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Glatman-Freedman A, Bromberg M, Dichtiar R, Hershkovitz Y, Keinan-Boker L. The BNT162b2 vaccine effectiveness against new COVID-19 cases and complications of breakthrough cases: A nation-wide retrospective longitudinal multiple cohort analysis using individualised data. EBioMedicine 2021; 72:103574. [PMID: 34537449 PMCID: PMC8445746 DOI: 10.1016/j.ebiom.2021.103574] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/21/2021] [Accepted: 08/22/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The rapid vaccination campaign against COVID-19 in Israel relied on the BNT162b2 vaccine. We performed a longitudinal analysis of multiple cohorts, using individual data, to evaluate the effectiveness of the vaccine against new and breakthrough cases. METHODS We estimated vaccine effectiveness (VE) for 27 consecutive cohorts, each comprised of individuals vaccinated on specific days. VE against new COVID-19 cases was evaluated for five SARS-CoV-2-related outcomes: infection, symptomatic disease, hospitalisation, severe/critical disease and death. For breakthrough cases, rate reduction was evaluated for hospitalisation, severe/critical disease and death. Outcomes were evaluated at predetermined time-periods after vaccination, the last one dedicated to individuals who became SARS-CoV-2-positive 22-28 days after the second dose. FINDINGS The highest VE estimates against new cases in ≥16 year old individuals, for all outcomes, were reached at the 15-21 day period after the second dose, ranging between 97.7% (95% CI: 95.9-98.7%) for deaths and 98.6% (95% CI: 97.8-99.1%) for severe/critical disease. VE estimates of the 14-20 day period after the first dose ranged between 54.3% (95% CI: 50.6-57.8%) for infection and 77.3% (95% CI: 71.2-82.1%) for severe/critical disease. VE rose more slowly among ≥80 year old individuals. Rate reductions of breakthrough complications were highest at the 22-28 day period after the second dose, ranging between 47.4% (95% CI: 4.3-71.2%) for death and 66.2% (95% CI: 44.2-79.6%) for severe/critical disease. INTERPRETATION The BNT162 vaccine is highly effective in preventing new SARS-CoV-2 cases. Among ≥80 year old individuals, high effectiveness develops more slowly. In breakthrough cases, vaccination reduces complications and death. FUNDING None.
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Affiliation(s)
- Aharona Glatman-Freedman
- The Israel Centre for Disease Control, Israel Ministry of Health, Tel Hashomer, Ramat Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Michal Bromberg
- The Israel Centre for Disease Control, Israel Ministry of Health, Tel Hashomer, Ramat Gan, Israel; Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rita Dichtiar
- The Israel Centre for Disease Control, Israel Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Yael Hershkovitz
- The Israel Centre for Disease Control, Israel Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Lital Keinan-Boker
- The Israel Centre for Disease Control, Israel Ministry of Health, Tel Hashomer, Ramat Gan, Israel; School of Public Health, Haifa University, Haifa, Israel
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202
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Batool R, Tahir Yousafzai M, Qureshi S, Ali M, Sadaf T, Mehmood J, Ashorn P, Naz Qamar F. Effectiveness of typhoid conjugate vaccine against culture-confirmed typhoid in a peri-urban setting in Karachi: A case-control study. Vaccine 2021; 39:5858-5865. [PMID: 34465474 DOI: 10.1016/j.vaccine.2021.08.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/23/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Enteric fever, caused by Salmonella Typhi and S. Paratyphi, is a cause of high morbidity and mortality among children in South Asia. Rising antimicrobial resistance presents an additional challenge. Typhoid Conjugate Vaccines (TCV) are recommended by the World Health Organization for use among people 6 months to 45 years old living in endemic settings. This study aimed to assess the effectiveness of TCV against culture-confirmed S. Typhi in Lyari Town, Karachi, Pakistan. This peri-urban town was one of the worst affected by the outbreak of extensively drug resistant (XDR) typhoid that started in November 2016. METHODS A matched case-control study was conducted following a mass immunization campaign with TCV at three key hospitals in Lyari Town Karachi, Pakistan. Children aged 6 months to 15 years presenting with culture-confirmed S. Typhi were enrolled as cases. For each case, at least 1 age-matched hospital control and two age-matched community controls were enrolled. Adjusted odds ratios with 95% confidence intervals (CIs) were calculated using conditional logistic regression. RESULTS Of 82 typhoid fever patients enrolled from August 2019 through December 2019, 8 (9·8%) had received vaccine for typhoid. Of the 164 community controls and 82 hospital controls enrolled, 38 (23·2%) community controls and 27 (32·9%) hospital controls were vaccinated for typhoid. The age and sex-adjusted vaccine effectiveness was found to be 72% (95% CI: 34% - 88%). The consumption of meals prepared outside home more than once per month (adjusted odds ratio: 3·72, 95% CI: 1·55- 8·94; p-value: 0·003) was associated with the development of culture-confirmed typhoid. CONCLUSION A single dose of TCV is effective against culture confirmed typhoid among children aged 6 months to 15 years old in an XDR typhoid outbreak setting of a peri-urban community in Karachi, Pakistan.
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Affiliation(s)
- Rabab Batool
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; Adolescent, and Maternal Health, Faculty of Medicine and Health Technology, Tampere University, Kalevantie 4, 33100 Tampere, Finland.
| | - Mohammad Tahir Yousafzai
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan; Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, High Street, Kensington, NSW 2052, Australia.
| | - Sonia Qureshi
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan.
| | - Miqdad Ali
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan.
| | - Tahira Sadaf
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan.
| | - Junaid Mehmood
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan.
| | - Per Ashorn
- Adolescent, and Maternal Health, Faculty of Medicine and Health Technology, Tampere University, Kalevantie 4, 33100 Tampere, Finland; Department of Paediatrics, Tampere University Hospital, Kalevantie 4, 33100 Tampere, Finland.
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Aga Khan University Hospital, Karachi City, Sindh 74800, Pakistan.
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203
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Thompson MG, Soto G, Perez A, Newes-Adeyim G, Yoo YM, Hirsch A, Katz M, Tinoco Y, Shemer Avni Y, Ticona E, Malosh R, Martin E, Matos E, Reynolds S, Wesley M, Ferdinands J, Cheung A, Levine M, Bravo E, Arriola CS, Ester Castillo M, Carlos Castro J, Dawood F, Goldberg D, Manuel Neyra Quijandría J, Azziz-Baumgartner E, Monto A, Balicer R. Influenza vaccine effectiveness within prospective cohorts of healthcare personnel in Israel and Peru 2016-2019. Vaccine 2021:S0264-410X(21)00982-8. [PMID: 34509322 DOI: 10.1016/j.vaccine.2021.07.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 06/29/2021] [Accepted: 07/28/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are limited data on influenza vaccine effectiveness (IVE) in preventing laboratory-confirmed influenza illness among healthcare personnel (HCP). METHODS HCP with direct patient contact working full-time in hospitals were followed during three influenza seasons in Israel (2016-2017 to 2018-2019) and Peru (2016 to 2018). Trivalent influenza vaccines were available at all sites, except during 2018-2019 when Israel used quadrivalent vaccines; vaccination was documented by electronic medical records, vaccine registries, and/or self-report (for vaccinations outside the hospital). Twice-weekly active surveillance identified acute respiratory symptoms or febrile illness (ARFI); self-collected respiratory specimens were tested by real-time reverse transcription polymerase chain reaction (PCR) assay. IVE was 100 × 1-hazard ratio (adjusted for sex, age, occupation, and hospital). RESULTS Among 5,489 HCP who contributed 10,041 person-seasons, influenza vaccination coverage was 47% in Israel and 32% in Peru. Of 3,056 ARFIs in Israel and 3,538 in Peru, A or B influenza virus infections were identified in 205 (7%) in Israel and 87 (2.5%) in Peru. IVE against all viruses across seasons was 1% (95% confidence interval [CI] = -30%, 25%) in Israel and 12% (95% CI = -61%, 52%) in Peru. CONCLUSION Estimates of IVE were null using person-time models during six study seasons in Israel and Peru.
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204
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Seppälä E, Veneti L, Starrfelt J, Danielsen AS, Bragstad K, Hungnes O, Taxt AM, Watle SV, Meijerink H. Vaccine effectiveness against infection with the Delta (B.1.617.2) variant, Norway, April to August 2021. Euro Surveill 2021; 26:2100793. [PMID: 34477054 PMCID: PMC8414959 DOI: 10.2807/1560-7917.es.2021.26.35.2100793] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/02/2021] [Indexed: 11/20/2022] Open
Abstract
Some variants of SARS-CoV-2 are associated with increased transmissibility, increased disease severity or decreased vaccine effectiveness (VE). In this population-based cohort study (n = 4,204,859), the Delta variant was identified in 5,430 (0.13%) individuals, of whom 84 were admitted to hospital. VE against laboratory confirmed infection with the Delta variant was 22.4% among partly vaccinated (95% confidence interval (CI): 17.0-27.4) and 64.6% (95% CI: 60.6-68.2) among fully vaccinated individuals, compared with 54.5% (95% CI: 50.4-58.3) and 84.4% (95%CI: 81.8-86.5) against the Alpha variant.
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Affiliation(s)
- Elina Seppälä
- Department of infectious disease control and vaccines, Norwegian Institute of Public Health, Oslo, Norway
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
| | - Lamprini Veneti
- Department of infectious disease control and preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Jostein Starrfelt
- Department of infectious disease control and preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Anders Skyrud Danielsen
- Department of infectious disease control and preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Karoline Bragstad
- Department of virology, Norwegian Institute of Public Health, Oslo, Norway
| | - Olav Hungnes
- Department of virology, Norwegian Institute of Public Health, Oslo, Norway
| | - Arne Michael Taxt
- Department of infectious disease control and vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Sara Viksmoen Watle
- Department of infectious disease control and vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Hinta Meijerink
- Department of infectious disease control and vaccines, Norwegian Institute of Public Health, Oslo, Norway
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205
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Nguyen T, Adnan M, Nguyen BP, de Ligt J, Geoghegan JL, Dean R, Jefferies S, Baker MG, Seah WK, Sporle AA, French NP, Murdoch DR, Welch D, Simpson CR. COVID-19 vaccine strategies for Aotearoa New Zealand: a mathematical modelling study. Lancet Reg Health West Pac 2021; 15:100256. [PMID: 34426804 PMCID: PMC8375363 DOI: 10.1016/j.lanwpc.2021.100256] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/15/2021] [Accepted: 07/29/2021] [Indexed: 12/16/2022]
Abstract
Background: COVID-19 elimination measures, including border closures have been applied in New Zealand. We have modelled the potential effect of vaccination programmes for opening borders. Methods: We used a deterministic age-stratified Susceptible, Exposed, Infectious, Recovered (SEIR) model. We minimised spread by varying the age-stratified vaccine allocation to find the minimum herd immunity requirements (the effective reproduction number Reff<1 with closed borders) under various vaccine effectiveness (VE) scenarios and R0 values. We ran two-year open-border simulations for two vaccine strategies: minimising Reff and targeting high-risk groups. Findings: Targeting of high-risk groups will result in lower hospitalisations and deaths in most scenarios. Reaching the herd immunity threshold (HIT) with a vaccine of 90% VE against disease and 80% VE against infection requires at least 86•5% total population uptake for R0=4•5 (with high vaccination coverage for 30-49-year-olds) and 98•1% uptake for R0=6. In a two-year open-border scenario with 10 overseas cases daily and 90% total population vaccine uptake (including 0-15 year olds) with the same vaccine, the strategy of targeting high-risk groups is close to achieving HIT, with an estimated 11,400 total hospitalisations (peak 324 active and 36 new daily cases in hospitals), and 1,030 total deaths. Interpretation: Targeting high-risk groups for vaccination will result in fewer hospitalisations and deaths with open borders compared to targeting reduced transmission. With a highly effective vaccine and a high total uptake, opening borders will result in increasing cases, hospitalisations, and deaths. Other public health and social measures will still be required as part of an effective pandemic response. Funding: This project was funded by the Health Research Council [20/1018]. Research in context.
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Affiliation(s)
- Trung Nguyen
- Institute of Environmental Science and Research, New Zealand
| | - Mehnaz Adnan
- Institute of Environmental Science and Research, New Zealand
| | - Binh P Nguyen
- School of Mathematics and Statistics, Victoria University of Wellington, New Zealand
| | - Joep de Ligt
- Institute of Environmental Science and Research, New Zealand
| | - Jemma L Geoghegan
- Department of Microbiology and Immunology, University of Otago, New Zealand and Institute of Environmental Science and Research, New Zealand
| | - Richard Dean
- Institute of Environmental Science and Research, New Zealand
| | - Sarah Jefferies
- Institute of Environmental Science and Research, New Zealand
| | - Michael G Baker
- Department of Public Health, University of Otago, New Zealand
| | - Winston Kg Seah
- School of Engineering and Computer Science, Victoria University of Wellington, New Zealand
| | - Andrew A Sporle
- Department of Statistics, The University of Auckland, New Zealand and iNZight Analytics Ltd
| | | | - David R Murdoch
- Department of Pathology and Biomedical Science, University of Otago, New Zealand
| | - David Welch
- School of Computer Science, The University of Auckland, New Zealand
| | - Colin R Simpson
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand.,Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
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206
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Hughes SL, Kwong JC, Schwartz KL, Chen C, Johnson C, Li Y, Marchand-Austin A, Bolotin S, Jamieson FB, Drews SJ, Russell ML, Svenson LW, Mahmud SM, Crowcroft NS. Exploring the reasons for low pertussis vaccine effectiveness in Ontario, Canada, 2006-2008: a Canadian Immunization Research Network study. Can J Public Health 2021; 113:155-164. [PMID: 34424508 DOI: 10.17269/s41997-021-00536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Although pertussis vaccines have been widely used for many decades, a burden of illness persists. Resurgences in Ontario, Canada, have not been substantial in the past decade, but an outbreak of pertussis occurred in Toronto between 1 October 2005 and 31 March 2006. Previous Ontario studies found high vaccine effectiveness (VE) in the initial years post-immunization. In order to explore the impact of outbreaks and external factors on VE, we investigated pertussis VE during the period 2006-2008. METHODS We assessed pertussis VE using a frequency-matched case-control study for the period 1 March 2006 to 31 December 2008. We used logistic regression to estimate VE by age, time since last vaccination, and vaccination status according to the Ontario recommended schedule. We compared analyses including and excluding cases from Toronto, and to two recent Ontario pertussis VE studies. RESULTS We included 1797 confirmed cases and 7188 matched controls. Most cases were under 4 years of age during the study period. Pertussis VE was 3.8% (95% CI: - 21.0, 24.0) in the period 15-364 days following the last pertussis vaccine dose, and increased with increasing time since vaccination. Pertussis VE in the first 15-364 days excluding Toronto increased to 57.1% (95% CI: 26.0, 75.1), but the trend of increasing VE with time since vaccination persisted. Although VE was higher in older (6-11 years) than younger (0-5 years) children, it was lower at 12-13 years than after 14 years. CONCLUSION VE was lower in comparison with other studies conducted in Ontario, particularly in younger children. Various factors occurring during the study period may have influenced the results, including clinical testing of asymptomatic contacts, laboratory testing and methods and reporting practice, and a sensitive case definition. Further studies are needed to optimize methods for measuring VE to inform pertussis vaccine policy.
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Affiliation(s)
| | - Jeffrey C Kwong
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Kevin L Schwartz
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,ICES, Toronto, ON, Canada
| | - Cynthia Chen
- Public Health Ontario, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | | | - Ye Li
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada
| | | | - Shelly Bolotin
- Public Health Ontario, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Frances B Jamieson
- Public Health Ontario, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Steven J Drews
- Canadian Blood Services, Ottawa, ON, Canada.,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Margaret L Russell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lawrence W Svenson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health, Edmonton, AB, Canada.,Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada.,School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Natasha S Crowcroft
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada.
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207
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Godoy P, García-Cenoz M, Rius C, Muñoz-Almagro C, Carmona G, Alsedà M, Jané M, Vidal MJ, Rodríguez R, Álvarez J, Camps N, Minguell S, Carol M, Sala MR, Castilla J, Domínguez À. Effectiveness of maternal pertussis vaccination in protecting newborn: A matched case-control study. J Infect 2021; 83:554-558. [PMID: 34407422 DOI: 10.1016/j.jinf.2021.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/15/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The objective was to estimate the effectiveness of maternal pertussis vaccination in protecting infants aged < 2 months. METHODS We performed a case-control study. Laboratory-confirmed cases aged <8 weeks at disease onset were identified and 2-4 matched-controls born within ± 15 days of the case were included. Information was obtained from healthcare providers and maternal interviews. Odds ratios (OR) were calculated using multivariable conditional logistic regression. Vaccine effectiveness (VE) was estimated as (1 - OR) × 100%. RESULTS 47 cases and 124 controls were studied. The mean age (in days) (39.8 ± 12.7 vs. 40.8 ± 13.2), weeks of gestation (38.8 vs. 39.1, p = 0.43) and mean birth weight (3.309 vs. 3.253 kg, p = 0.55) were comparable between cases and controls. Mothers of cases were less frequently vaccinated in the third trimester (59.6% vs. 83.9%, p <0.001). The VE of maternal vaccination in pregnancy was 88.0% (95%CI 53.8% -96.5%), and was slightly higher in those vaccinated before the 32nd week of gestation (88.5% vs 87.8%). CONCLUSION Pertussis vaccination in pregnancy is very effective in reducing pertussis in children aged < 2 months. Vaccination before and after the 32nd week of pregnancy are equally effective in reducing the risk of pertussis.
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Affiliation(s)
- Pere Godoy
- Agència de Salut Pública de Catalunya. Barcelona, Spain; Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Institut de Recerca Biomèdica de Lleida. IRBLleida. Lleida, Spain.
| | - Manuel García-Cenoz
- Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Instituto de Salud Pública de Navarra - idiSNA, Pamplona, Spain
| | - Cristina Rius
- Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Agència de Salut Pública de Barcelona. Barcelona, Spain
| | - Carmen Muñoz-Almagro
- Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Institut de Recerca Pediàtrica, Hospital de Sant Joan de Dèu, Barcelona, Spain; Departament de Medicina, Universitat Internacional de Catalunya
| | | | - Miquel Alsedà
- Agència de Salut Pública de Catalunya. Barcelona, Spain; Institut de Recerca Biomèdica de Lleida. IRBLleida. Lleida, Spain
| | - Mireia Jané
- Agència de Salut Pública de Catalunya. Barcelona, Spain; Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain
| | | | | | - Josep Álvarez
- Agència de Salut Pública de Catalunya. Barcelona, Spain
| | - Neus Camps
- Agència de Salut Pública de Catalunya. Barcelona, Spain
| | | | - Mónica Carol
- Agència de Salut Pública de Catalunya. Barcelona, Spain
| | | | - Jesús Castilla
- Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Instituto de Salud Pública de Navarra - idiSNA, Pamplona, Spain
| | - Àngela Domínguez
- Ciber de Epidemiología y Salud Pública. CIBERESP. Madrid, Spain; Departament de Medicina, Universitat de Barcelona. Barcelona, Spain
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208
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Pépin J, Labbé AC, Carignan A, Parent ME, Yu J, Grenier C, Beauchemin S, De Wals P, Valiquette L, Rousseau MC. Does BCG provide long-term protection against SARS-CoV-2 infection? A case-control study in Quebec, Canada. Vaccine 2021; 39:7300-7307. [PMID: 34493410 PMCID: PMC8354805 DOI: 10.1016/j.vaccine.2021.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 12/12/2022]
Abstract
Background Early in the coronavirus disease 2019 (COVID-19) pandemic, before severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines became available, it was hypothesized that BCG (Bacillus Calmette–Guérin), which stimulates innate immunity, could provide protection against SARS-CoV-2. Numerous ecological studies, plagued by methodological deficiencies, revealed a country-level association between BCG use and lower COVID-19 incidence and mortality. We aimed to determine whether BCG administered in early life decreased the risk of SARS-CoV-2 infection in adulthood and the severity of COVID-19. Methods This case-control study was conducted in Quebec, Canada. Cases were patients with a positive SARS-CoV-2 nucleic acid amplification test performed at two hospitals between March–October 2020. Controls were identified among patients with non-COVID-19 samples processed by the same microbiology laboratories during the same period. Enrolment was limited to individuals born in Quebec between 1956 and 1976, whose vaccine status was accessible in a computerized registry of 4.2 million BCG vaccinations. Results We recruited 920 cases and 2123 controls. Fifty-four percent of cases (n = 424) and 53% of controls (n = 1127) had received BCG during childhood (OR: 1.03; 95% CI: 0.89–1.21), while 12% of cases (n = 114) and 11% of controls (n = 235) had received two or more BCG doses (OR: 1.14; 95% CI: 0.88–1.46). After adjusting for age, sex, material deprivation, recruiting hospital and occupation there was no evidence of protection conferred by BCG against SARS-CoV-2 (AOR: 1.01; 95% CI: 0.84–1.21). Among cases, 77 (8.4%) needed hospitalization and 18 (2.0%) died. The vaccinated were as likely as the unvaccinated to require hospitalization (AOR: 1.01, 95% CI: 0.62–1.67) or to die (AOR: 0.85, 95% CI: 0.32–2.39). Conclusions BCG does not provide long-term protection against symptomatic COVID-19 or severe forms of the disease.
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Affiliation(s)
- Jacques Pépin
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, 3001, 12ième Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | - Annie-Claude Labbé
- Hôpital Maisonneuve-Rosemont - CIUSSS de l'Est-de-l'Ile-de-Montréal, 5415 Boulevard de l'Assomption, Montreal, Quebec H1T 2M4, Canada; Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Pavillon Roger-Gaudry, 2900 Boulevard Edouard Montpetit, Montreal, Quebec H3T 1J4, Canada
| | - Alex Carignan
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, 3001, 12ième Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | - Marie-Elise Parent
- Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique, 531, boul. des Prairies, Laval, Quebec H7V 1B7, Canada
| | - Jennifer Yu
- Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique, 531, boul. des Prairies, Laval, Quebec H7V 1B7, Canada
| | - Cynthia Grenier
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, 3001, 12ième Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | - Stéphanie Beauchemin
- Hôpital Maisonneuve-Rosemont - CIUSSS de l'Est-de-l'Ile-de-Montréal, 5415 Boulevard de l'Assomption, Montreal, Quebec H1T 2M4, Canada
| | - Philippe De Wals
- Department of Social and Preventive Medicine, Université Laval, 2725 Ch Ste-Foy, Quebec, Quebec G1V 4G5, Canada
| | - Louis Valiquette
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, 3001, 12ième Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
| | - Marie-Claude Rousseau
- Centre Armand-Frappier Santé Biotechnologie, Institut National de la Recherche Scientifique, 531, boul. des Prairies, Laval, Quebec H7V 1B7, Canada.
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Petrie JG, Fligiel H, Lamerato L, Martin ET, Monto AS. Agreement between state registry, health record, and self-report of influenza vaccination. Vaccine 2021; 39:5341-5345. [PMID: 34384635 DOI: 10.1016/j.vaccine.2021.07.090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/15/2021] [Accepted: 07/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Documentation of influenza vaccination, including the specific product received, is critical to estimate annual vaccine effectiveness (VE). METHODS We assessed performance of the Michigan Care Improvement Registry (MCIR) in defining influenza vaccination status relative to documentation by provider records or self-report among subjects enrolled in a study of influenza VE from 2011 through 2019. RESULTS The specificity and positive predictive value of MCIR were high; however, >10% of vaccinations were identified only by other sources each season. The proportion of records captured by MCIR increased from a low of 67% in 2013-2014 to a high of 89% in 2018-2019, largely driven by increased capture of vaccination among adults. CONCLUSIONS State vaccine registries, such as MCIR, are important tools for documenting influenza vaccination, including the specific product received. However, incomplete capture suggests that documentation from other sources and self-report should be used in combination with registries to reduce misclassification.
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Affiliation(s)
- Joshua G Petrie
- Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, United States.
| | - Helene Fligiel
- Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, United States
| | - Lois Lamerato
- Department of Public Health Sciences, Henry Ford Health System, Detroit, United States
| | - Emily T Martin
- Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, United States
| | - Arnold S Monto
- Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, United States
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210
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Khan SA, Choudhury P, Kakati S, Doley R, Barman MP, Murhekar MV, Kaur H. Effectiveness of a single dose of Japanese encephalitis vaccine among adults, Assam, India, 2012-2018. Vaccine 2021; 39:4973-4978. [PMID: 34325931 DOI: 10.1016/j.vaccine.2021.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/24/2021] [Accepted: 07/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Japanese encephalitis virus (JEV) remains the major etiology of encephalitis throughout Asia. In India, the state of Assam alone contributes more than one-third of the national burden of JE. Between 2011 and 2014, a single dose of JE vaccine SA 14-14-2 (LAJEV) was administered among adults aged 15-65 years residing in Sivasagar and Dibrugarh districts of Assam, India. We monitored the trend of JE incidence between 2009 and 2018 using JE surveillance data, estimated the long-term effectiveness of the single dose of LAJEV and estimated the coverage of JE vaccine in two districts. METHODS We compared the JE vaccination status of laboratory-confirmed hospitalized JE patients (case) and age, sex and locality matched healthy individuals (controls) to estimate the effectiveness of single dose of JE vaccine. We used surveillance data for 2009-2018 to calculate the incidence of JE among adults. We conducted a community-based survey to estimate the coverage of JE vaccine in the two districts. RESULTS A total of 452 laboratory-confirmed JE case-patients and 904 matched healthy controls were enrolled in the study between 2012 and 2018. The effectiveness of a single dose of JE vaccine over the 7-year period was 77.0 (95% CI: 67.0-83.0). Vaccine effectiveness decreased from 91% (95% CI: 73.0-97.0) in first year of vaccination to 71% (95% CI: 21.0-90.0) at six years post-vaccination. The incidence of adults JE cases declined from 10.5 per 100,000 in the pre-vaccination period to 5.7 per 100,000 in the years following vaccination. The coverage of vaccine among adults in two districts was 40.1% (36.8-43.5). CONCLUSIONS A single dose of JE vaccine offered adequate protection for at least six years. Conducting mass vaccination campaigns periodically would further reduce the incidence of JE in endemic districts in Assam.
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Affiliation(s)
- Siraj A Khan
- Department of Medical Entomology, Arbovirology and Rickettsial Diseases, Indian Council of Medical Research-Regional Medical Research Centre, Dibrugarh, Assam, India.
| | - Parveena Choudhury
- Department of Medical Entomology, Arbovirology and Rickettsial Diseases, Indian Council of Medical Research-Regional Medical Research Centre, Dibrugarh, Assam, India
| | - Sanjeeb Kakati
- Assam Medical College and Hospital, Dibrugarh, Assam, India
| | - Rimamoni Doley
- Assam Medical College and Hospital, Dibrugarh, Assam, India
| | - Manash P Barman
- Department of Statistics, Dibrugarh University, Dibrugarh, Assam, India
| | - Manoj V Murhekar
- Indian Council of Medical Research-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Harpreet Kaur
- Indian Council of Medical Research, New Delhi, India
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211
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Bobdey S, Kaushik SK, Sahu R, Naithani N, Vaidya R, Sharma M, Vashishtha K, Yadav AK, Sen S, Karade S. Effectiveness of ChAdOx1 nCOV-19 Vaccine: Experience of a tertiary care institute. Med J Armed Forces India 2021; 77:S271-S277. [PMID: 34334893 PMCID: PMC8313083 DOI: 10.1016/j.mjafi.2021.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/03/2021] [Indexed: 02/05/2023] Open
Abstract
Background The first dose of the ChAdOx1 nCoV- 19 Corona Virus Vaccine (Covishield) was administered to the eligible beneficiaries of tertiary care institute of Western Maharashtra on 16 Jan 21 and in the past three months almost 97% of the staff has been vaccinated. The present study analyses the incidence of COVID cases in the unvaccinated and vaccinated population of the institute. Methods All Covid 19 infections (RT-PCR positive) from 01 February 21 to 25 April 21 were included in the study and analyzed as per their vaccination status. To assess the COVID 19 transmission in contacts, Secondary Attack Rates (SAR) of the pre-vaccination period (Jun–Oct 20) was compared with the present SAR. Results A total of 113 cases occurred in the study period (01 Feb to 25 Apr 21). Lower number of infections were observed among the fully vaccinated as compared to partially vaccinated and non-vaccinated. The overall vaccine effectiveness was found to be 88.6% (81.55–92.37) and 44.1% (4.55–67.3) in completely and partially vaccinated individuals respectively. Hazard Ratios for getting infected dropped significantly after 28 days of the second dose. The SAR in high risk contacts (HRCs) was found to be 4.25%, which was lower than SAR (20.6%) of pre-vaccination period. Conclusion This is one of the earliest studies in India to report the impact of COVID-19 vaccination. The results indicate that the vaccine provides effective protection against COVID-19 infection. However, given the complex dynamics of vaccination, the role of NPIs and implementation of COVID appropriate behavior cannot be undermined.
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Affiliation(s)
- Saurabh Bobdey
- Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - S K Kaushik
- Professor & Head, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Rajesh Sahu
- Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Nardeep Naithani
- Director & Commandant, Armed Forces Medical College, Pune, India
| | - Rajesh Vaidya
- Dean & Dy Commandant, Armed Forces Medical College, Pune, India
| | - Mithun Sharma
- Resident, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Kundan Vashishtha
- Resident, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - A K Yadav
- Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Sourav Sen
- Professor & Head, Department of Microbiology, Armed Forces Medical College, Pune, India
| | - Santosh Karade
- Professor, Department of Microbiology, Armed Forces Medical College, Pune, India
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212
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Ghosh S, Shankar S, Chatterjee K, Chatterjee K, Yadav AK, Pandya K, Suryam V, Agrawal S, Ray S, Phutane V, Datta R. COVISHIELD (AZD1222) VaccINe effectiveness among healthcare and frontline Workers of INdian Armed Forces: Interim results of VIN-WIN cohort study. Med J Armed Forces India 2021; 77:S264-S270. [PMID: 34334892 PMCID: PMC8313084 DOI: 10.1016/j.mjafi.2021.06.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 06/28/2021] [Indexed: 01/10/2023] Open
Abstract
Background On 16 Jan 2021, India launched its immunization program against COVID-19. Among the first recipients were 1.59 million Health Care Workers (HCWs) and Frontline Workers (FLWs) of the Indian Armed Forces, who were administered COVISHIELD (Astra Zeneca). We present an interim analysis of vaccine effectiveness (VE) estimates till 30 May 2021. Methods The VIN-WIN cohort study was carried out on anonymized data of HCWs and FLWs of Indian Armed Forces. The existing surveillance system, enhanced for COVID-19 monitoring, was sourced for data. The cohort transitioned from Unvaccinated (UV) to Partially Vaccinated (PV) to Fully Vaccinated (FV), serving as its own internal comparison. Outcomes studied in the three groups were breakthrough infections and COVID related deaths. Incidence Rate Ratio (IRR) was used to compare outcomes among the three groups to estimate VE. Results Data of 1,595,630 individuals (mean age 27.6 years; 99% male) over 135 days was analysed. Till 30 May 21, 95.4% and 82.2% were partially and fully vaccinated. The UV, PV and FV compartments comprised 106.6, 46.7 and 58.7 million person-days respectively. The number of breakthrough cases in the UV, PV and FV groups were 10061, 1159 and 2512; while the deaths were 37, 16 and 7 respectively. Corrected VE was 91.8–94.9% against infections. Conclusion Interim results of the VIN-WIN cohort study of 1.59 million HCWs and FLWs of Indian Armed Forces showed a ∼93% reduction in COVID-19 breakthrough infections with COVISHIELD vaccination.
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Affiliation(s)
| | - Subramanian Shankar
- Consultant (Medicine & Clinical Immunology), Air Cmde AFMS (P&T), O/o DGAFMS, New Delhi, India
- Corresponding author and joint first author.
| | - Kaustuv Chatterjee
- Officer-in-Charge, School of Medical Assistants, INHS Asvini, Mumbai, India
| | - Kaushik Chatterjee
- Professor & Head, Department of Psychiatry, Armed Forces Medical College, Pune, India
| | - Arun Kumar Yadav
- Associate Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | | | - Vani Suryam
- Col Medical (Health), O/o DGMS (Army), AG's Branch, IHQ of MOD, New Delhi, India
| | - Sunil Agrawal
- Gp Capt MS (Health) & Senior Advisor (Community Medicine), Air HQ, O/o DGMS (Air), R K Puram, New Delhi, India
| | - Sougat Ray
- Capt (MS), Health, IHQ of MoD (Navy), New Delhi, India
| | - Vivek Phutane
- JDMS (ESM), Classified Specialist (Community Medicine), O/o DGMS (Navy), New Delhi, India
| | - Rajat Datta
- Director General Armed Forces Medical Services, O/o DGAFMS, Ministry of Defence, 'M' Block, New Delhi, India
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213
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Chua H, Kwan MYW, Chan ELY, Wong JSC, Peiris JSM, Cowling BJ, Chiu SS. Influenza vaccine effectiveness against influenza-associated hospitalization in children in Hong Kong, 2010-2020. Vaccine 2021; 39:4842-8. [PMID: 34301433 DOI: 10.1016/j.vaccine.2021.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Influenza virus infections can cause hospitalizations in children, and annual vaccination of children can provide protection against influenza. METHODS We analyzed a test-negative design study with data spanning from 2010/11 through 2019/20 to evaluate influenza vaccine effectiveness (VE) against influenza hospitalization in children by age group, influenza type/subtype and time period within each season. We enrolled children admitted to hospital with acute febrile respiratory illnesses. Nasopharyngeal aspirates were tested by culture and/or RT-PCR to determine influenza status, and vaccination status was obtained by interviewing parents or legal guardians and was verified where possible. VE was estimated by conditional logistic regression model adjusting for sex, age and age-squared, matching on week. RESULTS Influenza seasons in Hong Kong are prolonged with influenza-associated hospitalizations occurring in almost every month of the year during the study period. Influenza vaccination was effective in preventing influenza-associated hospitalizations in children of all ages. Influenza VE was higher in younger children than in older children, and higher against hospitalization due to influenza A(H1N1)pdm09 than A(H3N2) and B. CONCLUSIONS The childhood influenza vaccination program in Hong Kong has prevented influenza-associated hospitalizations particularly in younger children. Our findings support the use of influenza vaccines in children as an effective approach to influenza control and prevention.
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214
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Charmet T, Schaeffer L, Grant R, Galmiche S, Chény O, Von Platen C, Maurizot A, Rogoff A, Omar F, David C, Septfons A, Cauchemez S, Gaymard A, Lina B, Lefrancois LH, Enouf V, van der Werf S, Mailles A, Levy-Bruhl D, Carrat F, Fontanet A. Impact of original, B.1.1.7, and B.1.351/P.1 SARS-CoV-2 lineages on vaccine effectiveness of two doses of COVID-19 mRNA vaccines: Results from a nationwide case-control study in France. Lancet Reg Health Eur 2021; 8:100171. [PMID: 34278372 PMCID: PMC8277121 DOI: 10.1016/j.lanepe.2021.100171] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background We aimed to assess the effectiveness of two doses of mRNA COVID-19 vaccines against COVID-19 with the original virus and other lineages circulating in France. Methods In this nationwide case-control study, cases were SARS-CoV-2 infected adults with onset of symptoms between 14 February and 3 May 2021. Controls were non-infected adults from a national representative panel matched to cases by age, sex, region, population density and calendar week. Participants completed an online questionnaire on recent activity-related exposures and vaccination history. Information about the infecting virus was based on a screening RT-PCR for either B.1.1.7 or B.1.351/P.1 variants. Findings Included in our analysis were 7 288 adults infected with the original SARS-CoV-2 virus, 31 313 with the B.1.1.7 lineage, 2 550 with B.1.351/P1 lineages, and 3 644 controls. In multivariable analysis, the vaccine effectiveness (95% confidence interval) seven days after the second dose of mRNA vaccine was estimated at 88% (81-92), 86% (81-90) and 77% (63-86) against COVID-19 with the original virus, the B.1.1.7 lineage, and the B.1.351/P.1 lineages, respectively. Recent (2 to 6 months) history of virologically confirmed SARS-CoV-2 infection was found to be 83% (76-88), 88% (85-91) and 83% (71-90) protective against COVID-19 with the original virus, the B.1.1.7 lineage, and the B.1.351/P.1 lineages, respectively; and more distant (> 6 months) infections were 76% (54-87), 84% (75-90), and 74% (41-89) protective against COVID-19 with the original virus, the B.1.1.7 lineage, and the B.1.351/P.1 lineages, respectively. Interpretation In real-life settings, two doses of mRNA vaccines proved to be effective against COVID-19 with the original virus, B.1.1.7 lineage and B.1.351/P.1 lineages. Funding Institut Pasteur, Research & Action Emerging Infectious Diseases (REACTing), Fondation de France (Alliance “Tous unis contre le virus”).
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Affiliation(s)
- Tiffany Charmet
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
| | - Laura Schaeffer
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
| | - Rebecca Grant
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France.,Sorbonne University, Paris, France
| | - Simon Galmiche
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France
| | - Olivia Chény
- Institut Pasteur, Centre for Translational Research, Paris, France
| | | | | | | | | | | | | | - Simon Cauchemez
- Institut Pasteur, Mathematical Modelling of Infectious Diseases Unit; UMR2000; CNRS, Paris, France
| | - Alexandre Gaymard
- CNR des Virus des Infections Respiratoires, Institut des Agents Infectieux, Hospices Civils de Lyon.,Virpath, Centre International de Recherche En Infectiologie, Université de Lyon, Inserm U1111, CNRS UMR5308, École Normale Supérieure de Lyon, UCBL, Lyon, France
| | - Bruno Lina
- CNR des Virus des Infections Respiratoires, Institut des Agents Infectieux, Hospices Civils de Lyon.,Virpath, Centre International de Recherche En Infectiologie, Université de Lyon, Inserm U1111, CNRS UMR5308, École Normale Supérieure de Lyon, UCBL, Lyon, France
| | - Louise H Lefrancois
- Molecular Genetics of RNA Viruses, Department of Virology, Institut Pasteur CNRS UMR 3569; Université de Paris, Paris, France.,National Reference Center for Respiratory Viruses, Institut Pasteur, Paris, France
| | - Vincent Enouf
- Molecular Genetics of RNA Viruses, Department of Virology, Institut Pasteur CNRS UMR 3569; Université de Paris, Paris, France.,National Reference Center for Respiratory Viruses, Institut Pasteur, Paris, France.,Mutualized Platform of Microbiology, Pasteur International Bioresources Network, Institut Pasteur, Paris, France
| | - Sylvie van der Werf
- Molecular Genetics of RNA Viruses, Department of Virology, Institut Pasteur CNRS UMR 3569; Université de Paris, Paris, France.,National Reference Center for Respiratory Viruses, Institut Pasteur, Paris, France
| | | | | | - Fabrice Carrat
- Sorbonne Université, Inserm, IPLESP, hôpital Saint-Antoine, APHP, 27 rue Chaligny, Paris F75571, France
| | - Arnaud Fontanet
- Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France.,Conservatoire national des arts et métiers, Unité PACRI, Paris, France
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215
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Brosh-Nissimov T, Orenbuch-Harroch E, Chowers M, Elbaz M, Nesher L, Stein M, Maor Y, Cohen R, Hussein K, Weinberger M, Zimhony O, Chazan B, Najjar R, Zayyad H, Rahav G, Wiener-Well Y. BNT162b2 vaccine breakthrough: clinical characteristics of 152 fully vaccinated hospitalized COVID-19 patients in Israel. Clin Microbiol Infect 2021; 27:1652-1657. [PMID: 34245907 PMCID: PMC8261136 DOI: 10.1016/j.cmi.2021.06.036] [Citation(s) in RCA: 211] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022]
Abstract
Objectives The mRNA coronavirus disease 2019 (COVID-19) vaccines have shown high effectiveness in the prevention of symptomatic COVID-19, hospitalization, severe disease and death. Nevertheless, a minority of vaccinated individuals might become infected and experience significant morbidity. Characteristics of vaccine breakthrough infections have not been studied. We sought to portray the population of Israeli patients, who were hospitalized with COVID-19 despite full vaccination. Methods A retrospective multicentre cohort study of 17 hospitals included patients fully vaccinated with Pfizer/BioNTech's BNT162b2 vaccine who developed COVID-19 more than 7 days after the second vaccine dose and required hospitalization. The risk for poor outcome, defined as a composite of mechanical ventilation or death, was assessed. Results A total of 152 patients were included, accounting for half of hospitalized fully vaccinated patients in Israel. Poor outcome was noted in 38 patients and mortality rate reached 22% (34/152). Notably, the cohort was characterized by a high rate of co-morbidities predisposing to severe COVID-19, including hypertension (108; 71%), diabetes (73; 48%), congestive heart failure (41; 27%), chronic kidney and lung diseases (37; 24% each), dementia (29; 19%) and cancer (36; 24%), and only six (4%) had no co-morbidities. Sixty (40%) of the patients were immunocompromised. Higher viral load was associated with a significant risk for poor outcome. Risk also appeared higher in patients receiving anti-CD20 treatment and in patients with low titres of anti-Spike IgG, but these differences did not reach statistical significance. Conclusions We found that severe COVID-19 infection, associated with a high mortality rate, might develop in a minority of fully vaccinated individuals with multiple co-morbidities. Our patients had a higher rate of co-morbidities and immunosuppression compared with previously reported non-vaccinated hospitalized individuals with COVID-19. Further characterization of this vulnerable population may help to develop guidance to augment their protection, either by continued social distancing, or by additional active or passive vaccinations.
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Affiliation(s)
- Tal Brosh-Nissimov
- Infectious Diseases Unit, Samson Assuta Ashdod University Hospital, Ashdod, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel.
| | - Efrat Orenbuch-Harroch
- Division of Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Centre, Jerusalem, Israel; School of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Chowers
- Meir Medical Centre, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meital Elbaz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Infectious Diseases, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Lior Nesher
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel; Infectious Disease Institute, Soroka Medical Centre, Beer Sheba, Israel
| | - Michal Stein
- Infectious Disease and Infection Control Unit, Hillel Yaffe Medical Centre, Hadera, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Yasmin Maor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Disease Unit, Wolfson Medical Centre, Holon, Israel
| | - Regev Cohen
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Infectious Diseases Unit, Sanz Medical Centre, Laniado Hospital, Netanya, Israel
| | - Khetam Hussein
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Rambam Health Care Campus, Haifa, Israel
| | - Miriam Weinberger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Shamir (Assaf Harofe) Medical Centre, Zerifin, Israel
| | - Oren Zimhony
- School of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Infectious Diseases Unit, Kaplan Medical Centre, Rhovot, Israel
| | - Bibiana Chazan
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Infectious Diseases Unit, Emek Medical Centre, Afula, Israel
| | - Ronza Najjar
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Carmel Medical Centre, Haifa, Israel
| | - Hiba Zayyad
- Infectious Disease Unit, The Baruch Padeh Medical Centre, Tiberias, Israel; The Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
| | - Galia Rahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Sheba Medical Centre, Tel Hashomer, Israel
| | - Yonit Wiener-Well
- School of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Shaare Zedek Medical Centre, Jerusalem, Israel
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216
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Patel MK, Bergeri I, Bresee JS, Cowling BJ, Crowcroft NS, Fahmy K, Hirve S, Kang G, Katz MA, Lanata CF, L'Azou Jackson M, Joshi S, Lipsitch M, Mwenda JM, Nogareda F, Orenstein WA, Ortiz JR, Pebody R, Schrag SJ, Smith PG, Srikantiah P, Subissi L, Valenciano M, Vaughn DW, Verani JR, Wilder-Smith A, Feikin DR. Evaluation of post-introduction COVID-19 vaccine effectiveness: Summary of interim guidance of the World Health Organization. Vaccine 2021; 39:4013-4024. [PMID: 34119350 PMCID: PMC8166525 DOI: 10.1016/j.vaccine.2021.05.099] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/27/2021] [Indexed: 01/07/2023]
Abstract
Phase 3 randomized-controlled trials have provided promising results of COVID-19 vaccine efficacy, ranging from 50 to 95% against symptomatic disease as the primary endpoints, resulting in emergency use authorization/listing for several vaccines. However, given the short duration of follow-up during the clinical trials, strict eligibility criteria, emerging variants of concern, and the changing epidemiology of the pandemic, many questions still remain unanswered regarding vaccine performance. Post-introduction vaccine effectiveness evaluations can help us to understand the vaccine's effect on reducing infection and disease when used in real-world conditions. They can also address important questions that were either not studied or were incompletely studied in the trials and that will inform evolving vaccine policy, including assessment of the duration of effectiveness; effectiveness in key subpopulations, such as the very old or immunocompromised; against severe disease and death due to COVID-19; against emerging SARS-CoV-2 variants of concern; and with different vaccination schedules, such as number of doses and varying dosing intervals. WHO convened an expert panel to develop interim best practice guidance for COVID-19 vaccine effectiveness evaluations. We present a summary of the interim guidance, including discussion of different study designs, priority outcomes to evaluate, potential biases, existing surveillance platforms that can be used, and recommendations for reporting results.
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Affiliation(s)
- Minal K Patel
- World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland.
| | - Isabel Bergeri
- World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
| | - Joseph S Bresee
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, USA
| | - Benjamin J Cowling
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong, China
| | | | - Kamal Fahmy
- World Health Organization Regional Office for the Eastern Mediterranean, Monazamet El Seha El Alamia Str, Extension of Abdel Razak El Sanhouri Street, P.O. Box 7608, Nasr City, Cairo 11371, Egypt
| | | | - Gagandeep Kang
- Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu 632004, India
| | - Mark A Katz
- World Health Organization Regional Office of Europe, UN City, Marmorvej 51, Copenhagen DK-2100, Denmark
| | - Claudio F Lanata
- Instituto de Investigación Nutricional, Av. la Molina 1885, La Molina 15024, Peru
| | - Maïna L'Azou Jackson
- The Coalition for Epidemic Preparedness Innovations (CEPI), Gibbs building, 215 Euston Rd, Bloomsbury, London NW1 2BE, United Kingdom
| | - Sudhir Joshi
- World Health Organization Regional Office for South-East Asia, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Jason M Mwenda
- World Health Organization Regional Office for Africa, Cité du Djoué, P.O. Box 06, Brazzaville, Republic of Congo
| | - Francisco Nogareda
- Consultant to the Pan American Health Organization, 525 23rd Street NW, Washington, DC 20037, USA
| | | | - Justin R Ortiz
- Center for Vaccine Development & Global Health, University of Maryland School of Medicine, 685 W. Baltimore St., Room #480, Baltimore, MD 21201, USA
| | - Richard Pebody
- World Health Organization Regional Office of Europe, UN City, Marmorvej 51, Copenhagen DK-2100, Denmark
| | - Stephanie J Schrag
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, USA
| | - Peter G Smith
- MRC International Epidemiology & Statistics Group, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | | | - Lorenzo Subissi
- World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
| | | | - David W Vaughn
- Bill & Melinda Gates Foundation, 500 5th Ave N., Seattle, WA 98109, USA
| | - Jennifer R Verani
- U.S. Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, USA
| | | | - Daniel R Feikin
- World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
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217
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Trollfors B, Sigurdsson V, Dahlgren-Aronsson A. Prevalence of Latent TB and Effectiveness of BCG Vaccination Against Latent Tuberculosis: An Observational Study. Int J Infect Dis 2021; 109:279-282. [PMID: 34174429 DOI: 10.1016/j.ijid.2021.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES This study aimed to determine the prevalence of latent tuberculosis infection (LTBI) in immigrant children and adolescents (aged 0-17 years) living or recently arriving in Sweden. It also aimed to estimate the effectiveness of Bacillus Calmette-Guérin (BCG) against LTBI in immigrant children coming to Sweden from high-incidence countries, most of them being asylum seekers. LTBI was defined as a positive Quantiferon or a tuberculin skin test (TST) of ≥ 10 mm in small children from whom it was difficult to obtain 3 mL of blood. DESIGN A typical BCG scar was used as a substitute for written documentation of BCG vaccination. The study comprised 1,404 immigrants aged 0-17 years. The arms and legs of all of them were inspected for a BCG scar, and Quantiferon or TST was performed. The study was a retrospective, observational, comparative cohort study. RESULTS LTBI was found in 123 of 1,011 (12%) children with a BCG scar and in 116 of 393 (29.5%) without a BCG scar, giving an estimated vaccine effectiveness of 59%. CONCLUSIONS LTBI was common among the immigrant children (17%). LTBI can progress to active TB and then spread in the immigrant population and to the general population if all immigrant arrivals are not tested and given prophylactic treatment if they have LTBI. The BCG vaccine was found to have a significant effect on LTBI (59%).
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Affiliation(s)
- Birger Trollfors
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Vignir Sigurdsson
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
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218
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Zhang Z, Suo L, Pan J, Zhao D, Lu L. Two-dose varicella vaccine effectiveness in China: a meta-analysis and evidence quality assessment. BMC Infect Dis 2021; 21:543. [PMID: 34107891 PMCID: PMC8188742 DOI: 10.1186/s12879-021-06217-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/20/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The objectives of this review were to evaluate the vaccine effectiveness (VE) of the two-dose varicella vaccine for healthy children in China and explore the application of the approach of Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) in observational studies on VE. METHODS We searched for observational studies on two-dose varicella VE for children in China aged 1-12 years that were published from 1997 to 2019, and assessed the quality of each study using the Newcastle Ottawa Scale (NOS). We used meta-analysis models to obtain the pooled two-dose VE, and the studies were divided into subgroups and analysed according to whether or not it was an outbreak investigation and its NOS score. The quality of evidence of VEs were rated by approach of the GRADE system. RESULTS A total of 12 studies and 87,196 individuals were included. The pooled two-dose VE was 90% (95% confidence interval [CI]: 69-97%). The VE of outbreak studies (87% [95% CI: 76-93%]) was lower than non-outbreak studies (99% [95% CI: 98-99%]). There was no significant difference in VEs by different NOS quality. The quality of the evidence assessment of pooled two-dose VE was "low", which was rated down by one category in limitations and publication bias respectively and rated up by two category in large effect. The quality of evidence assessment in subgroup of NOS score ≥ 7 was "moderate". CONCLUSIONS The VE of two-dose varicella vaccine is relatively high in preventing varicella, and is recommended for countries which need further control for varicella. However, higher quality evidence is needed as a supplement for stronger recommendations. The approach of GRADE could be applied for rating the quality of evidence in observational study.
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Affiliation(s)
- Zhujiazi Zhang
- Department of Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, He Ping Li Zhong Jie No.16, Dongcheng District, Beijing, 100013, China
| | - Luodan Suo
- Department of Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, He Ping Li Zhong Jie No.16, Dongcheng District, Beijing, 100013, China
| | - Jingbin Pan
- Department of Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, He Ping Li Zhong Jie No.16, Dongcheng District, Beijing, 100013, China
| | - Dan Zhao
- Department of Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, He Ping Li Zhong Jie No.16, Dongcheng District, Beijing, 100013, China
| | - Li Lu
- Department of Immunization and Prevention, Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, He Ping Li Zhong Jie No.16, Dongcheng District, Beijing, 100013, China.
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219
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Sun Y, Jackson K, Dalmon CA, Shapiro BL, Nie S, Wong C, Arnold BF, Porco TC, Acharya NR. Effectiveness of the recombinant zoster vaccine among Kaiser Permanente Hawaii enrollees aged 50 and older: A retrospective cohort study. Vaccine 2021; 39:3974-3982. [PMID: 34116874 DOI: 10.1016/j.vaccine.2021.05.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The incidence of herpes zoster (HZ) has been on the rise for decades in the United States. Clinical trials for the recombinant zoster vaccine (RZV) demonstrated vaccine efficacy of over 90% in preventing herpes zoster. However, there is limited information on its effectiveness outside of a clinical trial setting, as well as its effectiveness against herpes zoster ophthalmicus (HZO). METHODS A de-identified electronic health records database from Kaiser Permanente Hawaii (KPH) was used to conduct this retrospective cohort study to assess the effectiveness of the recombinant zoster vaccine against HZ and HZO in immunocompetent, vaccine age-eligible individuals without a prior history of HZ, who were continuously enrolled in KPH for ≥365 days prior to becoming age-eligible for RZV between January 1, 2018, through December 31, 2019. RESULTS A total of 78 356 adults were included in this study, with 11 864 (15.1%) adults receiving two valid doses of the recombinant zoster vaccine. The incidence rate of HZ was 325.6 (95% CI: 217.7 to 464.4) cases per 100 000 person-years in vaccinated persons compared to 1063.3 cases per 100 000 person-years (95% CI: 1006.0 to 1122.8) in the unvaccinated group. The incidence rate of HZO was 11.9 (95% CI: 0.7 to 52.3) cases per 100 000 person-years in the vaccinated group compared to 72.1 (95% CI: 58.0 to 88.3) in the unvaccinated group. RZV was 83.5% (95% CI: 74.9% to 89.2%) effective against HZ and 93.3% (95% CI: 48.7% to 99.1%) effective against HZO. CONCLUSIONS RZV has demonstrated high effectiveness against both HZ and HZO outside of a clinical trial setting in the United States. Vaccine coverage is low, emphasizing the need for public health efforts to increase vaccination to reduce morbidity from HZ and HZO.
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Affiliation(s)
- Yuwei Sun
- F.I. Proctor Foundation, University of California, San Francisco, CA, United States
| | - Kaitlyn Jackson
- F.I. Proctor Foundation, University of California, San Francisco, CA, United States
| | | | | | - Sixiang Nie
- Kaiser Permanente Hawaii, Center for Integrated Health Care Research, United States
| | - Carmen Wong
- Kaiser Permanente Hawaii, Center for Integrated Health Care Research, United States
| | - Benjamin F Arnold
- F.I. Proctor Foundation, University of California, San Francisco, CA, United States; Department of Ophthalmology, University of California, San Francisco, CA, United States
| | - Travis C Porco
- F.I. Proctor Foundation, University of California, San Francisco, CA, United States; Department of Ophthalmology, University of California, San Francisco, CA, United States; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
| | - Nisha R Acharya
- F.I. Proctor Foundation, University of California, San Francisco, CA, United States; Department of Ophthalmology, University of California, San Francisco, CA, United States; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States.
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220
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Stuurman AL, Biccler J, Carmona A, Descamps A, Díez-Domingo J, Muñoz Quiles C, Nohynek H, Rizzo C, Riera-Montes M. Brand-specific influenza vaccine effectiveness estimates during 2019/20 season in Europe - Results from the DRIVE EU study platform. Vaccine 2021; 39:3964-3973. [PMID: 34092427 DOI: 10.1016/j.vaccine.2021.05.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
DRIVE (Development of Robust and Innovative Vaccine Effectiveness) is an IMI funded public-private platform that aims to annually estimate brand-specific influenza vaccine effectiveness (IVE), for public health and regulatory purposes. IVE analyses and reporting are conducted by public partners in the consortium. In 2019/20, four primary care-based test-negative design (TND) studies (Austria, England, Italy (n = 2)), eight hospital-based TND studies (Finland, France, Italy, Romania, Spain (n = 4)), and one population-based cohort study (Finland) were conducted. The COVID-19 pandemic affected influenza surveillance in all participating study sites, therefore the study period was truncated on February 29, 2020. Age-stratified (6 m-17y, 18-64y, ≥65y), confounder-adjusted, site-specific adjusted IVE estimates were calculated and pooled through meta-analysis. Parsimonious confounder-adjustment was performed, adjusting the estimates for age, sex and calendar time. TND studies included 3531 cases (351 vaccinated) and 5546 controls (1415 vaccinated) of all ages. IVE estimates were available for 8/11 brands marketed in Europe in 2019. Most children and adults < 64y were captured in primary care setting and the most frequently observed vaccine brand was Vaxigrip Tetra. The estimate against any influenza for Vaxigrip Tetra in primary care setting was 61% (95%CI 38-77) in children and 32% (95%CI -13-59) in adults up to 64y. Most adults ≥ 65y were captured in hospital setting and the most frequently observed brand was Fluad, with an estimate of 52% (95%CI 27-68). The population-based cohort covered 511,854 person-years and two vaccine brands. In children aged 2-6y, the IVE against any influenza was 68% (95%CI 58-75) for Fluenz Tetra and 71% (56-80) for Vaxigrip Tetra. In adults ≥ 65y, IVE against any influenza was 29% (20-36) for Vaxigrip Tetra. DRIVE is a growing platform. Public health institutes with surveillance data and hospitals in countries with high influenza vaccine coverage are encouraged to join DRIVE.
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Affiliation(s)
| | - Jorne Biccler
- P95 Pharmacovigilance and Epidemiology, Leuven, Belgium.
| | | | - Alexandre Descamps
- Institut National de la Sante et de la Recherche Medicale (INSERM), Paris, France.
| | | | | | - Hanna Nohynek
- Finnish Institute for Health and Welfare, Helsinki, Finland.
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221
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Ferdinands JM, Thompson MG, Blanton L, Spencer S, Grant L, Fry AM. Does influenza vaccination attenuate the severity of breakthrough infections? A narrative review and recommendations for further research. Vaccine 2021; 39:3678-3695. [PMID: 34090700 DOI: 10.1016/j.vaccine.2021.05.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 01/05/2023]
Abstract
The effect of influenza vaccination on influenza severity remains uncertain. We reviewed the literature for evidence to inform the question of whether influenza illness is less severe among individuals who received influenza vaccination compared with individuals with influenza illness who were unvaccinated prior to their illnesses. We conducted a narrative review to identify published findings comparing severity of influenza outcomes by vaccination status among community-dwelling adults and children ≥ 6 months of age with laboratory-confirmed influenza illness. When at least four effect estimates of the same type (e.g., odds ratio) were available for a specific outcome and age category (children versus adults), data were pooled with meta-analysis to generate a summary effect estimate. We identified 38 published articles reporting ≥ 1 association between influenza vaccination status and one of 21 indicators of severity of influenza illness among individuals with laboratory-confirmed influenza. Study methodologies and effect estimates were highly heterogenous, with only five severity indicators meeting criteria for calculating a combined effect. Among eight studies, influenza vaccination was associated with 26% reduction in odds of ICU admission among adults with influenza-associated hospitalization (OR = 0.74, 95% CI 0.58, 0.93). Among five studies of adults with influenza-associated hospitalization, vaccinated patients had 31% reduced risk of death compared with unvaccinated patients (OR = 0.69, 95% CI 0.52, 0.92). Among four studies of children with influenza virus infection, vaccination was associated with an estimated 45% reduction in the odds of manifesting fever (OR = 0.55, 95% CI 0.42, 0.71). Vaccination was not significantly associated with receiving a clinical diagnosis of pneumonia among adults hospitalized with influenza (OR = 0.92, 95% CI 0.82, 1.04) or with risk of hospitalization following outpatient influenza illness among adults (OR = 0.60, 95% CI 0.28, 1.28). Overall, our findings support the hypothesis that influenza vaccination may attenuate the course of disease among individuals with breakthrough influenza virus infection.
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Affiliation(s)
- Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Lenee Blanton
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sarah Spencer
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Lauren Grant
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
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222
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Dhand NK, Plain KM, Green AC, Martinez E, Eppleston J, Ly A, Arif S, Emery D. Factors influencing the effectiveness of the Gudair vaccine for controlling Johne's disease in sheep flocks in Australia. Prev Vet Med 2021; 193:105394. [PMID: 34119857 DOI: 10.1016/j.prevetmed.2021.105394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022]
Abstract
Ovine Johne's disease is a chronic debilitating disease of sheep caused by Mycobacterium avium subsp. paratuberculosis (Mptb) which results in diarrhoea, emaciation and mortalities in infected animals. Vaccination with Gudair® has been a key strategy for controlling the disease in Australia since its approval in 2002. Previous research conducted in Australia has demonstrated that the vaccine is quite effective in reducing sheep mortalities. While some farms have also been successful in reducing the prevalence of the disease in their flocks to undetectable levels, sheep in other flocks continue to shed Mptb in faeces even after an ongoing vaccination program . This study was conducted to investigate management, husbandry and biosecurity factors associated with paratuberculosis infection in Gudair® vaccinated sheep flocks in Australia. We enrolled 64 sheep farmers and interviewed them to obtain information about their management and biosecurity practices. Pooled faecal samples were collected from sheep at each farm and cultured to create two outcome variables: Mptb positive (yes/no) and disease prevalence level (nil, < 1 %, ≥ 1 %). Binary and ordinal logistic regression analyses were conducted to evaluate the association of management, husbandry and biosecurity factors with these outcome variables. Farms were more likely to have Mptb positive sheep and a higher disease prevalence in their flocks if they: (a) provided supplementary feed on the ground (instead of in a trough); (b) had a greater number of neighbours with sheep; and (c) had introduced rams from a greater number of sources. The results suggest the effectiveness of Gudair® vaccination to control OJD can be improved if sheep producers maintain other risk management strategies and biosecurity practices. Extension agencies should advise farmers not to relax their biosecurity practices and to purchase rams from only low-risk sources, even if they are continuing to vaccinate their flocks.
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Affiliation(s)
- Navneet K Dhand
- Sydney School of Veterinary Science, The University of Sydney, Australia.
| | - Karren M Plain
- Sydney School of Veterinary Science, The University of Sydney, Australia
| | - Alexandra C Green
- Sydney School of Veterinary Science, The University of Sydney, Australia
| | - Esteban Martinez
- Sydney School of Veterinary Science, The University of Sydney, Australia
| | - Jeff Eppleston
- Sydney School of Veterinary Science, The University of Sydney, Australia
| | - Anna Ly
- Sydney School of Veterinary Science, The University of Sydney, Australia
| | - Shumaila Arif
- Sydney School of Veterinary Science, The University of Sydney, Australia
| | - David Emery
- Sydney School of Veterinary Science, The University of Sydney, Australia
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223
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Butt AA, Khan T, Yan P, Shaikh OS, Omer SB, Mayr F. Rate and risk factors for breakthrough SARS-CoV-2 infection after vaccination. J Infect 2021; 83:237-279. [PMID: 34052241 PMCID: PMC8159711 DOI: 10.1016/j.jinf.2021.05.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Adeel A Butt
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Weill Cornell Medical College, New York, NY, USA; Hamad Medical Corporation, Doha, Qatar.
| | - Tasnim Khan
- Brown and Toland Physicians Group, Sacramento, CA, USA
| | - Peng Yan
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Obaid S Shaikh
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Saad B Omer
- Yale Institute for Global Health, Yale School of Medicine, New Haven, CT, USA
| | - Florian Mayr
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; University of Pittsburgh Medical Center, Pittsburgh, PA, USA; CRISMA Center, Department Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA
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224
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Chan YW, Wong ML, Kwok FY, Au AKW, Leung ECM, Chuang SK. The effect of seasonal influenza vaccine on medically-attended influenza and non-influenza respiratory viruses infections at primary care level, Hong Kong SAR, 2017/18 to 2019/20. Vaccine 2021; 39:3372-3378. [PMID: 34016472 DOI: 10.1016/j.vaccine.2021.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/31/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
Effectiveness of seasonal influenza vaccine (SIV) varies with the degree of matching with the vaccine and circulating viruses. We continued our SIV effectiveness against medically-attended influenza-like illness (ILI) under the Department of Health Hong Kong's sentinel private medical practitioners (PMP) network, using the test-negative case-control design, for the 2018/19 and 2019/20 season. In addition, we studied the potential interference between SIV and ILI caused by non-influenza respiratory viruses (NIRV) based on data collated from 2017/18 to 2019/20 seasons. 3404 patients were analysed. Across the 2017/18 to 2019/20 seasons, the vaccine effectiveness (VE) of SIV was 44% (95% CI 30-56%) against pan-negative controls, 57% (95%CI. 42-68%) against NIRV controls and 50% (95%CI 38-59%) against both. SIV was moderately effective against medically-attended ILI caused by influenza A/B in both 2018/19 and 2019/20 winter seasons (53.2% (95%CI 36.7-65.5%) and 41.8% (95%CI 6.3-64.1%), respectively). The VE against the main circulating subtype, influenza A(H1), was higher for the 2018/19 season (57.2% (95%CI 39.8-69.9%), compared to 34.6% (95%CI -9.6-61.4%) in the 2019/20 season). When compared to pan negative controls, those with single NIRV infections were similarly likely to have received SIV (OR 1.05 (95%CI 0.72-1.54) within the influenza season; OR 0.97 (95%CI 0.73-1.29) when including non-influenza seasons). Analyses by type of virus showed no increased risk of SIV identified among those with single infections of EV/RV, HMPV and parainfluenza but a 2-fold increased risk was shown for those with single infections of adenovirus and parainfluenza virus (adenovirus: OR 2.54 (95%CI 1.24-5.14) within influenza season and OR 1.78 (95%CI 1.01-3.09) for the whole period; parainfluenza virus: OR 2.01 (95%CI 1.22-3.29) within influenza season and OR 1.89 (95%CI 1.29-2.76) for the whole period). SIV programme and surveillance of influenza and NIRV, including SARS-CoV-2, should continue during the COVID-19 pandemic.
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Affiliation(s)
- Yung-Wai Chan
- Communicable Disease Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region.
| | - Miu-Ling Wong
- Communicable Disease Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region
| | - Fong-Yuen Kwok
- Communicable Disease Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region
| | - Albert Ka-Wing Au
- Communicable Disease Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region
| | - Emily Chi-Mei Leung
- Communicable Disease Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region
| | - Shuk-Kwan Chuang
- Communicable Disease Branch, Centre for Health Protection, Department of Health, Hong Kong Special Administrative Region
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225
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Wilkinson K, Righolt CH, Elliott LJ, Fanella S, Mahmud SM. Pertussis vaccine effectiveness and duration of protection - A systematic review and meta-analysis. Vaccine 2021; 39:3120-3130. [PMID: 33934917 DOI: 10.1016/j.vaccine.2021.04.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
A comprehensive review of observational pertussis vaccine effectiveness (VE) studies is needed to update gaps from previous reviews. We conducted a systematic review of VE and duration of protection studies for the whole-cell (wP) and acellular (aP) pertussis vaccines and conducted a formal meta-analysis using random effects models. Evidence continues to suggest that receipt of any pertussis vaccine confers protection in the short-term against disease although this protection wanes rapidly for aP vaccine. We detected significant heterogeneity in pooled estimates due, in part, to factors such as bias and confounding which may be mitigated by study design. Our review of possible sources of heterogeneity may help interpretation of other VE studies and aid design decisions in future pertussis VE research.
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Affiliation(s)
- Krista Wilkinson
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Christiaan H Righolt
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada
| | - Lawrence J Elliott
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada; Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sergio Fanella
- Department of Pediatric Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Salaheddin M Mahmud
- Vaccine and Drug Evaluation Centre, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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226
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Gras-Valentí P, Chico-Sánchez P, Algado-Sellés N, Jiménez-Sepúlveda NJ, Gómez-Sotero IL, Fuster-Pérez M, Cartagena-Llopis L, Sánchez-Valero M, Cerezo-Milán P, Martínez-Tornero I, Tremiño-Sánchez L, Nadal-Morante V, Monerris-Palmer M, Esclapez-Martínez A, MorenodeArcos-Fuentes E, Escalada-Martín I, Escribano-Cañadas I, Merino-Lucas E, Rodríguez-Díaz JC, Sánchez-Payá J. [Effectiveness of the first dose of BNT162b2 vaccine to preventing covid-19 in healthcare personnel.]. Rev Esp Salud Publica 2021; 95:e202104070. [PMID: 33913444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/20/2021] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE A first protective dose of vaccine may allow delaying the second dose in a context of low supply. The objective is to assess the effectiveness of a single dose of vaccine against SARS-CoV-2 (BNT162b2) after twelve days of its administration in healthcare personnel (HCP) of a Health Department. METHODS A case-control study was made. HCP with suspected COVID-19 and HCP close contacts of COVID-19 cases were included between January 27 and February 7, 2021. They were PCR tested for SARS-CoV-2; those with positive PCR were considered cases and those with negative PCR were considered controls. The crude (VE) and adjusted (VEa) vaccine effectiveness to prevent COVID-19 cases and their 95% confidence interval were calculated using the formula VE = (1-Odds ratio) x 100. RESULTS 268 HCP were included, of which 70 (26.1%) were considered cases and 198 (73.9%) controls. The frequency of vaccine exposure in cases was 55.7% vs. 69.7% in controls (p=0.035). The VEa of the first vaccine dose was 52.6% (95%CI: 1.1-77.3). The VEa in the subgroup of HCP studied for suspected disease was 74.6% (CI95%: 38.4-89.5). CONCLUSIONS One dose of BNT162b2 vaccine against SARS-CoV-2 offers early protection after twelve days of administration. These data could be considered to adapt strategies and consider postponing the second dose in situations of limited vaccine supply in order to achieve the maximum number of people covered with a first dose.
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Affiliation(s)
- Paula Gras-Valentí
- Unidad de Epidemiología. Servicio de Medicina Preventiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Pablo Chico-Sánchez
- Unidad de Epidemiología. Servicio de Medicina Preventiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Natividad Algado-Sellés
- Unidad de Epidemiología. Servicio de Medicina Preventiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Natali Juliet Jiménez-Sepúlveda
- Unidad de Epidemiología. Servicio de Medicina Preventiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Isel Lilibeth Gómez-Sotero
- Unidad de Epidemiología. Servicio de Medicina Preventiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Marina Fuster-Pérez
- Unidad de Epidemiología. Servicio de Medicina Preventiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
- Comisión de Infección Hospitalaria, Profilaxis y Política Antibiótica. Hospital General Universitario de Alicante. Alicante. España
| | - Lidia Cartagena-Llopis
- Unidad de Epidemiología. Servicio de Medicina Preventiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - María Sánchez-Valero
- Unidad de Epidemiología. Servicio de Medicina Preventiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Patricia Cerezo-Milán
- Unidad de Epidemiología. Servicio de Medicina Preventiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Iluminada Martínez-Tornero
- Unidad de Epidemiología. Servicio de Medicina Preventiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Laura Tremiño-Sánchez
- Unidad de Epidemiología. Servicio de Medicina Preventiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Verónica Nadal-Morante
- Unidad de Epidemiología. Servicio de Medicina Preventiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Miranda Monerris-Palmer
- Unidad de Epidemiología. Servicio de Medicina Preventiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Ana Esclapez-Martínez
- Unidad de Epidemiología. Servicio de Medicina Preventiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | | | | | - Isabel Escribano-Cañadas
- Servicio de Microbiología. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Esperanza Merino-Lucas
- Comisión de Infección Hospitalaria, Profilaxis y Política Antibiótica. Hospital General Universitario de Alicante. Alicante. España
- Unidad de Enfermedades Infecciosas. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
| | - Juan Carlos Rodríguez-Díaz
- Servicio de Microbiología. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
- Comisión de Infección Hospitalaria, Profilaxis y Política Antibiótica. Hospital General Universitario de Alicante. Alicante. España
| | - José Sánchez-Payá
- Unidad de Epidemiología. Servicio de Medicina Preventiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante. España
- Comisión de Infección Hospitalaria, Profilaxis y Política Antibiótica. Hospital General Universitario de Alicante. Alicante. España
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Xu J, Doyon-Plourde P, Tunis M, Quach C. Effect of early measles vaccination on long-term protection: A systematic review. Vaccine 2021; 39:2929-2937. [PMID: 33926750 DOI: 10.1016/j.vaccine.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 09/30/2022]
Abstract
BACKGROUND In North America, the first dose of a measles-containing vaccine (MCV1) is administered at ≥12 months of age. However, MCV1 may be given to infants <12 months living in highly endemic areas or traveling to these areas. Although an early dose of MCV1 leads to immediate protection, it remains unclear how this impacts long-term immunity. METHODS This systematic review and meta-analysis evaluates the impact of MCV1 given at <12 months vs. ≥12 months of age on long-term immunogenicity and vaccine effectiveness, with long-term defined as at least one-year post-vaccination. PubMed, EMBASE, Global Health, Web of Science and Scopus were searched on October 31st, 2019. Studies were included if they included a cohort of infants vaccinated <12 months of age and evaluated long-term immunogenicity, vaccine efficacy, or effectiveness. RESULTS A total of 51 texts were identified: 23 reported outcomes related to vaccine effectiveness and 30 to immunogenicity. Infants vaccinated with MCV1 < 12 months of age showed an overall higher risk of measles compared to ≥12 months of age (RR = 3.16, 95% CI: 2.00, 5.01; OR = 2.46, 95% CI: 1.40, 4.32). Risk of measles decreased with increasing age at first vaccination, with those vaccinated with one dose ≥15 months at a lesser risk compared to 12-14 months or <12 months. Measles seroconversion and seropositivity was not affected by age at first vaccination, but antibody levels were significantly lower in the MCV1 < 12-month group (MD = -0.40, 95% CI: -0.71, -0.09). CONCLUSION Long-term measles seroconversion and seropositivity did not appear to be affected by age at MCV1, while vaccine effectiveness decreased with younger age. There was not enough evidence to look at the effect of age at MCV1 on immune blunting.
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Affiliation(s)
- Janine Xu
- Department of Microbiology and Immunology, Faculty of Science, McGill University, Montreal, Canada
| | - Paméla Doyon-Plourde
- Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Matthew Tunis
- Centre for Immunization and Respiratory Infectious Disease, Public Health Agency of Canada, Ottawa, Canada
| | - Caroline Quach
- Department of Microbiology, Infectious Diseases, and Immunology, Faculty of Medicine, University of Montreal, Canada.
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228
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Kawamura Y, Hattori F, Higashimoto Y, Kozawa K, Yoshikawa T. Evaluation of varicella vaccine effectiveness during outbreaks in schools or nurseries by cross-sectional study. Vaccine 2021; 39:2901-2905. [PMID: 33895017 DOI: 10.1016/j.vaccine.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/26/2021] [Accepted: 04/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to elucidate vaccine effectiveness (VE) during varicella outbreaks in schools and nurseries in Japan. METHODS An outbreak was defined as emergence of three or more cases of varicella within 21 days at the same institute. Clinical information such as varicella vaccination status, and history of varicella was collected. If a child had varicella during the outbreak, information about absences, fever, and disease severity was collected. RESULTS From September 2018 to January 2020, four outbreaks were reported around our institute from three elementary schools and one nursery. A total of 676 children were analyzed in this study. Seventy-six children (11.2%) were unvaccinated, 309 (45.7%) had received one dose of vaccine, and 291 (43.0%) had received two doses. Most children in Pre-K2 (1-2 years old) to Pre-K6 (5-6 years old), who were the targets of the national immunization schedule, received two doses. Meanwhile, most children older than third grade received single dose. Seventy-five children (11.1%) had varicella. Varicella prevalence from Pre-K5 to the third grade was greater than 10%. The adjusted VEs of single- and two-dose of varicella vaccine were 57.8% and 89.0%. The number of days absent was significantly longer in unvaccinated children than single-dose recipients (P = 0.0145). Unvaccinated children had significantly more severe skin eruptions than single-dose recipients (P = 0.0046) and two-dose recipients (P = 0.0258). CONCLUSIONS Although VEs of single-dose varicella vaccination during outbreaks was not high, the VE of two-dose vaccination was similar to that in a previously reported case-control study.
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Affiliation(s)
- Yoshiki Kawamura
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan.
| | - Fumihiko Hattori
- Department of Pediatrics, Kariya Toyota General Hospital, Kariya, Aichi, Japan
| | - Yuki Higashimoto
- Faculty of Medical Technology, Fujita Health University School of Medical Sciences, Toyoake, Aichi, Japan
| | - Kei Kozawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Tetsushi Yoshikawa
- Department of Pediatrics, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
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Savage RD, Bell CA, Righolt CH, Wilkinson K, Schwartz KL, Chen C, Bolotin S, Deeks SL, Drews SJ, Jamieson FB, Johnson C, Kwong JC, Mahmud SM, Russell ML, Simmonds KA, Svenson LW, Crowcroft NS. A multisite study of pertussis vaccine effectiveness by time since last vaccine dose from three Canadian provinces: A Canadian Immunization Research Network study. Vaccine 2021; 39:2772-9. [PMID: 33875270 DOI: 10.1016/j.vaccine.2021.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pertussis remains poorly controlled relative to other diseases targeted by childhood vaccination programs. We combined estimates from four population-based studies of pertussis vaccine effectiveness (VE) in three Canadian provinces using a meta-analytic approach to improve precision and explore regional variation in VE and durability of protection. METHODS Studies were conducted in Alberta, Manitoba, and Ontario over periods ranging from 1996 to 2015. Adjusted log odds ratios (OR; VE = 100*[1-OR]) of the effect of vaccination on pertussis risk were estimated by time since last vaccination in each study and pooled using DerSimonian and Laird random-effects models. We used the I2 statistic to estimate between-study heterogeneity and assessed methodological and clinical heterogeneity through subgroup analyses of study design and age. RESULTS Data on 3,270 pertussis cases and 23,863 controls were available. Pertussis VE declined from 86% (95% CI 79%-90%, I2 = 81.5%) at < 1 year since last vaccination to 51% (11%-74%, I2 = 80.9%) by ≥ 8 years. Effect estimates were the most heterogeneous in the least and most elapsed time periods since last vaccine dose. This was attributable mostly to variation between provinces in the distribution of age groups and number of vaccine doses received within time periods, as well as study design and small numbers in the most elapsed time period. INTERPRETATION Consistent trends of decreasing pertussis VE with increasing time since last vaccination across three Canadian provinces indicate the need for immunization schedules and vaccine development to optimize protection for all individuals, especially for adolescents and young adults at greatest risk of infection.
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230
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Shen M, Zu J, Fairley CK, Pagán JA, An L, Du Z, Guo Y, Rong L, Xiao Y, Zhuang G, Li Y, Zhang L. Projected COVID-19 epidemic in the United States in the context of the effectiveness of a potential vaccine and implications for social distancing and face mask use. Vaccine 2021; 39:2295-2302. [PMID: 33771391 PMCID: PMC7914016 DOI: 10.1016/j.vaccine.2021.02.056] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/20/2021] [Accepted: 02/24/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Multiple candidates of COVID-19 vaccines have entered Phase III clinical trials in the United States (US). There is growing optimism that social distancing restrictions and face mask requirements could be eased with widespread vaccine adoption soon. METHODS We developed a dynamic compartmental model of COVID-19 transmission for the four most severely affected states (New York, Texas, Florida, and California). We evaluated the vaccine effectiveness and coverage required to suppress the COVID-19 epidemic in scenarios when social contact was to return to pre-pandemic levels and face mask use was reduced. Daily and cumulative COVID-19 infection and death cases from 26th January to 15th September 2020 were obtained from the Johns Hopkins University Coronavirus resource center and used for model calibration. RESULTS Without a vaccine (scenario 1), the spread of COVID-19 could be suppressed in these states by maintaining strict social distancing measures and face mask use levels. But relaxing social distancing restrictions to the pre-pandemic level without changing the current face mask use would lead to a new COVID-19 outbreak, resulting in 0.8-4 million infections and 15,000-240,000 deaths across these four states over the next 12 months. Under this circumstance, introducing a vaccine (scenario 2) would partially offset this negative impact even if the vaccine effectiveness and coverage are relatively low. However, if face mask use is reduced by 50% (scenario 3), a vaccine that is only 50% effective (weak vaccine) would require coverage of 55-94% to suppress the epidemic in these states. A vaccine that is 80% effective (moderate vaccine) would only require 32-57% coverage to suppress the epidemic. In contrast, if face mask usage stops completely (scenario 4), a weak vaccine would not suppress the epidemic, and further major outbreaks would occur. A moderate vaccine with coverage of 48-78% or a strong vaccine (100% effective) with coverage of 33-58% would be required to suppress the epidemic. Delaying vaccination rollout for 1-2 months would not substantially alter the epidemic trend if the current non-pharmaceutical interventions are maintained. CONCLUSIONS The degree to which the US population can relax social distancing restrictions and face mask use will depend greatly on the effectiveness and coverage of a potential COVID-19 vaccine if future epidemics are to be prevented. Only a highly effective vaccine will enable the US population to return to life as it was before the pandemic.
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Affiliation(s)
- Mingwang Shen
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Jian Zu
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Christopher K Fairley
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - José A Pagán
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Li An
- Center for Complex Human-Environment Systems, San Diego State University, San Diego, CA, USA; Department of Geography, San Diego State University, San Diego, CA, USA
| | - Zhanwei Du
- Department of Integrative Biology, The University of Texas at Austin, Austin, TX, USA
| | - Yuming Guo
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Libin Rong
- Department of Mathematics, University of Florida, Gainesville, FL, USA
| | - Yanni Xiao
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Guihua Zhuang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
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231
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Boddington NL, Pearson I, Whitaker H, Mangtani P, Pebody RG. Effectiveness of influenza vaccination in preventing hospitalisation due to influenza in children: a systematic review and meta-analysis. Clin Infect Dis 2021; 73:1722-1732. [PMID: 33772586 DOI: 10.1093/cid/ciab270] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Indexed: 02/02/2023] Open
Abstract
This systematic review assesses the literature for estimates of influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza-associated hospitalisation in children. Studies of any design to 08 June 2020 were included if the outcome was hospitalisation, participants were 17 years old or less and influenza infection was laboratory-confirmed. A random-effects meta-analysis of 37 studies that used a test-negative design gave a pooled seasonal IVE against hospitalisation of 53.3% (47.2-58.8) for any influenza. IVE was higher against influenza A/H1N1pdm09 (68.7%, 56.9-77.2) and lowest against influenza A/H3N2 (35.8%, 23.4-46.3). Estimates by vaccine type ranged from 44.3% (30.1-55.7) for LAIV to 68.9% (53.6-79.2) for inactivated vaccines. IVE estimates were higher in seasons when the circulating influenza strains were antigenically matched to vaccine strains (59.3%, 48.3-68.0). Influenza vaccination gives moderate overall protection against influenza-associated hospitalisation in children supporting annual vaccination. IVE varies by influenza subtype and vaccine type.
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Affiliation(s)
| | - Isabelle Pearson
- Immunisation and Countermeasures Department, Public Health England, UK
| | - Heather Whitaker
- Statistics, Modelling and Economics Department, Public Health England, UK
| | - Punam Mangtani
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK
| | - Richard G Pebody
- Immunisation and Countermeasures Department, Public Health England, UK
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232
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MacIntyre CR, Chughtai AA, Das A, Rahman B, Moa AM, Gan CH, Tan TC. Effect of statin use on the risk of influenza and influenza vaccine effectiveness. Int J Cardiol 2021; 332:205-208. [PMID: 33775795 DOI: 10.1016/j.ijcard.2021.03.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/07/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Some studies have shown that statins reduce the efficacy of influenza vaccine. The aim was to examine the impact of statins on influenza and influenza vaccine effectiveness (VE). METHODS This study was a post-hoc analysis of subjects in a prospective case-control study of influenza and acute myocardial infarction, where data on influenza infection, vaccination and statin use was collected. Study participants, aged ≥40 years were recruited from tertiary hospitals in Sydney from 2008 to 2010. Univariate and logistic regression analysis was performed. RESULTS Of total 559 participants, 276 (49.4%) had been vaccinated and 196 (35.1%) were taking statins. The rate of laboratory confirmed influenza was significantly higher in unvaccinated statin users (adjusted odds ratio (AOR), 2.44; 95% CI: 1.06-5.62) compared to unvaccinated non-users. The VE was 98% overall, and not significantly different between statin users (92.4%) and non-statin users (100%). In adjusted analysis of all subjects, vaccination was significantly protective (AOR, 0.02; 95% CI: 0.01-0.15), and statins remained significantly associated with influenza risk (AOR, 2.47; 95% CI: 1.08-5.64). CONCLUSION There was no significant difference in influenza VE by statin use, and vaccine was highly effective in both statin users and non-users. There was a significantly higher risk of influenza among statin users, independent of vaccination. Statins may increase the risk of influenza through immunomodulatory mechanisms, or this may be confounded by other risk factors for influenza. It is important that people on statins should be vaccinated against influenza.
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Affiliation(s)
- Chandini Raina MacIntyre
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; College of Health Solutions and College of Public Service & Community Solutions, Arizona State University, Tempe, AZ, United States
| | - Abrar Ahmad Chughtai
- School of Population Health, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Arpita Das
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Bayzidur Rahman
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia
| | - Aye M Moa
- Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Chieh H Gan
- Cardiology Department, Blacktown and Mt Druitt Hospital, Sydney, Australia
| | - Timothy C Tan
- Cardiology Department, Blacktown and Mt Druitt Hospital, Sydney, Australia; School of Medical Sciences, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
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233
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Lisewski AM. Interim estimates in null models of COVID-19 vaccine effectiveness. Int J Infect Dis 2021; 106:169-70. [PMID: 33746095 DOI: 10.1016/j.ijid.2021.03.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/22/2022] Open
Abstract
Recently released interim numbers from advanced vaccine candidate clinical trials suggest that a COVID-19 vaccine effectiveness (VE) of >90% is achievable. However, SARS-CoV-2 transmission dynamics are highly heterogeneous and exhibit localized bursts of transmission, which may lead to sharp localized peaks in the number of new cases, often followed by longer periods of low incidence. Here we show that, for interim estimates of VE, these characteristic bursts in SARS-CoV-2 infection may introduce a strong positive bias in VE. Specifically, we generate null models of vaccine effectiveness, i.e., random models with bursts that over longer periods converge to zero VE but that for interim periods frequently produce apparent VE near 100%. As an example, by following the relevant clinical trial protocol, we can reproduce recently reported interim outcomes from an ongoing phase 3 clinical trial of an RNA-based vaccine candidate. Thus, to avoid potential random biases in VE, it is suggested that interim estimates on COVID-19 VE should control for the intrinsic inhomogeneity in both SARS-CoV-2 infection dynamics and reported cases.
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234
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Yokomichi H, Kojima R, Horiuchi S, Ooka T, Akiyama Y, Miyake K, Mochizuki M, Otawa S, Shinohara R, Yamagata Z; Japan Environment and Children's Study Group. Effectiveness of influenza vaccination in infants and toddlers with and without prior infection history: The Japan Environment and Children's Study. Vaccine 2021; 39:1800-4. [PMID: 33685777 DOI: 10.1016/j.vaccine.2021.02.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 01/26/2023]
Abstract
We calculated the Poisson-regression-adjusted relative risk (RR) of new influenza infection by vaccination, prior infection, and vaccination after prior infection in a large Japanese birth cohort, using data from ≤89,253 children aged 6 months to 3 years. The effectiveness of risk reduction (1 - RR) by vaccination at ages 1.5-3 years was 21%-31%. The RR of new infection after prior infection vs. no prior infection was 2.58-19.3 at age 1-3 years. An analysis of the 1 - RR data stratified by having at least one senior sibling and/or attending nursery school revealed that vaccination reduced the RR by 22%-40%. The 1 - RR of new infection was 21% in 3-year-old children who were vaccinated after prior infection. All these findings are statistically significant. The results consistently indicate that, regardless of having at least one senior sibling, attending nursery school, and/or being previously infected with influenza, infants and toddlers will benefit from influenza vaccination.
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Abstract
Influenza is an acute respiratory infection for which vaccination is our best prevention strategy. Small seasonal changes in circulating influenza viruses (antigenic drift) result in the need for annual influenza vaccination, in which the vaccine formulation is updated to better match the predominant circulating influenza viruses that have undergone important antigenic changes. Although the burden of influenza infection and its complications is the highest in older adults, vaccine effectiveness is the lowest in this vulnerable population. This is largely due to waning of the immune response with age known as "immune senescence", and presents an important, unmet challenge. Possible strategies to tackle this include adjuvant and high-dose vaccines, and herd immunity induced by greater vaccine uptake.
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Affiliation(s)
- Jessica Bartoszko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8N 3Z5, Canada
| | - Mark Loeb
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8N 3Z5, Canada.
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236
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Truong DTT, Kang JM, Tran NTH, Phan LT, Nguyen HT, Ho TV, Nguyen TTT, Hoang PL, Pham TMT, Nguyen TD, Hoang TA, Luong QC, Pham QD, Ahn JG, Yoon S, Nguyen TV, Yeom JS. Rotavirus genotype trends from 2013 to 2018 and vaccine effectiveness in southern Vietnam. Int J Infect Dis 2021; 105:277-285. [PMID: 33596479 DOI: 10.1016/j.ijid.2021.02.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Rotavirus (RV) genotypes vary geographically, and this can affect vaccine effectiveness (VE). This study investigated the genotype distribution of RV and explored VE before introducing the RV vaccine to the national immunization programme in Vietnam. METHODS This hospital-based surveillance study was conducted at Children's Hospital 1, Ho Chi Minh City in 2013-2018. Stool samples and relevant data, including vaccination history, were collected from children aged <5 years who were hospitalized with gastroenteritis. RV was detected using enzyme immunoassays and then genotyped. Children aged ≥6 months were included in the VE analysis. RESULTS Overall, 5176 children were included in this study. RV was detected in 2421 children (46.8%). RV positivity decreased over the study period and was associated with age, seasonality, location and previous vaccination. Among 1105 RV-positive samples, G3P[8] was the most prevalent genotype (43.1%), followed by G8P[8] (19.7%), G1P[8] (12.9%) and G2P[4] (12.9%). Overall VE was 69.7% [95% confidence interval (CI) 53.3-80.6%] in fully vaccinated children and 58.6% (95% CI 44.1-69.4%) in children who had received at least one dose of RV vaccine. VE was highest for G3P[8] (95% CI 75.1-84.5%) and lowest for G2P[4] (95% CI 32.4-57.2%). CONCLUSIONS RV remains a major cause of acute gastroenteritis requiring hospitalization in southern Vietnam. The RV vaccine is effective, but its effectiveness varies with RV genotype.
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Affiliation(s)
- Dung Thi Thuy Truong
- Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam; Department of Global Health Security, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Ji-Man Kang
- Department of Paediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea; Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Ngoc Thi Hong Tran
- Department of Gastroenterology, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Lan Trong Phan
- Directorial Board, Pasteur Institute, Ho Chi Minh City, Vietnam
| | | | - Thang Vinh Ho
- Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Thao Thi Thanh Nguyen
- Microbiology and Immunology Department, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Phuc Le Hoang
- Department of Gastroenterology, Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Trang Mai Thuy Pham
- Microbiology and Immunology Department, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Thuy Dieu Nguyen
- Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Thang Anh Hoang
- Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Quang Chan Luong
- Department for Disease Control and Prevention, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Quang Duy Pham
- Planning Division, Pasteur Institute, Ho Chi Minh City, Vietnam; Training Centre, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Jong Gyun Ahn
- Department of Paediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea; Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Sangchul Yoon
- Department of Medical Humanities and Social Sciences, College of Medicine, Yonsei University, Seoul, South Korea
| | - Thuong Vu Nguyen
- Directorial Board, Pasteur Institute, Ho Chi Minh City, Vietnam.
| | - Joon-Sup Yeom
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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Sings HL, Gessner BD, Wasserman MD, Jodar L. Pneumococcal Conjugate Vaccine Impact on Serotype 3: A Review of Surveillance Data. Infect Dis Ther 2021; 10:521-39. [PMID: 33587245 DOI: 10.1007/s40121-021-00406-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/20/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Limited changes in serotype 3 invasive pneumococcal disease (IPD) incidence rates after a decade of 13-valent pneumococcal conjugate vaccine (PCV13) introduction into several national immunization programs (NIP) have raised questions about PCV13's effectiveness against this serotype. Methods We analyzed the impact of pediatric PCV programs on serotype 3 IPD with two approaches. First, we reviewed the publicly available surveillance data from countries identified in two recently published reviews to describe the population impact of pediatric PCV13 or PCV10 vaccination programs on serotype 3 IPD. We then compared the observed trends in PCV10 and PCV13 countries to a previously described dynamic transmission model that simulates the spread of pneumococcal carriage and development of IPD in a population over time. Results When serotype 3 disease rates are compared from countries that have introduced either a 10-valent (PCV10) vaccine that does not contain serotype 3 in its formulation or PCV13 in their pediatric NIP, over time, serotype 3 incidence rate trends are markedly different. Countries with a PCV10 NIP showed a substantial linear increase in serotype 3 pneumococcal disease among all age groups since the time of PCV10 introduction, whereas countries with a PCV13 NIP experienced a modest decline during the 3–4 years after vaccine introduction followed by an inflection upward in subsequent years. Conclusion These data suggest that PCV13 provides a certain degree of direct and indirect protection against serotype 3 at the population level and direct adult vaccination with a serotype 3-containing vaccine is likely to provide substantial benefit in the context of a pediatric PCV NIP. Further research around serotype 3 transmission patterns and epidemiology is nonetheless warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00406-w.
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238
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Okoli GN, Racovitan F, Abdulwahid T, Righolt CH, Mahmud SM. Variable seasonal influenza vaccine effectiveness across geographical regions, age groups and levels of vaccine antigenic similarity with circulating virus strains: A systematic review and meta-analysis of the evidence from test-negative design studies after the 2009/10 influenza pandemic. Vaccine 2021; 39:1225-1240. [PMID: 33494964 DOI: 10.1016/j.vaccine.2021.01.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 12/21/2020] [Accepted: 01/08/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND We examined the influence of some factors on seasonal influenza vaccine effectiveness (VE) from test-negative design (TND) studies. METHODS We systematically searched for full-text publications of VE against laboratory-confirmed influenza from TND studies in outpatient settings after the 2009/10 influenza pandemic. Two reviewers independently selected and extracted data from the included studies. We calculated pooled adjusted VE across geographical regions, age groups and levels of vaccine antigenic similarity with circulating virus strains, using an inverse variance, random-effects model. RESULTS We included 76 full-text articles from 11,931 citations. VE estimates against A(H1N1)pdm09, A(H3N2), influenza B, and all influenza were homogenous and point pooled VE higher in the Southern hemisphere compared with the Northern hemisphere. The difference in pooled VE between the Southern and Northern hemispheres was statistically significant for A(H3N2), influenza B, and all influenza. A consistent pattern was observed in pooled VE across both hemispheres and continents, with the highest point pooled VE being against A(H1N1)pdm09, followed by influenza B, and lowest against A(H3N2). A nearly consistent pattern was observed in pooled VE across age groups in the Northern hemisphere, with pooled VE mostly decreasing with age. Point pooled VE against A(H3N2), influenza B, and all influenza were statistically significantly higher when vaccine was antigenically similar to circulating virus strains compared with when antigenically dissimilar. Similar pattern was observed in the Northern hemisphere, but there was a lack of data from the Southern hemisphere. CONCLUSION Consistent patterns appear to exist in seasonal influenza VE across regions, age groups, and levels of vaccine antigenic similarity with circulating virus strains, with best vaccine performance against A(H1N1)pdm09 and worst against A(H3N2). The evidence highlights the need to consider geographical location, age, and vaccine antigenic similarity with circulating virus strains when designing and evaluating influenza VE studies.
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Affiliation(s)
- G N Okoli
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada
| | - F Racovitan
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada
| | - T Abdulwahid
- George and Fay Yee Centre for Healthcare Innovation, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - C H Righolt
- Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada; Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - S M Mahmud
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada; Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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239
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Balasubramani GK, Zimmerman RK, Eng H, Lyons J, Clarke L, Nowalk MP. Comparison of local influenza vaccine effectiveness using two methods. Vaccine 2021; 39:1283-1289. [PMID: 33485643 PMCID: PMC7825890 DOI: 10.1016/j.vaccine.2021.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/04/2020] [Accepted: 01/04/2021] [Indexed: 11/19/2022]
Abstract
Background In some settings, research methods to determine influenza vaccine effectiveness (VE) may not be appropriate because of cost, time constraints, or other factors. Administrative database analysis of viral testing results and vaccination history may be a viable alternative. This study compared VE estimates from outpatient research and administrative databases. Methods Using the test-negative, case-control design, data for 2017–2018 and 2018–2019 influenza seasons were collected using: 1) consent, specimen collection, RT-PCR testing and vaccine verification using multiple methods; and 2) an administrative database of outpatients with a clinical respiratory viral panel combined with electronic immunization records. Odds ratios for likelihood of influenza infection by vaccination status were calculated using multivariable logistic regression. VE = (1 − aOR) × 100. Results Research participants were significantly younger (P < 0.001), more often white (69% vs. 59%; P < 0.001) than non-white and less frequently enrolled through the emergency department (35% vs. 72%; P < 0.001) than administrative database participants. VE was significant against all influenza and influenza A in each season and both seasons combined (37–49%). Point estimate differences between methods were evident, with higher VE in the research database, but insignificant due to low sample sizes. When enrollment sites were separately analyzed, there were significant differences in VE estimates for all influenza (66% research vs. 46% administrative P < 0.001) and influenza A (67% research vs. 49% administrative; P < 0.001) in the emergency department. Conclusions: The selection of the appropriate method for determining influenza vaccine effectiveness depends on many factors, including sample size, subgroups of interest, etc., suggesting that research estimates may be more generalizable. Other advantages of research databases for VE estimates include lack of clinician-related selection bias for testing and less misclassification of vaccination status. The advantages of the administrative databases are potentially shorter time to VE results and lower cost.
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Affiliation(s)
- G K Balasubramani
- University of Pittsburgh Department of Epidemiology, Suite 600 Schenley Place, 4420 Bayard St., Pittsburgh, PA 15260 USA.
| | - Richard K Zimmerman
- University of Pittsburgh Department of Family Medicine, Suite 520 Schenley Place, 4420 Bayard St., Pittsburgh, PA 15260 USA.
| | - Heather Eng
- University of Pittsburgh Department of Epidemiology, Suite 600 Schenley Place, 4420 Bayard St., Pittsburgh, PA 15260 USA.
| | - Jason Lyons
- University of Pittsburgh Department of Epidemiology, Suite 600 Schenley Place, 4420 Bayard St., Pittsburgh, PA 15260 USA.
| | - Lloyd Clarke
- UPMC Health System Department of Pharmacy, Division of Infectious Diseases/Pharmacy Department - AMP 5th Floor Falk Medical Building, 3601 Fifth Ave, Pittsburgh, PA, USA.
| | - Mary Patricia Nowalk
- University of Pittsburgh Department of Family Medicine, Suite 520 Schenley Place, 4420 Bayard St., Pittsburgh, PA 15260 USA.
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240
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Cao L, Lou J, Zhao S, Chan RWY, Chan M, Wu WKK, Chong MKC, Zee BCY, Yeoh EK, Wong SYS, Chan PKS, Wang MH. In silico prediction of influenza vaccine effectiveness by sequence analysis. Vaccine 2021; 39:1030-1034. [PMID: 33483214 DOI: 10.1016/j.vaccine.2021.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/31/2020] [Accepted: 01/03/2021] [Indexed: 12/30/2022]
Abstract
The effectiveness of seasonal influenza vaccines varies with the matching of vaccine strains to circulating strains. Based on the genetic distance of hemagglutinin and neuraminidase gene of the influenza viruses to vaccine strains, we statistically quantified the relationship between the genetic mismatch and vaccine effectiveness (VE) for influenza A/H1N1pdm09, A/H3N2 and B. We also proposed a systematic approach to integrate multiple genes and influenza types for overall VE estimation. Evident linear relationships were identified and validated in independent data. The modelling framework may enable in silico prediction for VE on a real-time basis and inform the influenza vaccine selection strategy.
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Affiliation(s)
- Lirong Cao
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region; CUHK Shenzhen Research Institute, Shenzhen, China.
| | - Jingzhi Lou
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region; CUHK Shenzhen Research Institute, Shenzhen, China.
| | - Shi Zhao
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region; CUHK Shenzhen Research Institute, Shenzhen, China.
| | - Renee W Y Chan
- Department of Pediatrics, Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region; CUHK-UMCU Joint Research Laboratory of Respiratory Virus & Immunobiology, Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
| | - Martin Chan
- Department of Microbiology, Stanley Ho Centre for Emerging Infectious Diseases, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
| | - William K K Wu
- CUHK Shenzhen Research Institute, Shenzhen, China; Department of Anesthesia and Intensive Care, Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
| | - Marc Ka Chun Chong
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region; CUHK Shenzhen Research Institute, Shenzhen, China.
| | - Benny Chung-Ying Zee
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region; CUHK Shenzhen Research Institute, Shenzhen, China.
| | - Eng Kiong Yeoh
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
| | - Samuel Yeung-Shan Wong
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
| | - Paul K S Chan
- Department of Microbiology, Stanley Ho Centre for Emerging Infectious Diseases, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
| | - Maggie Haitian Wang
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region; CUHK Shenzhen Research Institute, Shenzhen, China.
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241
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Baum U, Kulathinal S, Auranen K. Mitigation of biases in estimating hazard ratios under non-sensitive and non-specific observation of outcomes-applications to influenza vaccine effectiveness. Emerg Themes Epidemiol 2021; 18:1. [PMID: 33446220 PMCID: PMC7807790 DOI: 10.1186/s12982-020-00091-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
Background Non-sensitive and non-specific observation of outcomes in time-to-event data affects event counts as well as the risk sets, thus, biasing the estimation of hazard ratios. We investigate how imperfect observation of incident events affects the estimation of vaccine effectiveness based on hazard ratios. Methods Imperfect time-to-event data contain two classes of events: a portion of the true events of interest; and false-positive events mistakenly recorded as events of interest. We develop an estimation method utilising a weighted partial likelihood and probabilistic deletion of false-positive events and assuming the sensitivity and the false-positive rate are known. The performance of the method is evaluated using simulated and Finnish register data. Results The novel method enables unbiased semiparametric estimation of hazard ratios from imperfect time-to-event data. False-positive rates that are small can be approximated to be zero without inducing bias. The method is robust to misspecification of the sensitivity as long as the ratio of the sensitivity in the vaccinated and the unvaccinated is specified correctly and the cumulative risk of the true event is small. Conclusions The weighted partial likelihood can be used to adjust for outcome measurement errors in the estimation of hazard ratios and effectiveness but requires specifying the sensitivity and the false-positive rate. In absence of exact information about these parameters, the method works as a tool for assessing the potential magnitude of bias given a range of likely parameter values.
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Affiliation(s)
- Ulrike Baum
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00300, Helsinki, Finland.
| | - Sangita Kulathinal
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Kari Auranen
- Department of Mathematics and Statistics, University of Turku, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
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242
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Su WJ, Chuang PH, Chang LY, Lo HY, Chiang CS, Wang ET, Yang CH. Application of the screening and indirect cohort methods to evaluate the effectiveness of pneumococcal vaccination program in adults 75 years and older in Taiwan. BMC Infect Dis 2021; 21:45. [PMID: 33423657 PMCID: PMC7798272 DOI: 10.1186/s12879-020-05721-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 12/18/2020] [Indexed: 11/23/2022] Open
Abstract
Background The Taiwanese national 23-valent pneumococcal polysaccharide vaccine (PPV23) program in adults ≥75 years of age and the 13-valent pneumococcal conjugate vaccine (PCV13) program for children were implemented in 2008 and 2013, respectively. In this study we evaluated PPV23 vaccine effectiveness (PPV23VE) in the elderly, with regard to both direct protection from the vaccine itself and the indirect protection conferred by PCV13 immunization in children. Methods The incidence of invasive pneumococcal disease (IPD) in Taiwan from July 2008 to June 2016 was collected from IPD surveillance data. A comparison of IPD incidence with a nationwide vaccination registry allowed an estimation of PPV23VE by the screening and indirect cohort methods. Results The incidence of IPD in adults ≥75 years of age ranged from 13.9 per 100,000 inhabitants during the period July 2008–June 2013 to 10.4 per 100,000 inhabitants between July 2013 and June 2016 (relative risk [RR]: 0.75; 95% confidence interval [95% CI]: 0.67–0.85). According to the screening method, PPV23VE against death within 30 days of IPD onset, all IPD, and PPV23-serotype IPD was 32.5% (95% CI: 17.5–44.7%), 33.9% (95% CI: 25.2–41.5%) and 43.4% (95% CI: 34.4–51.2%), respectively. PPV23VE with the indirect cohort method was 39.0% (95% CI: 15.5–55.9%) for all PPV23 serotypes and 71.5% (95% CI: 44.2–85.4%) for 11 serotypes included in PPV23 but not in PCV13. During the period July 2008–June 2012, PPV23VE against PPV23-serotype IPD was 55.1% (95% CI: 27.2–72.3%). Conclusions PPV23 is able to prevent IPD and 30-day fatality in adults 75 years of age and older due to a combination of direct effects from PPV23 and indirect effects from PCV13. It might confer higher protection against PPV23-serotype IPD before the introduction of PCV13 program in children. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05721-0.
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Affiliation(s)
- Wei-Ju Su
- Division of Acute Infectious Diseases, Centers for Disease Control, Ministry of Health and Welfare, 6, Linsen South Road, Taipei, 100, Taiwan, Republic of China.,Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Pei-Hung Chuang
- Center for Prevention and Treatment of Occupational Injury and Diseases, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.,Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | - Luan-Yin Chang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan, Republic of China
| | - Hsiu-Yun Lo
- Division of Acute Infectious Diseases, Centers for Disease Control, Ministry of Health and Welfare, 6, Linsen South Road, Taipei, 100, Taiwan, Republic of China
| | - Chuen-Sheue Chiang
- Division of Acute Infectious Diseases, Centers for Disease Control, Ministry of Health and Welfare, 6, Linsen South Road, Taipei, 100, Taiwan, Republic of China
| | - Ez-Tzu Wang
- Division of Acute Infectious Diseases, Centers for Disease Control, Ministry of Health and Welfare, 6, Linsen South Road, Taipei, 100, Taiwan, Republic of China
| | - Chin-Hui Yang
- Division of Acute Infectious Diseases, Centers for Disease Control, Ministry of Health and Welfare, 6, Linsen South Road, Taipei, 100, Taiwan, Republic of China.
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243
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Rose N, Storch J, Mikolajetz A, Lehmann T, Reinhart K, Pletz MW, Forstner C, Vollmar HC, Freytag A, Fleischmann-Struzek C. Preventive effects of influenza and pneumococcal vaccination in the elderly - results from a population-based retrospective cohort study. Hum Vaccin Immunother 2021; 17:1844-1852. [PMID: 33412080 PMCID: PMC8115600 DOI: 10.1080/21645515.2020.1845525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Influenza and pneumococcal vaccinations are recommended in the elderly to reduce life-threatening complications like sepsis. Protection may be reduced with increasing age. We aimed to assess the effectiveness of both vaccines in the elderly by performing a retrospective cohort study of 138,877 individuals aged ≥60 y in Germany, who were insured in a large statutory health insurance (AOK PLUS). We used longitudinal claims data to classify individuals according to vaccination status 2008–2014, and assessed vaccine effectiveness (VE) in 2015 and 2016. Inverse probability weighting based on generalized propensity scores was used to adjust for systematic between-group differences. Influenza vaccination was associated with a reduction of hospital treatment in laboratory-confirmed influenza in 2015 (VE = 41.32 [95%CI 0.85, 65.26]), but had no significant impact on the overall influenza incidence. Complications of influenza (pneumonia and sepsis) were reduced in 2016. We found a rise in influenza-like illness and acute respiratory infections in both years and an increased 90-d mortality after hospital-treated pneumonia in vaccinees in 2015. Pneumococcal vaccination was effective in preventing hospital-treated pneumonia within the first and second year after vaccination (VE = 52.45 [13.31, 73.92] and 46.04 [5.46, 69.21], respectively), but had no impact on sepsis incidence or pneumonia mortality. Influenza and pneumococcal vaccination can prevent severe complications from influenza and hospital-treated pneumonia in the elderly, respectively. Vaccine effects differ between years and seasons and are partly difficult to interpret. Despite extensive efforts to adjust for between-group differences, residual bias cannot be ruled out, possibly explaining signals like increased ILI or pneumonia mortality.
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Affiliation(s)
- Norman Rose
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Josephine Storch
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.,International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Anna Mikolajetz
- Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Thomas Lehmann
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Konrad Reinhart
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.,Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.,Department of Anesthesiology and Intensive Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mathias W Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Christina Forstner
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.,Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.,Institute of General Practice and Family Medicine, Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Antje Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
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244
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Thangarajah D, Malo JA, Field E, Andrews R, Ware RS, Lambert SB. Effectiveness of quadrivalent influenza vaccination in the first year of a funded childhood program in Queensland, Australia, 2018. Vaccine 2020; 39:729-737. [PMID: 33358414 DOI: 10.1016/j.vaccine.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/31/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Following high influenza activity in 2017, the state of Queensland, Australia, funded a quadrivalent inactivated influenza vaccination program for children aged 6 months to <5 years in 2018. We calculated influenza vaccine effectiveness (VE) among children eligible for this program. METHODS A matched case-control study was conducted. Cases were identified using Queensland 2018 influenza notification data among children age-eligible for funded vaccination. Controls were drawn from Australian Immunisation Register records of Queensland resident children age-eligible for funded influenza vaccine. Up to 10 controls per case were matched for location and birthdate. First dose vaccination was valid if received ≥14 days prior to specimen collection; a second dose was valid if received ≥28 days after first dose receipt. VE was calculated for vaccine doses and adherence to national recommendations for two doses in the first season (schedule completeness) and adjusted (VEadj) for sex and First Nations status. RESULTS There were 1,125 cases and 10,645 matched controls analysed. Overall VEadj against laboratory-confirmed influenza was 51% (95% confidence interval (CI) 41-60). VEadj was 60% (95% CI 46-70) for children who received two doses in 2018, and 60% (95% CI 48-69) for children vaccinated appropriately according to schedule completeness. VE increased with age. CONCLUSIONS Moderate vaccine effectiveness was observed for children eligible for the funded program in Queensland in 2018, adding to the sparse evidence for influenza vaccine use in Australian children. Adhering to the national first season two dose schedule for influenza vaccine receipt in children ensures maximum protection.
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Affiliation(s)
- Dharshi Thangarajah
- Communicable Diseases Branch, Queensland Health, Brisbane, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra Australia.
| | - Jonathan A Malo
- Communicable Diseases Branch, Queensland Health, Brisbane, Australia.
| | - Emma Field
- National Centre for Epidemiology and Population Health, Australian National University, Canberra Australia; Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
| | - Ross Andrews
- National Centre for Epidemiology and Population Health, Australian National University, Canberra Australia; Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
| | - Stephen B Lambert
- Communicable Diseases Branch, Queensland Health, Brisbane, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra Australia.
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245
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Drori Y, Pando R, Sefty H, Rosenberg A, Mendelson E, Keinan-Boker L, Shohat T, Mandelboim M, Glatman-Freedman A. Influenza vaccine effectiveness against laboratory-confirmed influenza in a vaccine-mismatched influenza B-dominant season. Vaccine 2020; 38:8387-8395. [PMID: 33243633 DOI: 10.1016/j.vaccine.2020.10.074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The 2017-2018 influenza season in Israel was characterized by the predominance of influenza B Yamagata, with a lesser circulation of influenza A(H1N1)pdm09 and influenza A(H3N2). We estimated vaccine effectiveness (VE) of the inactivated influenza vaccine which was selected for use that season. METHODS End-of-season VE and 95% confidence intervals (CI) against laboratory-confirmed influenza-like illness (ILI) were estimated by means of the test-negative design. Age-specific VE analysis was carried out using a moving age interval. RESULTS Specimen were obtained from 1,453 community ILI patients; 610 (42.0%) were influenza-positive, among which 69.7% were B, 17.2% A(H1N1)pdm09 and 13.4% A(H3N2). A 98.6% of molecularly characterized influenza B belonged to the Yamagata lineage. Of the sampled individuals, 1320 were suitable for VE analysis. Of those vaccinated, 90.6% received the inactivated trivalent influenza vaccine (TIV) containing a Victoria lineage influenza B-like virus. VE against influenza A differed by age, with the highest VE of 72.9% (95%CI 31.9-89.2%) observed in children 0.5-14 years old, while all ages VE was 46.6% (95%CI 10.4-68.2%). All ages VE against influenza B was 23.2% (95%CI -10.1-46.4%) with age-specific analysis showing non-significant VE estimates. Utilizing a moving age interval of 15 years, afforded a detailed age-specific insight into influenza VE against the influenza viruses circulating during the 2017-2018 season. CONCLUSIONS The moderate-high 2017-2018 influenza A VE among children and adolescents, supports seasonal influenza vaccination at a young age. The low VE against influenza B in Israel, is most likely the result of influenza B/TIV-mismatch.
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Affiliation(s)
- Y Drori
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - R Pando
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel; Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - H Sefty
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - A Rosenberg
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - E Mendelson
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Keinan-Boker
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel; School of Public Health, University of Haifa, Haifa, Israel
| | - T Shohat
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Mandelboim
- Central Virology Laboratory, Chaim Sheba Medical Center, Israel Ministry of Health, Tel-Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Glatman-Freedman
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Ramat Gan, Israel; School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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246
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Shiko Y, Konno R, Konishi H, Sauvaget C, Ohashi Y, Kakizoe T. Effectiveness of HPV vaccination against the development of high-grade cervical lesions in young Japanese women. BMC Infect Dis 2020; 20:808. [PMID: 33153446 PMCID: PMC7643434 DOI: 10.1186/s12879-020-05513-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/14/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Although more than 10 years have passed since HPV vaccination was implemented, first as an interim programme (Emergent vaccine promotion programme) in November 2010, followed by incorporating into the National Immunization Programme in April, 2013 and suspended in June 2013, limited studies have investigated the HPV vaccine effectiveness against high-grade cervical lesions in Japan. METHODS We collected the matched data of the results of cervical biopsy and history of vaccination from the Japan Cancer Society database. The subjects were women aged 20 to 29 years screened for cervical cancer between April, 2015 and March, 2017, and with information on HPV vaccination status. We estimated the relative risk of developing high-grade cervical lesions in vaccinated subjects using Poisson regression as compared to unvaccinated subjects. RESULTS Among the 34,281 women screened, 3770 (11.0%) were vaccinated. The prevalence of CIN2+ was statistically significantly lower in the vaccinated women as compared to the unvaccinated women (Vaccine Effectiveness (VE) =76%; RR = 0.24, 95% CI:0.10-0.60). High VE against CIN3+ was also observed (91%; RR = 0.09, 95% CI:0.00-0.42). CONCLUSION Women aged 20-29 years who received at least one dose of HPV vaccine had a significantly lower risk of high-grade cervical lesions than those not vaccinated. In Japan, HPV vaccination should be resumed in order to reduce the incidence of cervical cancer.
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Affiliation(s)
- Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677 Japan
| | - Ryo Konno
- Department of Obstetrics and Gynecology, Jichi Medical University Saitama Medical Center, Omiya-ku, Saitama, 330-8530 Japan
| | | | - Catherine Sauvaget
- Screening Group, Early Detection and Prevention Section, International Agency for Research on Cancer (WHO), Lyon, France
| | - Yasuo Ohashi
- Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan
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247
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Beyer WEP, Osterhaus ADME. Bivalent AS04-adjuvanted HPV vaccine provides optimal cancer prevention for HPV types not included in the vaccine. Vaccine 2020; 38:7414-7416. [PMID: 33051041 DOI: 10.1016/j.vaccine.2020.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 08/12/2020] [Accepted: 09/02/2020] [Indexed: 11/26/2022]
Abstract
All available HPV vaccines contain oncogenic types 16 and 18, most often found in HPV-related cancers and precursor lesions, but they differ in their valence and adjuvant potency. The quadri- and nonavalent HPV vaccines both contain additional types 6 and 11, related to anogenital warts, while the nonavalent vaccine contains another five types that are less frequently found in cancers. The bivalent vaccine is adjuvanted by AS04. Phase-III randomised controlled trials and population-based studies on bi- and quadrivalent vaccines suggest that the two vaccines when administered to HPV-naive persons, are optimally effective in preventing cervical intra-epithelial neoplasia grade 3 or greater, caused by types 16 or 18 (specific protection). In addition, the bivalent vaccine, but not the quadrivalent vaccine, cross-protects against HPV types not contained in the vaccine. The advantage of the quadrivalent vaccine to provide additional protection against anogenital warts, should not be traded for a lower overall efficacy in preventing pre-cancerous lesions and eventually cancer.
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248
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Brehony C, Dunford L, Bennett C, O'Donnell J, Domegan L, McNamara E, De Gascun CF. Neuraminidase characterisation reveals very low levels of antiviral resistance and the presence of mutations associated with reduced antibody effectiveness in the Irish influenza 2018/2019 season. J Clin Virol 2020; 132:104653. [PMID: 33038626 PMCID: PMC7527353 DOI: 10.1016/j.jcv.2020.104653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/29/2020] [Accepted: 09/27/2020] [Indexed: 11/24/2022]
Abstract
Very low antiviral resistance in Irish 2018/2019 influenza season. Supports current antiviral use. Continued molecular neuraminidase surveillance essential for resistance emergence. Surveillance also useful for monitoring vaccine effectiveness. Mutations associated with reduced antibody effectiveness detected.
Neuraminidase inhibitor (NAI) resistance levels globally are currently low. However, as antivirals are increasingly being used, and even in the absence of selective pressure, resistance may increase or emerge. The neuraminidase (NA) genes from influenza viruses from the Irish 2018/2019 season were sequenced: 1/144 (0.7 %) A(H1N1)pdm09 sequences harboured a substitution associated with highly-reduced susceptibility to NAIs. The very low NAI resistance we describe supports current Irish NAI use recommendations. However, continued monitoring is essential. NA characterisation also identified substitutions associated with reduced antibody effectiveness, thereby highlighting the potential of NA sequence surveillance as an additional tool for investigating influenza vaccine effectiveness (VE).
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Affiliation(s)
- Carina Brehony
- Public Health Laboratory, Health Service Executive, Dublin, Ireland; European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Control and Prevention, Stockholm, Sweden.
| | - Linda Dunford
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Charlene Bennett
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
| | - Joan O'Donnell
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland
| | - Lisa Domegan
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland; European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Eleanor McNamara
- Public Health Laboratory, Health Service Executive, Dublin, Ireland
| | - Cillian F De Gascun
- National Virus Reference Laboratory, University College Dublin, Dublin, Ireland
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249
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Moore DP, Madhi SA. Of novel analytic approaches and impactful findings… and an opportunity to pose more questions. Lancet Reg Health West Pac 2020; 2:100018. [PMID: 34327374 PMCID: PMC8315651 DOI: 10.1016/j.lanwpc.2020.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/27/2022]
Affiliation(s)
- David P Moore
- Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A Madhi
- Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit (VIDA); Department of Science and Technology/National Research Foundation South African Research Chair: Vaccine Preventable Diseases, Johannesburg, South Africa
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250
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Weaver R, Nguyen CD, Chan J, Vilivong K, Lai JY, Lim R, Satzke C, Vongsakid M, Newton PN, Mulholland K, Gray A, Dubot-Pérès A, Dance DA, Russell FM. The effectiveness of the 13-valent pneumococcal conjugate vaccine against hypoxic pneumonia in children in Lao People's Democratic Republic: An observational hospital-based test-negative study. Lancet Reg Health West Pac 2020; 2:100014. [PMID: 34327372 PMCID: PMC8315332 DOI: 10.1016/j.lanwpc.2020.100014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pneumococcal pneumonia is a leading cause of childhood mortality. Pneumococcal conjugate vaccines (PCVs) have been shown to reduce hypoxic pneumonia in children. However, there are no studies from Asia examining the effectiveness of PCVs on hypoxic pneumonia. We describe a novel approach to determine the effectiveness of the 13-valent PCV (PCV13) against hypoxia in children admitted with pneumonia in the Lao People's Democratic Republic. METHODS A prospective hospital-based, test-negative observational study of children aged up to 59 months admitted with pneumonia to a single tertiary hospital in Vientiane was undertaken over 54 months. Pneumonia was defined using the 2013 WHO definition. Hypoxia was defined as oxygen saturation <90% in room air or requiring oxygen supplementation during hospitalisation. Test-negative cases and controls were children with hypoxic and non-hypoxic pneumonia, respectively. PCV13 status was determined by written record. Vaccine effectiveness was calculated using logistic regression. Propensity score and multiple imputation analyses were used to handle confounding and missing data. FINDINGS There were 826 children admitted with pneumonia, 285 had hypoxic pneumonia and 377 were PCV13-vaccinated. The unadjusted, propensity-score adjusted and multiple-imputation adjusted estimates of vaccine effectiveness against hypoxic pneumonia were 23% (95% confidence interval: -9, 46%; p=0•14); 37% (6, 57%; p=0•02) and 35% (7, 55%; p=0•02) respectively. INTERPRETATION PCV13 is effective against hypoxic pneumonia in Asia, and should be prioritised for inclusion in national immunisation programs. This single hospital-based, test-negative approach can be used to assess vaccine effectiveness in other similar settings. FUNDING Funded by the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Rupert Weaver
- Centre for International Child Health, Department of Paediatrics (WHO Collaborating Centre for Child and Neonatal Health Research and Training), The University of Melbourne, Melbourne, Victoria, Australia
| | - Cattram D. Nguyen
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Jocelyn Chan
- Centre for International Child Health, Department of Paediatrics (WHO Collaborating Centre for Child and Neonatal Health Research and Training), The University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Keoudomphone Vilivong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR
| | - Jana Y.R. Lai
- Murdoch Children's Research Institute, Melbourne, Australia
- Australian National University, Canberra, Australia
| | - Ruth Lim
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Catherine Satzke
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Malisa Vongsakid
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR
| | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - Kim Mulholland
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Amy Gray
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Audrey Dubot-Pérès
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
- Unite des Virus Emergents (UVE: Aix-Marseille Univ – IRD 190 – Inserm 1207 – IHU Mediterranee Infection), Marseille, France
| | - David A.B. Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Fiona M. Russell
- Centre for International Child Health, Department of Paediatrics (WHO Collaborating Centre for Child and Neonatal Health Research and Training), The University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
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