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Ayoub HH, Tomy M, Chemaitelly H, Altarawneh HN, Coyle P, Tang P, Hasan MR, Al Kanaani Z, Al Kuwari E, Butt AA, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Nasrallah GK, Benslimane FM, Al Khatib HA, Yassine HM, Al Kuwari MG, Al Romaihi HE, Abdul-Rahim HF, Al-Thani MH, Al Khal A, Bertollini R, Abu-Raddad LJ. Estimating protection afforded by prior infection in preventing reinfection: applying the test-negative study design. Am J Epidemiol 2024; 193:883-897. [PMID: 38061757 DOI: 10.1093/aje/kwad239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 06/04/2024] Open
Abstract
The COVID-19 pandemic has highlighted the need to use infection testing databases to rapidly estimate effectiveness of prior infection in preventing reinfection ($P{E}_S$) by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. Mathematical modeling was used to demonstrate a theoretical foundation for applicability of the test-negative, case-control study design to derive $P{E}_S$. Apart from the very early phase of an epidemic, the difference between the test-negative estimate for $P{E}_S$ and true value of $P{E}_S$ was minimal and became negligible as the epidemic progressed. The test-negative design provided robust estimation of $P{E}_S$ and its waning. Assuming that only 25% of prior infections are documented, misclassification of prior infection status underestimated $P{E}_S$, but the underestimate was considerable only when > 50% of the population was ever infected. Misclassification of latent infection, misclassification of current active infection, and scale-up of vaccination all resulted in negligible bias in estimated $P{E}_S$. The test-negative design was applied to national-level testing data in Qatar to estimate $P{E}_S$ for SARS-CoV-2. $P{E}_S$ against SARS-CoV-2 Alpha and Beta variants was estimated at 97.0% (95% CI, 93.6-98.6) and 85.5% (95% CI, 82.4-88.1), respectively. These estimates were validated using a cohort study design. The test-negative design offers a feasible, robust method to estimate protection from prior infection in preventing reinfection.
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Affiliation(s)
- Houssein H Ayoub
- Mathematics Program, Department of Mathematics and Statistics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Milan Tomy
- Mathematics Program, Department of Mathematics and Statistics, College of Arts and Sciences, Qatar University, Doha, Qatar
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY 10065, United States
| | - Heba N Altarawneh
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY 10065, United States
| | - Peter Coyle
- Hamad Medical Corporation, Doha, Qatar
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast BT9 7BL, United Kingdom
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha, Qatar
| | | | | | | | - Adeel A Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY 10065, United States
- Hamad Medical Corporation, Doha, Qatar
| | | | | | | | | | - Gheyath K Nasrallah
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Fatiha M Benslimane
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Hebah A Al Khatib
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | | | | | - Hanan F Abdul-Rahim
- Department of Public Health, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | | | | | | | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation-Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY 10065, United States
- Department of Public Health, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
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Rauch W, Schenk H, Rauch N, Harders M, Oberacher H, Insam H, Markt R, Kreuzinger N. Estimating actual SARS-CoV-2 infections from secondary data. Sci Rep 2024; 14:6732. [PMID: 38509181 PMCID: PMC10954653 DOI: 10.1038/s41598-024-57238-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/15/2024] [Indexed: 03/22/2024] Open
Abstract
Eminent in pandemic management is accurate information on infection dynamics to plan for timely installation of control measures and vaccination campaigns. Despite huge efforts in diagnostic testing of individuals, the underestimation of the actual number of SARS-CoV-2 infections remains significant due to the large number of undocumented cases. In this paper we demonstrate and compare three methods to estimate the dynamics of true infections based on secondary data i.e., (a) test positivity, (b) infection fatality and (c) wastewater monitoring. The concept is tested with Austrian data on a national basis for the period of April 2020 to December 2022. Further, we use the results of prevalence studies from the same period to generate (upper and lower bounds of) credible intervals for true infections for four data points. Model parameters are subsequently estimated by applying Approximate Bayesian Computation-rejection sampling and Genetic Algorithms. The method is then validated for the case study Vienna. We find that all three methods yield fairly similar results for estimating the true number of infections, which supports the idea that all three datasets contain similar baseline information. None of them is considered superior, as their advantages and shortcomings depend on the specific case study at hand.
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Affiliation(s)
- Wolfgang Rauch
- Unit of Environmental Engineering, Department of Infrastructure, University of Innsbruck, Technikerstrasse 13, 6020, Innsbruck, Austria.
| | - Hannes Schenk
- Unit of Environmental Engineering, Department of Infrastructure, University of Innsbruck, Technikerstrasse 13, 6020, Innsbruck, Austria
| | - Nikolaus Rauch
- Interactive Graphics and Simulation Group, University of Innsbruck, Innsbruck, Austria
| | - Matthias Harders
- Interactive Graphics and Simulation Group, University of Innsbruck, Innsbruck, Austria
| | - Herbert Oberacher
- Institute of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Innsbruck, Austria
| | - Heribert Insam
- Department of Microbiology, University of Innsbruck, Technikerstrasse 25, 6020, Innsbruck, Austria
| | - Rudolf Markt
- Department of Health Sciences and Social Work, Carinthia University of Applied Sciences, Villach, Austria
| | - Norbert Kreuzinger
- Institute of Water Quality and Resource Management, Technical University Vienna, Vienna, Austria
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Alsayyad A, Chlif S, Mohamed A, Habbash F, Ayoob Z, Almarabheh A, Al Sayed K, Alsaleh A, Alhajeri M, Alzayani S, Abu Alfatah N, Ahmed J, Ben Salah A. Super-spreading social events for COVID-19 transmission: evidence from the investigation of six early clusters in Bahrain. Front Public Health 2023; 11:1216113. [PMID: 37744496 PMCID: PMC10513455 DOI: 10.3389/fpubh.2023.1216113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction This study aimed to characterize six early clusters of COVID-19 and derive key transmission parameters from confirmed cases that were traced between April and June 2020 in Bahrain. Methods Pairs of "infector-infectee" allowed us to map the clusters and estimate the incubation period serial interval as the secondary attack rate. The chi-squared test, with a p-value computed using the Monte Carlo test, measured associations between categorical variables. Statistical analysis was performed using R software and the "data.tree, tidyverse" libraries. Results From 9 April to 27 June 2020, we investigated 596 individuals suspected of COVID-19, of whom 127 positive cases were confirmed by PCR and linked in six clusters. The mean age was 30.34 years (S.D. = 17.84 years). The male-to-female ratio was 0.87 (276/318), and most of the contacts were of Bahraini citizenship (511/591 = 86.5%). Exposure occurred within the family in 74.3% (411/553), and 18.9% of clusters' cases were symptomatic (23/122 = 18.9%). Mapped clusters and generations increased after 24 May 2020, corresponding to "Aid El-Fitr." The mean incubation period was 4 days, and the mean serial interval ranged from 3 to 3.31 days. The secondary attack rate was 0.21 (95% C.I.) = [0.17-0.24]. Conclusion COVID-19 transmission was amplified due to the high number of families mixing during "Aid El Fitr" and "Ramadhan," generating important clusters. Estimated serial intervals and incubation periods support asymptomatic transmission.
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Affiliation(s)
- Adel Alsayyad
- Ministry of Health, Manama, Bahrain
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Sadok Chlif
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Institut Pasteur de Tunis, Tunis, Tunisia
| | | | - Fatema Habbash
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- King Abdullah University Medical Centre, Manama, Bahrain
| | | | - Amer Almarabheh
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | | | - Aseel Alsaleh
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | | | - Salman Alzayani
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | | | - Jamil Ahmed
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Afif Ben Salah
- Family and Community Medicine Department, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Institut Pasteur de Tunis, Tunis, Tunisia
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Tayar E, Abdeen S, Abed Alah M, Chemaitelly H, Bougmiza I, Ayoub HH, Kaleeckal AH, Latif AN, Shaik RM, Al-Romaihi HE, Al-Thani MH, Bertollini R, Abu-Raddad LJ, Al-Khal A. Effectiveness of influenza vaccination against SARS-CoV-2 infection among healthcare workers in Qatar. J Infect Public Health 2023; 16:250-256. [PMID: 36603377 PMCID: PMC9791790 DOI: 10.1016/j.jiph.2022.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/17/2022] [Accepted: 12/22/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Some studies have reported that influenza vaccination is associated with lower risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and/or coronavirus disease 2019 (COVID-19) morbidity and mortality. This study aims to estimate effectiveness of influenza vaccination, using Abbott's quadrivalent Influvac Tetra vaccine, against SARS-CoV-2 infection and against severe COVID-19. METHODS This matched, test-negative, case-control study was implemented on a population of 30,774 healthcare workers (HCWs) in Qatar during the 2020 annual influenza vaccination campaign, September 17, 2020-December 31, 2020, before introduction of COVID-19 vaccination. RESULTS Of 30,774 HCWs, 576 with PCR-positive tests and 10,033 with exclusively PCR-negative tests were eligible for inclusion in the study. Matching by sex, age, nationality, reason for PCR testing, and PCR test date yielded 518 cases matched to 2058 controls. Median duration between influenza vaccination and the PCR test was 43 days (IQR, 29-62). Estimated effectiveness of influenza vaccination against SARS-CoV-2 infection> 14 days after receiving the vaccine was 29.7% (95% CI: 5.5-47.7%). Estimated effectiveness of influenza vaccination against severe, critical, or fatal COVID-19 was 88.9% (95% CI: 4.1-98.7%). Sensitivity analyses confirmed the main analysis results. CONCLUSIONS Recent influenza vaccination is associated with a significant reduction in the risk of SARS-CoV-2 infection and COVID-19 severity.
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Affiliation(s)
- Elias Tayar
- Community Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Sami Abdeen
- Community Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Muna Abed Alah
- Community Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar,World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Doha, Qatar,Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Iheb Bougmiza
- Community Medicine Department, Primary Health Care Corporation, Doha, Qatar,Community Medicine Department, College of Medicine, Sousse University, Tunisia
| | - Houssein H. Ayoub
- Mathematics Program, Department of Mathematics, Statistics, and Physics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Anvar Hassan Kaleeckal
- Business Intelligence and Operational Performance Unit, Hamad Medical Corporation, Doha, Qatar
| | - Ali Nizar Latif
- Business Intelligence and Operational Performance Unit, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | | | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar,World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Doha, Qatar,Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA,Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar,Corresponding author at: Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
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Bellusci L, Grubbs G, Zahra FT, Forgacs D, Golding H, Ross TM, Khurana S. Antibody affinity and cross-variant neutralization of SARS-CoV-2 Omicron BA.1, BA.2 and BA.3 following third mRNA vaccination. Nat Commun 2022; 13:4617. [PMID: 35941152 PMCID: PMC9358642 DOI: 10.1038/s41467-022-32298-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/25/2022] [Indexed: 11/11/2022] Open
Abstract
There is limited knowledge on durability of neutralization capacity and antibody affinity maturation generated following two versus three doses of SARS-CoV-2 mRNA vaccines in naïve versus convalescent individuals (hybrid immunity) against the highly transmissible Omicron BA.1, BA.2 and BA.3 subvariants. Virus neutralization titers against the vaccine-homologous strain (WA1) and Omicron sublineages are measured in a pseudovirus neutralization assay (PsVNA). In addition, antibody binding and antibody affinity against spike proteins from WA1, BA.1, and BA.2 is determined using surface plasmon resonance (SPR). The convalescent individuals who after SARS-CoV-2 infection got vaccinated develop hybrid immunity that shows broader neutralization activity and cross-reactive antibody affinity maturation against the Omicron BA.1 and BA.2 after either second or third vaccination compared with naïve individuals. Neutralization activity correlates with antibody affinity against Omicron subvariants BA.1 and BA.2 spikes. Importantly, at four months post-third vaccination the neutralization activity and antibody affinity against the Omicron subvariants is maintained and trended higher for the individuals with hybrid immunity compared with naïve adults. These findings about hybrid immunity resulting in superior immune kinetics, breadth, and durable high affinity antibodies support the need for booster vaccinations to provide effective protection from emerging SARS-CoV-2 variants like the rapidly spreading Omicron subvariants. Here the authors show that a third SARS-CoV-2 vaccination significantly boosts neutralizing antibodies against Omicron subvariants and that hybrid immunity (infection and vaccination) results in broader neutralization activity and cross-reactive antibody affinity maturation.
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Affiliation(s)
- Lorenza Bellusci
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, 20871, USA
| | - Gabrielle Grubbs
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, 20871, USA
| | - Fatema Tuz Zahra
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, 20871, USA
| | - David Forgacs
- Center for Vaccines and Immunology, University of Georgia, Athens, GA, 30602, USA
| | - Hana Golding
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, 20871, USA
| | - Ted M Ross
- Center for Vaccines and Immunology, University of Georgia, Athens, GA, 30602, USA.,Department of Infectious Diseases, University of Georgia, Athens, GA, 30602, USA
| | - Surender Khurana
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD, 20871, USA.
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