lipid nanoparticle mixture resulted in a precision of ≤10% RSD and an accuracy of 100 ± 9%.

Informed consent for national registration of COVID-19 vaccination caused information bias of vaccine effectiveness estimates mostly in older adults: a bias correction study

OBJECTIVES

Registration in the Dutch national COVID-19 vaccination register requires consent from the vaccinee. This causes misclassification of nonconsenting vaccinated persons as being unvaccinated. We quantified and corrected the resulting information bias in vaccine effectiveness (VE) estimates.

STUDY DESIGN AND SETTING

National data were used for the period dominated by the SARS-CoV-2 Delta variant (July 11 to November 15, 2021). VE ((1-relative risk)∗100%) against COVID-19 hospitalization and intensive care unit (ICU) admission was estimated for individuals 12 to 49, 50 to 69, and ≥70 years of age using negative binomial regression. Anonymous data on vaccinations administered by the Municipal Health Services were used to determine informed consent percentages and estimate corrected VEs by iteratively imputing corrected vaccination status. Absolute bias was calculated as the absolute change in VE; relative bias as uncorrected/corrected relative risk.

RESULTS

A total of 8804 COVID-19 hospitalizations and 1692 COVID-19 ICU admissions were observed. The bias was largest in the 70+ age group where the nonconsent proportion was 7.0% and observed vaccination coverage was 87%: VE of primary vaccination against hospitalization changed from 75.5% (95% CI 73.5-77.4) before to 85.9% (95% CI 84.7-87.1) after correction (absolute bias -10.4 percentage point, relative bias 1.74). VE against ICU admission in this group was 88.7% (95% CI 86.2-90.8) before and 93.7% (95% CI 92.2-94.9) after correction (absolute bias -5.0 percentage point, relative bias 1.79).

CONCLUSION

VE estimates can be substantially biased with modest nonconsent percentages for vaccination data registration. Data on covariate-specific nonconsent percentages should be available to correct this bias.

Spatial nonstationarity and the role of environmental metal exposures on COVID-19 mortality in New Mexico

Worldwide, the COVID-19 pandemic has been influenced by a combination of environmental and sociodemographic drivers. To date, population studies have overwhelmingly focused on the impact of societal factors. In New Mexico, the rate of COVID-19 infection and mortality varied significantly among the state's geographically dispersed, and racially and ethnically diverse populations who are exposed to unique environmental contaminants related to resource extraction industries (e.g. fracking, mining, oil and gas exploration). By looking at local patterns of COVID-19 disease severity, we sought to uncover the spatially varying factors underlying the pandemic. We further explored the compounding role of potential long-term exposures to various environmental contaminants on COVID-19 mortality prior to widespread applications of vaccinations. To illustrate the spatial heterogeneity of these complex associations, we leveraged multiple modeling approaches to account for spatial non-stationarity in model terms. Multiscale geographically weighted regression (MGWR) results indicate that increased potential exposure to fugitive mine waste is significantly associated with COVID-19 mortality in areas of the state where socioeconomically disadvantaged populations were among the hardest hit in the early months of the pandemic. This relationship is paradoxically reversed in global models, which fail to account for spatial relationships between variables. This work contributes both to environmental health sciences and the growing body of literature exploring the implications of spatial nonstationarity in health research.

Effectiveness of vaccination (Sinopharm) among Covid-19 positive patients in a tertiary care hospital

The SARS-CoV-2, has caused a pandemic of acute respiratory disease, 'coronavirus disease 2019' (Covid-19), posed a major threat to health and the international economy during past few years. It is believed that vaccine can stop the rapid spread of the disease. The aim of this study was to evaluate the effect of the Sinopharm vaccine in terms of mortality and severity of the disease among Covid-19 positive patients. This observational cross-sectional study was done at the Department of Medicine and Department of Pathology Shaikh Khalifa Bin Zayed Al-Nahyan/CMH Teaching Hospital (Poonch Medical College), Rawalakot AJK Pakistan from July 2021 to September 2021. Total 350 individuals with greater than or equal to 18 years of age, who were tested positive for Covid-19, were included. Patients who had received two doses of the vaccine at least 28 days apart were considered as vaccinated. The Sinopharm vaccination status was checked among patients. The severity of Covid-19 was categorized as mild, moderate and severe. A log rank regression test was applied to determine significant difference in disease severity and survival rate. The patients age range was 25-60 years (the patients mean age was 55 years). The majority of participants, 69.1% (n=242), were vaccinated by Sinopharm, and 30.9% (n=108) were non-vaccinated. Most patients had mild disease 80% (n=280) followed by moderate disease 9.7% (n=34), and severe disease 6.6% (n=23), and stratification analysis had significant (p ≤ 0.05) association between vaccinated individuals and disease severity. The overall mortality rate was 3.7%. The mortality rate was 8% (n=9) in none vaccinated individuals, whereas 1.65% (n=4) in vaccinated individuals. The Sinopharm vaccine after both doses was found effective in reducing mortality and disease severity by 98.3% and 94.4%. The study concluded that Sinopharm vaccine after two doses at least 28 days apart given to patients, after two weeks of vaccination is highly effective in reducing the mortality, disease severity and hospital admission in Covid-19 positive patients.

Diabetic Mice Spleen Vulnerability Contributes to Decreased Persistence of Antibody Production after SARS-CoV-2 Vaccine

During the COVID-19 pandemic, diabetic and obese patients experienced higher rates of hospital admissions, severe illness, and mortality. However, vaccinations failed to provide those vulnerable populations the same level of protection against COVID-19 severity as those without diabetic and obese phenotypes. Our study aimed to investigate how diabetes mellitus (DM) impacts the immune response following vaccination including the artificially designed trimeric SARS-CoV-2 spike (S)-protein. By using two diabetic mouse models, ob/ob mice (obese, hyperglycemic, and insulin-resistant) and STZ-treated mice (insulin-deficient and hyperglycemic), we observed a significant reduction in S-protein-specific IgG antibody titer post-vaccination in both diabetic models compared to wild-type (WT) mice. Both diabetic mouse models exhibited significant abnormalities in spleen tissue, including marked reductions in splenic weight and the size of the white pulp regions. Furthermore, the splenic T-cell and B-cell zones were notably diminished, suggesting an underlying immune dysfunction that could contribute to impaired antibody production. Notably, vaccination with the S-protein, when paired with an optimal adjuvant, did not exacerbate diabetic cardiomyopathy, blood glucose levels, or liver function, providing reassurance about the vaccine's safety. These findings offer valuable insights into potential mechanisms responsible for the decreased persistence of antibody production in diabetic patients.

Effectiveness of COVID-19 Vaccines in People with Severe Mental Illness: A Systematic Review and Meta-Analysis

Prior to the introduction of COVID-19 vaccines, patients with severe mental illness (SMI) were at greater risk of COVID-19-related outcomes than the general population. It is not yet clear whether COVID-19 vaccines have reduced the risk gap. We systematically searched nine international databases and three Chinese databases to identify relevant studies from December 2020 to December 2023 to compare the risk of COVID-19-related outcomes for SMI patients to those without SMI after vaccination. Random effects meta-analysis was performed to estimate the pooled odds ratio (OR) with 95% confidence intervals (CI). Subgroup analysis, sensitivity analysis, and publication bias analysis were conducted with R software 4.3.0. A total of 11 observational studies were included. Compared with controls, SMI patients were associated with a slightly increased risk of infection (pooled OR = 1.10, 95% CI, 1.03-1.17, I2 = 43.4%), while showing a 2-fold higher risk of hospitalization (pooled OR = 2.66, 95% CI, 1.13-6.22, I2 = 99.6%), even after both groups have received COVID-19 vaccines. Limited evidence suggests a higher mortality risk among SMI patients compared to controls post vaccination, but the findings did not reach statistical significance. SMI patients remain at increased risk compared to their peers in COVID-19-related outcomes even after vaccination. Vaccination appears an effective approach to prevent severe COVID-19 illness in SMI patients, and actions should be taken by healthcare providers to improve vaccination coverage in these vulnerable groups.

Infectious diseases and global security: Analysis of global control and vaccination strategies

Introduction: Given the recent experience with the COVID-19 vaccine campaign, an optimal global policy to control future pandemics and ensure infectious security globally is highly relevant. Objective: The study aims to determine the optimal vaccination strategy to reduce COVID-19 morbidity and mortality during a pandemic.Methods: A systematic search of studies on infectious disease control and vaccination strategies for the period 2000-2023 in PubMed, Scopus, Web of Science and Google Scholar databases using keywords was conducted for the review. Relevant publications, data extraction and systematisation were selected.Results: The findings of the analysis highlight the importance of integrated interventions in global vaccination strategies, including health systems strengthening, innovative technologies for outbreak detection and international collaboration. Vaccination, as an effective preventive measure, significantly reduces the spread of infectious diseases. Vaccination with different types of vaccines has been shown to improve immune response compared to the use of the same type of vaccine. This approach, where the first and second vaccine doses are different, may increase the effectiveness of the immune response.Conclusions: Studies confirm that vaccination reduces the number of cases and deaths, reducing the economic burden. A variety of vaccines, including mRNA, vector, and inactivated vaccines, provide high efficacy in preventing COVID-19 infection and mortality, especially when a heterologous vaccination regimen is used. This review identifies the most effective infectious disease control strategies for the development of global health recommendations

Mathematical assessment of the roles of age heterogeneity and vaccination on the dynamics and control of SARS-CoV-2

The COVID-19 pandemic, caused by SARS-CoV-2, disproportionately affected certain segments of society, particularly the elderly population (which suffered the brunt of the burden of the pandemic in terms of severity of the disease, hospitalization, and death). This study presents a generalized multigroup model, with m heterogeneous sub-populations, to assess the population-level impact of age heterogeneity and vaccination on the transmission dynamics and control of the SARS-CoV-2 pandemic in the United States. Rigorous analysis of the model for the homogeneous case (i.e., the model with m = 1) reveal that its disease-free equilibrium is globally-asymptotically stable for two special cases (with perfect vaccine efficacy or negligible disease-induced mortality) whenever the associated reproduction number is less than one. The model has a unique and globally-asymptotically stable endemic equilibrium, for special a case, when the associated reproduction threshold exceeds one. The homogeneous model was fitted using the observed cumulative mortality data for the United States during three distinct waves (Waves A (October 17, 2020 to April 5, 2021), B (July 9, 2021 to November 7, 2021) and C (January 1, 2022 to May 7, 2022)) chosen to align with time periods when the Alpha, Delta and Omicron were, respectively, the predominant variants in the United States. The calibrated model was used to derive a theoretical expression for achieving vaccine-derived herd immunity (needed to eliminate the disease in the United States). It was shown that, using the one-group homogeneous model, vaccine-derived herd immunity is not attainable during Wave C of the pandemic in the United States, regardless of the coverage level of the fully-vaccinated individuals. Global sensitivity analysis was carried out to determine the parameters of the model that have the most influence on the disease dynamics and burden. These analyses reveal that control and mitigation strategies that may be very effective during one wave may not be so very effective during the other wave or waves. However, strategies that target asymptomatic and pre-symptomatic infectious individuals are shown to be consistently effective across all waves. To study the impact of the disproportionate effect of COVID-19 on the elderly population, we considered the heterogeneous model for the case where the total population is subdivided into the sub-populations of individuals under 65 years of age and those that are 65 and older. The resulting two-group heterogeneous model, which was also fitted using the cumulative mortality data for wave C, was also rigorously analysed. Unlike for the case of the one-group model, it was shown, for the two-group model, that vaccine-derived herd immunity can indeed be achieved during Wave C of the pandemic if at least 61% of the populace is fully vaccinated. Thus, this study shows that adding age heterogeneity into a SARS-CoV-2 vaccination model with homogeneous mixing significantly reduces the level of vaccination coverage needed to achieve vaccine-derived herd immunity (specifically, for the heterogeneous model, herd-immunity can be attained during Wave C if a moderate proportion of susceptible individuals are fully vaccinated). The consequence of this result is that vaccination models for SARS-CoV-2 that do not explicitly account for age heterogeneity may be overestimating the level of vaccine-derived herd immunity threshold needed to eliminate the SARS-CoV-2 pandemic.

Predictors for cause-specific and timing of deaths in patients with COVID-19: a cohort study in Taiwan

BACKGROUND

This cohort study determines the predictors for cause-specific and timing of deaths in patients with COVID-19 in Taiwan.

METHODS

Patients with laboratory-confirmed COVID-19 admitted to Taipei City Hospital from January 1 to July 31, 2022, were recruited in this cohort. All patients were followed up until death, discharge from the hospital, or August 31, 2022. Early deaths within the first 2 weeks were recorded, and the cause of death was confirmed by the death certificate database of Taiwan. Predictors of cause-specific and timing of deaths of patients with COVID-19 were determined using multinomial Cox proportional hazards regression analysis.

RESULTS

Of the 195 (8.0%) patients who died during hospitalization, 147 (84.0%) had COVID-19-specific deaths. Moreover, 54.9% of the deceased patients had early death. After controlling for other covariates, patients aged ≥ 65 years had a higher risk of COVID-19-specific, non-COVID-19-specific, early, and late deaths [adjusted hazards ratio (AHR): 3.85, 6.45, 3.33, and 6.57; 95% confidence interval (CI): 1.91-7.78, 1.17-35.68, 1.51-7.36, and 2.18-19.76, respectively]. Fully vaccinated patients had a lower risk of COVID-19-specific (AHR: 0.68; 95% CI: 0.47-0.98) and early deaths (AHR: 0.54; 95% CI: 0.35-0.84), whereas comorbid patients with chronic obstructive pulmonary disease had a higher risk of non-COVID-19-specific deaths (AHR: 5.43; 95% CI: 1.73-17.03).

CONCLUSIONS

This study suggests that prioritizing COVID-19 vaccination and carefully monitoring comorbid patients during hospitalization can reduce the risk of COVID-19-specific and early deaths and non-COVID-19-specific mortalities, respectively.

Immune signature in vaccinated versus non-vaccinated aged people with COVID-19 pneumonia

BACKGROUND

A definition of the immunological features of COVID-19 pneumonia is needed to support clinical management of aged patients. In this study, we characterized the humoral and cellular immune responses in presence or absence of SARS-CoV-2 vaccination, in aged patients admitted to the IRCCS San Raffaele Hospital (Italy) for COVID-19 pneumonia between November 2021 and March 2022.

METHODS

The study was approved by local authorities. Disease severity was evaluated according to WHO guidelines. We tested: (A) anti-SARS-CoV-2 humoral response (anti-RBD-S IgG, anti-S IgM, anti-N IgG, neutralizing activity against Delta, BA1, BA4/5 variants); (B) Lymphocyte B, CD4 and CD8 T-cell phenotype; (C) plasma cytokines. The impact of vaccine administration and different variants on the immunological responses was evaluated using standard linear regression models and Tobit models for censored outcomes adjusted for age, vaccine doses and gender.

RESULT

We studied 47 aged patients (median age 78.41), 22 (47%) female, 33 (70%) older than 70 years (elderly). At hospital admission, 36% were unvaccinated (VACno), whilst 63% had received 2 (VAC2) or 3 doses (VAC3) of vaccine. During hospitalization, WHO score > 5 was higher in unvaccinated (14% in VAC3 vs. 43% in VAC2 and 44% VACno). Independently from vaccination doses and gender, elderly had overall reduced anti-SARS-CoV-2 humoral response (IgG-RBD-S, p = 0.0075). By linear regression, the anti-RBD-S (p = 0.0060), B (p = 0.0079), CD8 (p = 0.0043) and Th2 cell counts (p = 0.0131) were higher in VAC2 + 3 compared to VACno. Delta variant was the most representative in VAC2 (n = 13/18, 72%), detected in 41% of VACno, whereas undetected in VAC3, and anti-RBD-S production was higher in VAC2 vs. VACno (p = 0.0001), alongside neutralization against Delta (p = 0141), BA1 (p = 0.0255), BA4/5 (p = 0.0162). Infections with Delta also drove an increase of pro-inflammatory cytokines (IFN-α, p = 0.0463; IL-6, p = 0.0010).

CONCLUSIONS

Administration of 3 vaccination doses reduces the severe symptomatology in aged and elderly. Vaccination showed a strong association with anti-SARS-CoV-2 humoral response and an expansion of Th2 T-cells populations, independently of age. Delta variants and number of vaccine doses affected the magnitude of the humoral response against the original SARS-CoV-2 and emerging variants. A systematic surveillance of the emerging variants is paramount to define future vaccination strategies.

Role of ACE2 and TMPRSS2 polymorphisms on COVID-19 outcome and disease severity in adult patients: A prospective cohort study in a tertiary hospital, Indonesia

Coronavirus disease 2019 (COVID-19) has led to a significant number of infections and deaths worldwide, yet its pathogenesis and severity remain incompletely understood. Angiotensin-converting enzyme 2 (ACE2) and transmembrane protease, serine 2 (TMPRSS2), play crucial roles as receptors and molecules responsible for the virus's entry into host cells, initiating the infection process. Their polymorphisms have been extensively studied in relation to COVID-19 severity. The aim of this study was to examine the association of ACE2 (rs2074192) and TMPRSS2 (rs12329760) polymorphisms with COVID-19 outcome and severity. A prospective cohort study was conducted in 2022 at Haji Adam Malik Hospital, Medan, Indonesia. We randomly recruited hospitalized adult patients with COVID-19, confirmed by real-time polymerase chain reaction (RT-PCR). The baseline demographic data, disease severity, underlying disease, comorbidities, and COVID-19 vaccination status were collected. The single-nucleotide polymorphism (SNP) was assessed using TaqMan SNP genotyping assay, and the levels of TMPRSS2 and ACE2 proteins were measured using enzyme-linked immunosorbent assay (ELISA). A total of 151 COVID-19 patients were recruited and there were significant associations between age and severity with mortality outcomes. The age, kidney and lung diseases, and vaccination status were associated with severity levels. The results showed the CC genotype of ACE2 had the highest proportion, followed by TT and CT genotypes among patients, while CT was the most prevalent genotype, followed by CC and TT for TMPRSS2. This study did not find a significant association between ACE2 and TMPRSS2 genetic variants with disease severity and outcome but highlighted a specific association of TMPRSS2 SNP with mortality within the group. In addition, ACE2 concentration was significant different between mild-moderate and severe-critical COVID-19 groups (p=0.033).

Causal Inference of the Effect of Vaccination on COVID-19 Disease Severity and Need for Intensive Care Unit Admission Among Hospitalized Patients in an African Setting

Background Coronavirus disease 2019 (COVID-19) is a novel, primarily respiratory, coronavirus that became a pandemic when it spread to over 210 countries and led to the death of over six million people. There is no definitive treatment for COVID-19, but vaccines have been developed that can help prevent severe illness and death. Studies have investigated the effect of vaccination on disease severity and outcome, and the findings indicate that vaccination is linked to a significant reduction in the risk of hospitalization, intensive care unit (ICU) admission, and disease mortality. However, there is a scarcity of evidence in Africa in general, and no similar study has been conducted in Ethiopia yet. Therefore, the study aimed to assess the effect of vaccination on COVID-19 disease severity and the need for ICU admission among hospitalized patients at a private specialty clinic in Ethiopia. Methods A retrospective cohort study was conducted among 126 patients with COVID-19, 41 vaccinated and 85 unvaccinated, who were hospitalized between September 2021 and May 2022. Data were summarized using frequency (percentage) and median (interquartile range (IQR)). To compare the characteristics of the two groups, Chi-square/Fisher's exact and Mann-Whitney U tests at p-values of ≤ 0.05 were used. To identify the effect of vaccination on COVID-19 disease severity, a marginal structural model (MSM) with an inverse probability weighting (IPW) approach using a robust Poisson regression model was fitted. Adjusted relative risk (ARR) and 95% confidence interval (CI) for ARR were used for interpreting the result. Results The cohort included groups that were comparable in terms of their sociodemographic and clinical characteristics. More than half of the participants were older than 60 years (n = 66, 52.4%), were males (n = 71, 56.3%), and had one or more comorbid illnesses (n = 66, 52.4%). At admission, 85 (67.5%) had severe disease, and 11 (8.7%) progressed after hospitalization and required ICU admission, of which three unvaccinated cases died. From the final model, vaccination was found to be associated with a 62% decreased risk of developing severe COVID-19 disease if infected, compared to not getting vaccinated (ARR = 0.38, 95% CI = 0.23-0.65, p < 0.0001). Conclusions The study's findings support previous reports that vaccinated people are less likely to develop severe COVID-19 disease if later infected with the virus, emphasizing the importance of continuing efforts to promote COVID-19 vaccination not only to safeguard individuals but also to confer community-level immunity.

Looking beyond vaccines: Cultural tightness-looseness moderates the relationship between immunization coverage and disease prevention vigilance

Advancements in vaccination technologies mitigate disease transmission risks but may inadvertently suppress the behavioral immune system, an evolved disease avoidance mechanism. Applying behavioral immune system theory and utilizing robust big data analytics, we examined associations between rising vaccination coverage and government policies, public mobility, and online information seeking regarding disease precautions. We tested whether cultural tightness-looseness moderates the relationship between mass immunization and disease prevention vigilance. Comprehensive time series analyses were conducted using American data (Study 1) and international data (Study 2), employing transfer function modeling, cross-correlation function analysis, and meta-regression analysis. Across both the US and global analyses, as vaccination rates rose over time, government COVID-19 restrictions significantly relaxed, community mobility increased, and online searches for prevention information declined. The relationship between higher vaccination rates and lower disease prevention vigilance was stronger in culturally looser contexts. Results provide initial evidence that mass immunization may be associated with attenuated sensitivity and enhanced flexibility of disease avoidance psychology and actions. However, cultural tightness-looseness significantly moderates this relationship, with tighter cultures displaying sustained vigilance amidst immunization upticks. These findings offer valuable perspectives to inform nuanced policymaking and public health strategies that balance prudent precautions against undue alarm when expanding vaccine coverage worldwide.

Perceived Risk for Severe COVID-19 and Oral Antiviral Use Among Antiviral-Eligible US Adults

INTRODUCTION

Oral antiviral medications are important tools for preventing severe COVID-19 outcomes. However, their uptake remains low for reasons that are not entirely understood. Our study aimed to assess the association between perceived risk for severe COVID-19 outcomes and oral antiviral use among those who were eligible for treatment based on Centers for Disease Control and Prevention (CDC) guidelines.

METHODS

We surveyed 4034 non-institutionalized US adults in April 2023, and report findings from 934 antiviral-eligible participants with at least one confirmed SARS-CoV-2 infection since December 1, 2021 and no current long COVID symptoms. Survey weights were used to yield nationally representative estimates. The primary exposure of interest was whether participants perceived themselves to be "at high risk for severe COVID-19." The primary outcome was use of a COVID-19 oral antiviral within 5 days of suspected SARS-CoV-2 infection.

RESULTS

Only 18.5% of antiviral-eligible adults considered themselves to be at high risk for severe COVID-19 and 16.8% and 15.9% took oral antivirals at any time or within 5 days of SARS-CoV-2 infection, respectively. In contrast, 79.8% were aware of antiviral treatments for COVID-19. Perceived high-risk status was associated with being more likely to be aware (adjusted prevalence ratio [aPR]: 1.11 [95% confidence interval (CI) 1.03-1.20]), to be prescribed (aPR 1.47 [95% CI 1.08-2.01]), and to take oral antivirals at any time (aPR 1.61 [95% CI 1.16-2.24]) or within 5 days of infection (aPR 1.72 [95% CI 1.23-2.40]).

CONCLUSIONS

Despite widespread awareness of the availability of COVID-19 oral antivirals, more than 80% of eligible US adults did not receive them. Our findings suggest that differences between perceived and actual risk for severe COVID-19 (based on current CDC guidelines) may partially explain this low uptake.

Clinical Features and Outcomes of Pediatric and Adult Patients Hospitalized for Coronavirus Disease 2019: A Comparison Across Age Strata

Background

Coronavirus disease 2019 (COVID-19) continues to cause hospitalizations and severe disease in children and adults.

Methods

This study compared the risk factors, symptoms, and outcomes of children and adults hospitalized for COVID-19 from March 2020 to May 2023 across age strata at 5 US sites participating in the Predicting Viral-Associated Inflammatory Disease Severity in Children with Laboratory Diagnostics and Artificial Intelligence consortium. Eligible patients had an upper respiratory swab that tested positive for severe acute respiratory syndrome coronavirus 2 by nucleic acid amplification. Adjusted odds ratios (aOR) of clinical outcomes were determined for children versus adults, for pediatric age strata compared to adolescents (12-17 years), and for adult age strata compared to young adults (22-49 years).

Results

Of 9101 patients in the Predicting Viral-Associated Inflammatory Disease Severity in Children with Laboratory Diagnostics and Artificial Intelligence cohort, 1560 were hospitalized for COVID-19 as the primary reason. Compared to adults (22-105 years, n = 675), children (0-21 years, n = 885) were less commonly vaccinated (14.3% vs 34.5%), more commonly infected with the Omicron variant (49.5% vs 26.1%) and had fewer comorbidities (P < .001 for most comparisons), except for lung disease (P = .24). After adjusting for confounding variables, children had significantly lower odds of receiving supplemental oxygen (aOR, 0.57; 95% confidence interval, .35-.92) and death (aOR, 0.011; 95% confidence interval, <.01-.58) compa--red to adults. Among pediatric age strata, adolescents 12-17 years had the highest odds of receiving supplemental oxygen, high-flow oxygen, and ICU admission. Among adults, those 50-64 years had the highest odds of mechanical ventilation and ICU admission.

Conclusions

Clinical outcomes of COVID-19 differed across pediatric and adult age strata. Adolescents experienced the most severe disease among children, whereas adults 50-64 years experienced the most severe disease among adults.

Tailoring COVID-19 Vaccination Strategies in High-Seroprevalence Settings: Insights from Ethiopia

This study aimed to retrospectively assess the cost-effectiveness of various COVID-19 vaccination strategies in Ethiopia. It involved healthcare workers (HCWs) and community participants; and was conducted through interviews and serological tests. Local SARS-CoV-2 variants and seroprevalence rates, as well as national COVID-19 reports and vaccination status were also analyzed. A cost-effectiveness analysis was performed to determine the most economical vaccination strategies in settings with limited vaccine access and high SARS-CoV-2 seroprevalence. Before the arrival of the vaccines, 65% of HCWs had antibodies against SARS-CoV-2, indicating prior exposure to the virus. Individuals with prior infection exhibited a greater antibody response to COVID-19 vaccines and experienced fewer new infections compared to those without prior infection, regardless of vaccination status (5% vs. 24%, p < 0.001 for vaccinated; 3% vs. 48%, p < 0.001 for unvaccinated). The cost-effectiveness analysis indicated that a single-dose vaccination strategy is optimal in settings with high underlying seroprevalence and limited vaccine availability. This study underscores the need for pragmatic vaccination strategies tailored to local contexts, particularly in high-seroprevalence regions, to maximize vaccine impact and minimize the spread of COVID-19. Implementing a targeted approach based on local seroprevalence information could have helped Ethiopia achieve higher vaccination rates and prevent subsequent outbreaks.

The association between emotional and physical intimate partner violence and COVID-19 vaccine uptake in a community-based U.S. Cohort

Objective

To estimate risk of being unvaccinated against COVID-19 by experience of intimate partner violence (IPV).

Methods

Among 3,343 partnered individuals in a community-based U.S. cohort, we quantified emotional and physical IPV experienced between March and December 2020 and estimated risk of being unvaccinated against COVID-19 through June 2021 by experience of IPV. Experience of recent IPV was defined as endorsement of more frequent or severe IPV since the start of the pandemic or report of any past-month IPV in at least one of four follow-up surveys conducted by the end of December 2020. We created a three-level composite variable - no experience of IPV, experience of emotional but not physical IPV, and experience of physical IPV.

Results

Cisgender women, non-binary, or transgender individuals who reported experiencing emotional, but not physical, IPV and those who reported experiencing physical IPV were both at significantly higher risk of being unvaccinated for COVID-19 compared to those who reported experiencing no IPV (ARRemotional violence: 1.28 [95 % CI: 1.09 - 1.51]; ARRphysical violence: 1.70 [95 % CI: 1.41 - 2.05]). Cisgender men who reported experiencing physical IPV were also at significantly higher risk of being unvaccinated for COVID-19 (ARRphysical violence: 1.52 [95 % CI: 1.15 - 2.02]).

Conclusions

IPV may increase the risk of low vaccine uptake. Results highlight the need to incorporate IPV prevention and support into public health responses, with targeted resources and consideration for reducing barriers to public health interventions among those impacted.

Chemokine receptors in COVID-19 infection

Chemokine receptors play diverse roles in the immune response against pathogens by recruiting innate and adaptive immune cells to sites of infection. However, their involvement could also be detrimental, causing tissue damage and exacerbating respiratory diseases by triggering histological alterations such as fibrosis and remodeling. This chapter reviews the role of chemokine receptors in the immune defense against SARS-CoV-2 infection. In COVID-19, CXCR3 is expressed mainly in T cells, and its upregulation is related to an increase in SARS-CoV-2-specific antibodies but also to COVID-19 severity. CCR5 is a key player in T-cell recruitment, and its suppression leads to reduced inflammation and viremia levels. Conversely, CXCR6 is implicated in the aberrant migration of memory T cells within airways. On the other hand, increased CCR4+ cells in the blood and decreased CCR4+ cells in lung cells are associated with severe COVID-19. Additionally, CCR2 is associated with an increase in macrophage recruitment to lung tissues. Elevated levels of CXCR1 and CXCR2, which are predominantly expressed in neutrophils, are associated with the severity of the disease, and finally, the expression of CX3CR1 in cytotoxic T lymphocytes affects the retention of these cells in lung tissues, thereby impacting the severity of COVID-19. Despite the efforts of many clinical trials to find effective therapies for COVID-19 using chemokine receptor inhibitors, no conclusive results have been found due to the small number of patients, redundancy, and co-expression of chemokine receptors by immune cells, which explains the difficulty in finding a single therapeutic target or effective treatment.

COVID-19: Post infection implications in different age groups, mechanism, diagnosis, effective prevention, treatment, and recommendations

SARS-CoV-2 is a highly contagious pathogen that predominantly caused the COVID-19 pandemic. The persistent effects of COVID-19 are defined as an inflammatory or host response to the virus that begins four weeks after initial infection and persists for an undetermined length of time. Chronic effects are more harmful than acute ones thus, this review explored the long-term effects of the virus on various human organs, including the pulmonary, cardiovascular, and neurological, reproductive, gastrointestinal, musculoskeletal, endocrine, and lymphoid systems and found that SARS-CoV-2 adversely affects these organs of older adults. Regarding diagnosis, the RT-PCR is a gold standard method of diagnosing COVID-19; however, it requires specialized equipment and personnel for performing assays and a long time for results production. Therefore, to overcome these limitations, artificial intelligence employed in imaging and microfluidics technologies is the most promising in diagnosing COVID-19. Pharmacological and non-pharmacological strategies are the most effective treatment for reducing the persistent impacts of COVID-19 by providing immunity to post-COVID-19 patients by reducing cytokine release syndrome, improving the T cell response, and increasing the circulation of activated natural killer and CD8 T cells in blood and tissues, which ultimately reduces fever, nausea, fatigue, and muscle weakness and pain. Vaccines such as inactivated viral, live attenuated viral, protein subunit, viral vectored, mRNA, DNA, or nanoparticle vaccines significantly reduce the adverse long-term virus effects in post-COVID-19 patients; however, no vaccine was reported to provide lifetime protection against COVID-19; consequently, protective measures such as physical separation, mask use, and hand cleansing are promising strategies. This review provides a comprehensive knowledge of the persistent effects of COVID-19 on people of varying ages, as well as diagnosis, treatment, vaccination, and future preventative measures against the spread of SARS-CoV-2.

Sociodemographic Inequalities in COVID-19 Booster Dose Vaccination Coverage: a Retrospective Study of 196 Provinces in Peru

BACKGROUND

The COVID-19 vaccination coverage shows variability in booster doses between residency areas or ethnicity. The aim of this study was to evaluate how sociodemographic conditions influence unequal vaccination coverage with booster doses against COVID-19 in Peru.

METHODS

A retrospective, ecological study with an evaluation of 196 provinces in Peru. The sociodemographic conditions were evaluated as sources of inequality (sex, age group, educational level, residence area, and ethnic group). The inequality measure used was the GINI, an index that show the inequal vaccination coverage with third and fourth booster doses against COVID-19 in Peruvians provinces. The index allow determinate a higher inequality when the value is near to 1, and a lower inequality when the value is near to 0. Also, the impact of each sociodemographic condition in the general inequality was evaluate with a decomposition analysis of GINI coefficient into Sk (composition effect), Gk (redistribution effect), Rk (differential effect).

RESULTS

In provinces evaluated the mean vaccine coverage for the third and fourth booster doses was 57.00% and 22.19%, respectively at twelve months since the beginning of vaccination campaign. The GINI coefficient was 0.33 and 0.31, for the third and fourth booster doses coverage, respectively. In the decomposition analysis, twelve months after the start of the third and fourth dose vaccination campaign, revealed higher Sk values for people living in rural areas (Sk = 0.94 vs. Sk = 2.39, respectively for third and fourth dose), while higher Gk values for Aymara (Gk = 0.92 vs. Gk = 0.92, respectively), Quechua (Gk = 0.53 vs. Gk = 0.53, respectively), and Afro-Peruvians (Gk = 0.61 vs. Gk = 0.61, respectively). Also, higher negative correlation in Rk values for people with elementary education (Rk=-0.43 vs. Rk=-0.33, respectively), aged between 15 and 19 years (Rk=-0.49 vs. Rk=-0.37, respectively), and Aymara (Rk=-0.51 vs. Rk=-0.66, respectively).

CONCLUSION

The rural residency area, lower education and Quechua, Aymara or Afro-Peruvians ethnicity determinated inequalities in vaccination coverage with booster doses against COVID-19 in Peruvian provinces.

Who is "anti-science"?

Objectives

"Anti-science" accusations are common in medicine and public health, sometimes to discredit scientists who hold opposing views. However, there is no such thing as "one science". Epistemology recognizes that any "science" is sociologically embedded, and therefore contextual and intersubjective. In this paper, we reflect on how "science" needs to adopt various perspectives to give a comprehensive and nuanced understanding of a phenomenon.

Study design

Opinion paper.

Methods

Based on a targeted literature survey, we first clarify the known limits of traditional scientific methods and then reflect on how the scientific reporting about Covid-19 mRNA vaccines has evolved.

Results

The first reports of the Covid-19 mRNA vaccines randomised controlled trial results showed impressive efficacy. Nevertheless, an abundant literature has since depicted a far more nuanced picture of the effectiveness and safety of those vaccines over the medium-term. We organise them around five themes: (i) differentiating between relative and absolute reduction; (ii) taking account of time in reporting effectiveness; (iii) taking account of all outcomes, including adverse effects; (iv) stratifying effectiveness and considering other decision criteria (efficiency, equity, and acceptance); (v) changing the outcome of concern and assessing vaccines' effectiveness on mortality.

Conclusions

Science offers a wide range of perspectives on a given study object. Only the process of deliberation amongst scientists and other stakeholders can result in accepted new knowledge useful to support decision-making. Unfortunately, by trying to reduce "science" to simple messages set in stone, scientists can become the worse enemies of science.

Healthcare workers' attitudes toward and factors influencing their acceptance of an annual COVID-19 booster vaccine: a cross-sectional study in Palestine

BACKGROUND

The emergence of several SARS-CoV-2 variants may necessitate an annual COVID-19 booster vaccine. This study aimed to evaluate healthcare workers' (HCWs) acceptance of a COVID-19 yearly booster vaccine if recommended and its association with their attitudes and burnout levels.

METHODS

We used an online self-administered questionnaire to conduct a cross-sectional study of all HCWs in the West Bank and Gaza Strip of Palestine between August and September 2022. We used the Vaccination Attitudes Examination scale to assess HCWs' vaccination attitudes and the Maslach Burnout Inventory to assess work-related Burnout. In addition, we conducted logistic regression to identify factors independently associated with the acceptance of the booster vaccine.

RESULTS

The study included 919 HCWs; 52.4% were male, 46.5% were physicians, 30.0% were nurses, and 63.1% worked in hospitals. One-third of HCWs (95% CI: 30.5%-36.7%) said they would accept an annual COVID-19 booster vaccine if recommended. HCWs who are suspicious of vaccine benefits [aOR = .70; 95%CI: .65-.75] and those concerned about unforeseeable future effects [aOR = .90; 95%CI: .84-.95] are less likely to accept the booster vaccine if recommended, whereas those who receive annual influenza vaccine are more likely to get it [aOR = 2.9; 95%CI: 1.7-5.0].

CONCLUSION

Only about a third of HCWs would agree to receive an annual COVID-19 booster vaccine if recommended. Mistrust of the vaccine's efficacy and concerns about side effects continue to drive COVID-19 vaccine reluctance. Health officials need to address HCWs' concerns to increase their acceptance of the annual vaccine if it is to be recommended.

Review: N1-methyl-pseudouridine (m1Ψ): Friend or foe of cancer?

Due to the health emergency created by SARS-CoV-2, the virus that causes the COVID-19 disease, the rapid implementation of a new vaccine technology was necessary. mRNA vaccines, being one of the cutting-edge new technologies, attracted significant interest and offered a lot of hope. The potential of these vaccines in preventing admission to hospitals and serious illness in people with comorbidities has recently been called into question due to the vaccines' rapidly waning immunity. Mounting evidence indicates that these vaccines, like many others, do not generate sterilizing immunity, leaving people vulnerable to recurrent infections. Additionally, it has been discovered that the mRNA vaccines inhibit essential immunological pathways, thus impairing early interferon signaling. Within the framework of COVID-19 vaccination, this inhibition ensures an appropriate spike protein synthesis and a reduced immune activation. Evidence is provided that adding 100 % of N1-methyl-pseudouridine (m1Ψ) to the mRNA vaccine in a melanoma model stimulated cancer growth and metastasis, while non-modified mRNA vaccines induced opposite results, thus suggesting that COVID-19 mRNA vaccines could aid cancer development. Based on this compelling evidence, we suggest that future clinical trials for cancers or infectious diseases should not use mRNA vaccines with a 100 % m1Ψ modification, but rather ones with the lower percentage of m1Ψ modification to avoid immune suppression.

Cytokine profiles of mild-to-moderate SARS-CoV-2 infected and recovered pre-vaccinated individuals residing in Indonesia

Background

Accumulating evidence suggests the involvement of cytokine-mediated inflammation, in clinical severity and death related to SARS-CoV-2 infection, especially among pre-vaccinated individuals. An increased risk of death was also described among SARS-CoV-2 recovered individuals, which might be correlated with prolonged inflammatory responses. Despite being among the countries with the highest cumulative deaths due to COVID-19, evidence regarding cytokine profiles among SARS-CoV-2 infected and recovered pre-vaccinated individuals in Indonesia is scarce. Thus, this study aimed to describe the cytokines profiles of pre-vaccinated individuals residing in Indonesia, with mild-to-moderate SARS-CoV-2 infection and those who recovered.

Methods

Sixty-one sera from 24 hospitalized patients with mild-to-moderate SARS-CoV-2 infection, 24 individuals recovered from asymptomatic-to-moderate SARS-CoV-2 infection, and 13 healthy controls unexposed to SARS-CoV-2 were used in this study. Quantification of serum cytokine levels, including IL-6, IL-8, IP-10, TNF-α, CCL-2, CCL-3, CCL-4, and CXCL-13, was performed using a Luminex multi-analyte-profiling (xMAP)-based assay.

Results

The levels of IL-8 along with CCL-2 and CCL-4, were significantly higher (p ≤ 0.01) in hospitalized patients with mild-to-moderate SARS-CoV-2 infection and recovered individuals compared to healthy controls. However, no significant difference was observed in these cytokine levels between infected and recovered individuals. On the other hand, there were no significant differences in several other cytokine levels, including IL-6, IL-10, TNF-α, CCL-3, and CXCL-13, among all groups.

Conclusion

IL-8, CCL-2, and CCL-4 were significantly elevated in pre-vaccinated Indonesian individuals with mild-to-moderate SARS-CoV-2 infection and those who recovered. The cytokine profiles described in this study might indicate inflammatory responses not only among SARS-CoV-2 infected, but also recovered individuals.

The effect of microbiome therapy on COVID-19-induced gut dysbiosis: A narrative and systematic review

AIMS

Emerging evidence highlights the role of COVID-19 in instigating gut dysbiosis, with repercussions on disease severity and bidirectional gut-organ communication involving the lung, heart, brain, and liver. This study aims to evaluate the efficacy of probiotics, prebiotics, synbiotics, and fecal microbiota transplantation (FMT) in addressing gut dysbiosis associated with COVID-19, as well as their impact on related disease severity and clinical outcomes.

MATERIALS AND METHODS

We systematically review 27 studies exploring the efficacy of different microbiome-modulating therapies: probiotics, prebiotics, synbiotics, and fecal microbiota transplantation as potential interventions for COVID-19.

KEY FINDINGS

The probiotics and synbiotics investigated encompassed a spectrum of eight bacterial and fungal genera, namely Lactobacillus, Bifidobacterium, Streptococcus, Enterococcus, Pediococcus, Bacillus, Saccharomyces, and Kluyveromyces. Noteworthy prebiotics employed in these studies included chestnut tannin, galactooligosaccharides, fructooligosaccharides, xylooligosaccharide, and resistant dextrin. The majority of the investigated biotics exhibited positive effects on COVID-19 patients, manifesting in symptom alleviation, inflammation reduction, and notable decreases in mortality rates. Five studies reported death rates, showing an average mortality ranging from 0 % to 11 % in the intervention groups, as compared to 3 % to 30 % in the control groups. Specifically, probiotics, prebiotics, and synbiotics demonstrated efficacy in diminishing the duration and severity of symptoms while significantly accelerating viral and symptomatic remission. FMT emerged as a particularly effective strategy, successfully restoring gut microbiota and ameliorating gastrointestinal disorders.

SIGNIFICANCE

The insights gleaned from this review significantly contribute to our broader comprehension of the therapeutic potential of biotics in addressing COVID-19-related gut dysbiosis and mitigating secondary multi-organ complications.