Developing Covid-19 Vaccines at Pandemic Speed

Exploring Impacts to COVID-19 Herd Immunity Thresholds Under Demographic Heterogeneity that Lowers Vaccine Effectiveness

The COVID-19 pandemic has caused severe health, economic, and societal impacts across the globe. Although highly efficacious vaccines were developed at an unprecedented rate, the heterogeneity in vaccinated populations has reduced the ability to achieve herd immunity. Specifically, as of Spring 2022, the 0-4 year-old population is still unable to be vaccinated and vaccination rates across 5-11 year olds are low. Additionally, vaccine hesitancy for older populations has further stalled efforts to reach herd immunity thresholds. This heterogeneous vaccine landscape increases the challenge of anticipating disease spread in a population. We developed an age-structured Susceptible-Infectious-Recovered-type mathematical model to investigate the impacts of unvaccinated subpopulations on herd immunity. The model considers two types of undervaccination - age-related and behavior-related - by incorporating four age groups based on available FDA-approved vaccines. The model accounts for two different types of vaccines, mRNA (e.g., Pfizer, Moderna) and vector (e.g., Johnson and Johnson), as well as their effectiveness. Our goal is to analyze different scenarios to quantify which subpopulations and vaccine characteristics (e.g., rate or efficacy) most impact infection levels in the United States, using the state of New Mexico as an example.

RNA Viruses, Pregnancy and Vaccination: Emerging Lessons from COVID-19 and Ebola Virus Disease

Pathogenic viruses with an RNA genome represent a challenge for global human health since they have the tremendous potential to develop into devastating pandemics/epidemics. The management of the recent COVID-19 pandemic was possible to a certain extent only because of the strong foundations laid by the research on previous viral outbreaks, especially Ebola Virus Disease (EVD). A clear understanding of the mechanisms of the host immune response generated upon viral infections is a prime requisite for the development of new therapeutic strategies. Hence, we present here a comparative study of alterations in immune response upon SARS-CoV-2 and Ebola virus infections that illustrate many common features. Vaccination and pregnancy are two important aspects that need to be studied from an immunological perspective. So, we summarize the outcomes and immune responses in vaccinated and pregnant individuals in the context of COVID-19 and EVD. Considering the significance of immunomodulatory approaches in combating both these diseases, we have also presented the state of the art of such therapeutics and prophylactics. Currently, several vaccines against these viruses have been approved or are under clinical trials in various parts of the world. Therefore, we also recapitulate the latest developments in these which would inspire researchers to look for possibilities of developing vaccines against many other RNA viruses. We hope that the similar aspects in COVID-19 and EVD open up new avenues for the development of pan-viral therapies.

Vacunación contra SARS-COV-2: un año después de iniciada en Colombia

Introducción: el 17 de febrero 2021 se inició el programa de vacunación masiva en Colombia contra el COVID-19, al 17 de febrero 2022 se han aplicado 75’732.846 de dosis en todo el país. El mejor momento de la vacunación se dio el 6 de agosto 2021 cuando se aplicaron 594.933 dosis. Objetivo: mostrar el comportamiento del plan de vacunación contra el SARS-COV-2 en el periodo comprendido entre el 17 de febrero 2021 al 17 de febrero 2022. Metodología: estudio transversal con fuente de información del plan de vacunación nacional contra el COVID-19 de la página web del Ministerio de Salud y Protección Social. Resultados: en noviembre 2021 se evidenció el mayor número de aplicaciones (10’117.202), en junio el mayor número de segunda dosis (3’469.508), en julio el mayor de monodosis (2’322.994), en julio el de esquemas completos (5’282.778) y el mayor número de dosis de refuerzo se presentó en enero 2022 (2’390.185). Conclusión: es de transcendental   importancia   realizar   el   seguimiento   al   proceso de vacunación para comprender su eficacia, la posible disminución de la respuesta inmune con el tiempo y los posibles efectos adversos.  También es fundamental hacer el seguimiento a las mutaciones del virus que se presenten en el país y que afecten la inmunidad proporcionada por las vacunas.

Artificial Intelligence-Based Data-Driven Strategy to Accelerate Research, Development, and Clinical Trials of COVID Vaccine

The global COVID-19 (coronavirus disease 2019) pandemic, which was caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in a significant loss of human life around the world. The SARS-CoV-2 has caused significant problems to medical systems and healthcare facilities due to its unexpected global expansion. Despite all of the efforts, developing effective treatments, diagnostic techniques, and vaccinations for this unique virus is a top priority and takes a long time. However, the foremost step in vaccine development is to identify possible antigens for a vaccine. The traditional method was time taking, but after the breakthrough technology of reverse vaccinology (RV) was introduced in 2000, it drastically lowers the time needed to detect antigens ranging from 5-15 years to 1-2 years. The different RV tools work based on machine learning (ML) and artificial intelligence (AI). Models based on AI and ML have shown promising solutions in accelerating the discovery and optimization of new antivirals or effective vaccine candidates. In the present scenario, AI has been extensively used for drug and vaccine research against SARS-COV-2 therapy discovery. This is more useful for the identification of potential existing drugs with inhibitory human coronavirus by using different datasets. The AI tools and computational approaches have led to speedy research and the development of a vaccine to fight against the coronavirus. Therefore, this paper suggests the role of artificial intelligence in the field of clinical trials of vaccines and clinical practices using different tools.

Clinical progress of therapeutics and vaccines: Rising hope against COVID-19 treatment

Cases of deaths due to COVID-19 (COrona VIrus Disease-19) infection are increasing gradually worldwide. Immense research is ongoing to control this pandemic condition. Continual research outcomes are indicating that therapeutic and prophylactic agents are the possible hope to prevent the pandemic from spreading and to combat this increasing death count. Experience gained from previous coronavirus infections (eg., SARS (Severe Acute Respiratory Syndrome), MERS (Middle Ease Respiratory Syndrome), accumulated clinical knowledge during this pandemic, and research helped to identify a few therapeutic agents for emergency treatment of COVID-19. Thereby, monoclonal antibodies, antivirals, broad-spectrum antimicrobials, immunomodulators, and supplements are being suggested for treatment depending on the stage of the disease. These recommended treatments are authorized under medical supervision in emergency conditions only. Urgent need to control the pandemic condition had resulted in various approaches of repurposing the existing drugs, However, poorly designed clinical trials and associated outcomes do not provide enough evidence to fully approve treatments against COVID-19. So far, World Health Organization (WHO) authorized three vaccines as prophylactic against SARS-CoV-2. Here, we discussed about various therapeutic agents, their clinical trials, and limitations of trials for the management of COVID-19. Further, we have also spotlighted different vaccines in research in combating COVID-19.

The long road of pandemic vaccine development to rollout: A systematic review on the lessons learnt from the 2009 H1N1 influenza pandemic

BACKGROUND

The 2009 Influenza A(H1N1) pandemic prompted one of the largest public health responses in history. The continuous emergence of new and deadly pathogens has highlighted the need to reflect upon past experiences to improve pandemic preparedness. The aim of this study was to examine the development and rollout of 2009 influenza A(H1N1) pandemic vaccine and knowledge challenges for the effective implementation of vaccination programs for COVID-19 and future influenza pandemics.

METHODS

A systematic review was conducted searching EMBASE (inception to current date) and PUBMED (from January 2009 to current date) databases for relevant published studies about influenza A(H1N1) pandemic vaccines. A Google search was conducted to identify relevant documents from gray literature. Selected Studies were reviewed and summarized.

RESULTS

A total of 22, comprising of 12 original studies and 10 relevant documents met the inclusion criteria. Fourteen papers reported an initial high demand that outweighed production capacity and caused vaccine shortages. Vaccine procurement and supply were skewed toward high-income countries. Low vaccination rates of about 5%-50% were reported in all studies mainly due to a low-risk perception of getting infected, safety concerns, and the fear of adverse effects.

CONCLUSIONS

Safety concerns about the approved H1N1 vaccines resulted in many unsuccessful vaccination campaigns worldwide. Understanding the factors that influence people's decision to accept or refuse vaccination, effective risk communication strategies, adequate resources for vaccine deployment initiatives and building local capacities through shared knowledge and technology transfer may help to improve COVID-19 vaccine uptake and accelerate pandemic control.

Hematologic Malignancies Diagnosed in the Context of the mRNA COVID-19 Vaccination Campaign: A Report of Two Cases

BACKGROUND

During the last two years, the COVID-19 pandemic led to millions of disease-related deaths worldwide. The efforts of the scientific community facing this global challenge resulted in outstanding achievements. Thus, within one year, new mRNA-based vaccines against SARS-CoV-2 viral infection were released, providing highly efficient protection and showing a very good safety profile in the general population. However, clinical data collection after vaccination is a continuous process for the long-term safety of any new medical product. The aim of our paper is to present two cases of hematological malignancies: diffuse large B-cell non-Hodgkin lymphoma and T/NK-cell lymphoma, diagnosed shortly after the administration of the mRNA COVID-19 vaccine.

METHODS AND RESULTS

Case 1: A female patient was admitted with a suspicious cervical mass that emerged within one week after the administration of second dose of the BNT162b2 COVID-19 vaccine. Surgical removal followed by pathology assessment of the specimen confirmed the diagnosis of diffuse large B-cell non-Hodgkin lymphoma. Case 2: A male patient was admitted with multiple ulcerative oral lesions arising on the third day after the initial dose of the BNT162b2 COVID-19 vaccine. These lesions had a progressive character and during the following months were complicated with repetitive episodes of heavy oral bleeding, requiring blood transfusions. The incisional biopsy of the lesions and pathological assessment of the specimens confirmed the diagnosis of T/NK-cell lymphoma.

CONCLUSIONS

The safety profile of the mRNA-based vaccines is an undeniable fact. In most cases, suspicions of potentially aggressive side effects were ruled out, proving to be transient post-vaccine reactions. Clinicians should remain alert to report any potentially aggressive manifestations emerging in the context of mRNA COVID-19 vaccination, such as these cases of hematological malignancies, in order to promote additional investigations on the particular mechanisms of action of COVID-19 vaccines and to provide the best medical care to the patients.

Vaccine innovation model: A technology transfer perspective in pandemic contexts

This work identifies the innovations that made it possible for the Bio-Manguinhos/Fiocruz Immunobiological Technology Institute to engage in the entire production of the Oxford/AstraZeneca vaccine (ChAdOx1 nCov-19) in Brazil, just 1.8 years after the COVID-19 pandemic was declared. The results were summarized in a case-based innovation model composed of 11 workstreams, 32 stages, 22 gates, 11 innovations, and 38 events. In terms of research contributions, three were found: (i) the identification of firm and government-level innovations allowing the substantial reduction in the COVID-19 vaccine time-to-market in Brazil; (ii) the presentation of empirical evidence supporting the new Outbreak Paradigm for vaccine research, development, and production; and (iii) the proposition of a conceptual model for describing innovations through the vaccine value chain in pandemic contexts, particularly when technology transfer is involved.

Predictors of COVID-19 Stress and COVID-19 Vaccination Acceptance among Adolescents in Ghana

Coronavirus disease 2019 (COVID-19) continues to ravage world economies, and with its recent mutations, countries worldwide are finding ways of ramping up their vaccination programmes. This cross-sectional design study, therefore, examined the predictors of COVID-19 stress and COVID-19 vaccination acceptance among adolescents in Ghana. A total of 817 participants were conveniently selected to respond to measures on fear of COVID-19, perceived stigma from COVID-19, self-stigma from COVID-19, believing COVID-19 information, COVID-19 infection prevention behaviours, COVID-19 stress, and COVID-19 vaccination acceptance. It was found that females believed COVID-19 information and accepted COVID-19 vaccination more than males did. Moreover, there were significant relationships between the majority of the COVID-19-related variables. Furthermore, fear of COVID-19, self-stigma from COVID-19, and COVID-19 infection prevention behaviours were found to be significant predictors of COVID-19 stress. Additionally, believing COVID-19 information, danger and contamination fears (a subscale of COVID-19 stress), and traumatic stress (a subscale of COVID-19 stress) were significant predictors of COVID-19 vaccination acceptance. These findings imply that different factors influence different COVID-19 variable. Therefore, careful considerations and research should be employed by health authorities and policymakers in preparing COVID-19 information to target different age groups and for different COVID-19 purposes.

Innovations and Challenges in Electroanalytical Tools for Rapid Biosurveillance of SARS-CoV-2

Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, preventive social paradigms and vaccine development have undergone serious renovations, which drastically reduced the viral spread and increased collective immunity. Although the technological advancements in diagnostic systems for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) detection are groundbreaking, the lack of sensitive, robust, and consumer-end point-of-care (POC) devices with smartphone connectivity are conspicuously felt. Despite its revolutionary impact on biotechnology and molecular diagnostics, the reverse transcription polymerase chain reaction technique as the gold standard in COVID-19 diagnosis is not suitable for rapid testing. Today's POC tests are dominated by the lateral flow assay technique, with inadequate sensitivity and lack of internet connectivity. Herein, the biosensing advancements in Internet of Things (IoT)-integrated electroanalytical tools as superior POC devices for SARS-CoV-2 detection will be demonstrated. Meanwhile, the impeding factors pivotal for the successful deployment of such novel bioanalytical devices, including the incongruous standards, redundant guidelines, and the limitations of IoT modules will be discussed.

Uncovering the genetic links of SARS-CoV-2 infections on heart failure co-morbidity by a systems biology approach

Aims

The co‐morbidities contribute to the inferior prognosis of COVID‐19 patients. Recent reports suggested that the higher co‐morbidity rate between COVID‐19 and heart failure (HF) leads to increased mortality. However, the common pathogenic mechanism between them remained elusive. Here, we aimed to reveal underlying molecule mechanisms and genetic correlation between COVID‐19 and HF, providing a new perspective on current clinical management for patients with co‐morbidity.

Methods

The gene expression profiles of HF (GSE26887) and COVID‐19 (GSE147507) were retrieved from the GEO database. After identifying the common differentially expressed genes (|log2FC| > 1 and adjusted P < 0.05), integrated analyses were performed, namely, enrichment analyses, protein–protein interaction network, module construction, critical gene identification, and functional co‐expression analysis. The performance of critical genes was validation combining hierarchical clustering, correlation, and principal component analysis in external datasets (GSE164805 and GSE9128). Potential transcription factors and miRNAs were obtained from the JASPER and RegNetwork repository used to construct co‐regulatory networks. The candidate drug compounds in potential genetic link targets were further identified using the DSigDB database.

Results

The alteration of 12 genes was identified as a shared transcriptional signature, with the role of immune inflammatory pathway, especially Toll‐like receptor, NF‐kappa B, chemokine, and interleukin‐related pathways that primarily emphasized in response to SARS‐CoV‐2 complicated with HF. Top 10 critical genes (TLR4, TLR2, CXCL8, IL10, STAT3, IL1B, TLR1, TP53, CCL20, and CXCL10) were identified from protein–protein interaction with topological algorithms. The unhealthy microbiota status and gut–heart axis in co‐morbidity were identified as potential disease roads in bridging pathogenic mechanism, and lipopolysaccharide acts as a potential marker for monitoring HF during COVID‐19. For transcriptional and post‐transcriptional levels, regulation networks tightly coupling with both disorders were constructed, and significant regulator signatures with high interaction degree, especially FOXC1, STAT3, NF‐κB1, miR‐181, and miR‐520, were detected to regulate common differentially expressed genes. According to genetic links targets, glutathione‐based antioxidant strategy combined with muramyl dipeptide‐based microbe‐derived immunostimulatory therapies was identified as promising anti‐COVID‐19 and anti‐HF therapeutics.

Conclusions

This study identified shared transcriptomic and corresponding regulatory signatures as emerging therapeutic targets and detected a set of pharmacologic agents targeting genetic links. Our findings provided new insights for underlying pathogenic mechanisms between COVID‐19 and HF.

Acute Unilateral Central Serous Chorioretinopathy after Immunization with Pfizer-BioNTech COVID-19 Vaccine: A Case Report and Literature Review

INTRODUCTION

A 43-year-old Caucasian male presented to our ophthalmology clinic with blurry vision and metamorphopsia in his right eye, 24 hours after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine.

METHODS

Clinical examination and imaging tests were consistent with acute unilateral central serous chorioretinopathy (CSCR) that completely resolved after 2 months without any treatment. He had no significant ophthalmic or medical history. He also lacked the classical risk factors for CSCR such as recent psychosocial stressors, Type-A personality traits, history of exogenous steroid use, connective tissue disorders and obstructive sleep apnea.

RESULTS

This appears to be only the second reported case of CSCR, temporally associated with a recombinant COVID-19 mRNA vaccine. We also present a summary of published reports demonstrating intraocular complications associated with the novel recombinant COVID-19 mRNA vaccines.

CONCLUSION

Findings in this report should not deter COVID-19 vaccinations given the rarity of aforementioned ocular complications and the greater benefit of protection from COVID-19 infection. Medical practitioners, however, should remain mindful of potential ocular complications, given the greater likelihood of occurrence with increasing vaccination booster rates.

Willingness and Influencing Factors to Receive COVID-19 Vaccination Among Chinese Medical Students

Objectives

The aim of this study is to evaluate the desire of medical students in China to get vaccinated or not get vaccinated and the reasons for either decision.

Methods

A cross-sectional survey was conducted from 11 March and 12 March 2021, by administering an online questionnaire to the Chinese medical students. Data entry and analysis were conducted using IBM SPSS ver. 26.0.

Results

Of 3,047 students who completed the survey, 37.9% (1,154) of participants indicated that they would be vaccinated against COVID-19, while 62.1% (1,893) declared that they would not. Attitudes to the COVID-19 vaccine (p = 0.000), levels of eHealth Literacy (p = 0.000), the impact of COVID19 (p = 0.000), concerns about the COVID-19 vaccine (p = 0.000) and gender (p = 0.000) strong associations with willingness to receive the COVID-19 vaccine.

Conclusion

The willingness to receive COVID-19 vaccination was sub-optimal among medical students in China. Educational interventions to improve medical students' perceptions and acceptance toward the COVID-19 vaccine are needed.

Nonhuman primate models for evaluation of SARS-CoV-2 vaccines

INTRODUCTION

Evaluation of immunogenicity and efficacy in animal models provide critical data in vaccine development. Nonhuman primates (NHPs) have been used extensively in the evaluation of SARS-CoV-2 vaccines.

AREAS COVERED

A critical synthesis of SARS-CoV-2 vaccine development with a focus on challenge studies in NHPs is provided. The benefits and drawbacks of the NHP models are discussed. The citations were selected by the authors based on PubMed searches of the literature, summaries from national public health bodies, and press-release information provided by vaccine developers.

EXPERT OPINION

We identify several aspects of NHP models that limit their usefulness for vaccine-challenge studies and numerous variables that constrain comparisons across vaccine platforms. We propose that studies conducted in NHPs for vaccine development should use a standardized protocol and, where possible, be substituted with smaller animal models. This will ensure continued rapid progression of vaccines to clinical trials without compromising assessments of safety or efficacy.

Acceptance and willingness to pay under the different COVID-19 vaccines: A contingent valuation method

Background

The COVID-19 vaccine is recognized as a novel tool in the battle against COVID-19. Recently, there were several types of vaccines that have a different effectiveness and safety profile. Understanding the vaccine acceptance and willingness to pay (WTP) are essential to develop a strategic plan to increase the rate of COVID-19 vaccination uptake.

Objectives

To assess the acceptance and WTP for a COVID-19 Vaccine in Thailand using the contingent valuation method (CVM). Additionally, to identify the factors that affect the acceptance and the amount of WTP for a COVID-19 Vaccine.

Methods

We conducted a cross-sectional survey using a payment card approach with open-ended questions during September 2021. Three hypothetical COVID-19 vaccines (Vaccines A, B, and C) in two scenarios were employed. Data were collected from 752 people. Multivariate logistic regression was performed to assess the predictors of vaccine acceptance. Multiple linear regression was used to analyze factors associated with the maximum amount WTP for a vaccine.

Results

Of 742 respondents, the highest acceptance was vaccine C (70.71%), followed by B (17.72%) and A (11.57%). Similarly, 53.87%, 41.44%, and 36.21% of the respondents expressed WTP for vaccine C, B and A, respectively. The maximum amount WTP for vaccine C was US$46, followed by B (US$35) and A (US$32). Factors affecting acceptance included monthly salary, region of residence, education, perceived risk of COVID-19 infection, knowledge and attitude about the COVID-19 vaccine. In addition, monthly salary, region of residence, education and knowledge on COVID-19 vaccine were related to maximum amount WTP.

Conclusion

Acceptance and WTP depends on vaccine characteristics. Educational campaigns should be implemented to improve people's awareness, knowledge, and attitude towards COVID-19 vaccines to increase the vaccines' acceptance. To increase the rate of vaccination, the Thai government needs to allow freedom of choice on vaccines, while considering effectiveness and safety issues.

Mission, Organization, and Future Direction of the Serological Sciences Network for COVID-19 (SeroNet) Epidemiologic Cohort Studies

Background

Global efforts are needed to elucidate the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the underlying cause of coronavirus disease 2019 (COVID-19), including seroprevalence, risk factors, and long-term sequelae, as well as immune responses after vaccination across populations and the social dimensions of prevention and treatment strategies.

Methods

In the United States, the National Cancer Institute in partnership with the National Institute of Allergy and Infectious Diseases, established the SARS-CoV-2 Serological Sciences Network (SeroNet) as the nation's largest coordinated effort to study coronavirus disease 2019. The network comprises multidisciplinary researchers bridging gaps and fostering collaborations among immunologists, epidemiologists, virologists, clinicians and clinical laboratories, social and behavioral scientists, policymakers, data scientists, and community members. In total, 49 institutions form the SeroNet consortium to study individuals with cancer, autoimmune disease, inflammatory bowel diseases, cardiovascular diseases, human immunodeficiency virus, transplant recipients, as well as otherwise healthy pregnant women, children, college students, and high-risk occupational workers (including healthcare workers and first responders).

Results

Several studies focus on underrepresented populations, including ethnic minorities and rural communities. To support integrative data analyses across SeroNet studies, efforts are underway to define common data elements for standardized serology measurements, cellular and molecular assays, self-reported data, treatment, and clinical outcomes.

Conclusions

In this paper, we discuss the overarching framework for SeroNet epidemiology studies, critical research questions under investigation, and data accessibility for the worldwide scientific community. Lessons learned will help inform preparedness and responsiveness to future emerging diseases.

Advanced Liver Fibrosis Correlates With Impaired Efficacy of Pfizer-BioNTech COVID-19 Vaccine in Medical Employees

The Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine has been offered to nonallergic ≥16-year-old Israeli adults since December 19, 2020. Data regarding factors associated with vaccine ineffectiveness are limited. The aim of this study is to assess the impact of hepatic fibrosis on the efficacy of the BioNTech vaccine. Serum severe acute respiratory syndrome coronavirus 2 spike immunoglobulins (S IgG) obtained at least 7 days following vaccination completion was correlated with the prevaccine calculated Fibrosis-4 (FIB-4) score among 719 employees in the Hadassah Medical Center, Jerusalem. Positive vaccine response (S IgG levels ≥ 19 AU/mL) was found in 708 of 719 individuals (98.5%). Vaccine failure (S IgG levels < 19) was found in 11 (1.5%); of these, 7 were immunosuppressed. Mean FIB-4 available in 501 of 708 vaccine responders was 1.13 ± 0.66, mean age 51.4 ± 12.4 years (29.3% males), and mean S IgG titers 239.7 ± 86.1 AU/mL. Similar to the general population, 70.5% had normal FIB-4 (<1.3), 26.8% undetermined FIB-4 (1.3-2.67), and 2.7% advanced FIB-4 (>2.67). When divided into response subgroups, 158 of 501 individuals (30.1%) with IgG titers 19-100 AU/mL had a mean FIB-4 of 1.48 ± 0.82; 198 (39.5%) with IgG titers 101-200 AU/mL had mean FIB-4 of 1.22 ± 0.76; 83 (16.6%) with titers 201-300 AU/mL had mean FIB-4 of 1.04 ± 0.48; 38 (7.6%) individuals with IgG titers 301-400 AU/ml had a mean FIB-4 of 1.08 ± 0.63; and 121 (24.2%) with IgG titers >400 AU/mL had mean FIB-4 of 1.18 ± 0.87. Increased FIB-4, age, and male gender significantly correlated with lower postvaccine IgG titers (P < 0.001). FIB-4 results were confirmed using FibroScan data displaying advanced fibrosis impact on weakened COVID-19 vaccine response. Conclusion: Immune suppression, older age, male gender, and advanced chronic liver disease are risk factors for lower vaccine response. The FIB-4 provides a simple tool to prioritize candidates for third-dose vaccine booster.

Differences in COVID-19 Vaccine Concerns Among Asian Americans and Pacific Islanders: The COMPASS Survey

BACKGROUND

Understanding concerns for receiving COVID-19 vaccines is key to ensuring appropriately tailored health communications to increase vaccine uptake. However, limited data exists about vaccine concerns among Asian Americans and Pacific Islanders (AAPI).

METHODS

Data from the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS), a cross-sectional, national survey for AAPI adults in the U.S. were used (N=1,646). Descriptive statistics were used to assess sample characteristics including proportions of AAPI with various COVID-19 vaccine concerns, categorized as none, side-effects only, unsafe only, and multiple reasons, and differences in vaccine concerns by socio-demographics. Ordinary multivariable logistic regression analyses were conducted to evaluate associations between a characteristic and having any vaccine concerns.

RESULTS

Overall, 76% of the respondents reported having at ≥1 concerns about the vaccine. The most common concern was side effects (65%). Vietnamese Americans reported less concerns (vs. Chinese Americans). Those who were 30-39 and 40-49 years old (vs. <30), females (vs. males), and experienced mild negative impacts from COVID-19 on family income/employment (vs. no change) reported more concerns about the vaccine. Those who had less vaccine concerns were those who reported higher (vs. low) health status, ≥60 years old (vs. <30), and separated/divorced/widowed (vs. single).

DISCUSSION

AAPI is a diverse population and this study revealed differences in vaccine concerns across AAPI groups. Findings revealed potential targets for patient education needs. Effective strategies to address various vaccine concerns across subgroups of AAPI will be crucial to ensure equity in vaccination uptake.

The Role of General Attitudes and Perceptions Towards Vaccination on the Newly-Developed Vaccine: Results From a Survey on COVID-19 Vaccine Acceptance in China

Background

Vaccination has been considered one of the most effective public health interventions. In the context of the global epidemic of coronavirus disease 2019 (COVID-19), it remains unclear what role general vaccination attitudes and perceptions have on the acceptance of COVID-19 vaccine.

Objective

This study aims to explore the impact of general attitudes and perceptions toward vaccination on the acceptance of a newly developed vaccine, taking COVID-19 vaccines as an example.

Method

A cross-sectional survey was conducted among 2,013 Chinese adult participants. Generalized order logistic regression and path analysis models were used to analyze impacts of general attitudes and perceptions toward vaccination on the acceptance of the COVID-19 vaccine.

Results

The prevalence of hesitancy to vaccination in general is 49.9% among the Chinese adult population. General perceptions of vaccination were associated with corresponding perceptions of the COVID-19 vaccine. A “no hesitancy” attitude toward vaccination is a significant determinant (aOR = 1.77, 95% CI = 1.36–2.31) of future COVID-19 vaccination compared to vaccine refusers, and perceptions of COVID-19 vaccine remain a significant determinant for the acceptance of the COVID-19 vaccine. Path analysis indicates that perceptions of the importance and safety of vaccination have a positive overall effect on the acceptance of the COVID-19 vaccine, and that general perceptions of vaccination as a whole on each measure indirectly influence the acceptance of the COVID-19 vaccine.

Conclusion

General attitudes and perceptions toward vaccination were associated with those of the COVID-19 vaccine and future vaccination intention. To prepare for possible emergence of diseases in the future, routine health campaigns should be launched by relevant government departments and vaccination authorities to enhance the overall awareness and knowledge of vaccination among the public and to ensure optimal vaccination experience. In addition, targeted knowledge dissemination and mass mobilizations should be urged for newly developed vaccines when some specific infectious diseases emerge, such as COVID-19 at present.

SARS-CoV-2 variants and COVID-19 vaccines: Current challenges and future strategies

The ongoing COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global threat. Despite strict control measures implemented worldwide and immunization using novel vaccines, the pandemic continues to rage due to emergence of several variants of SARS-CoV-2 with increased transmission and immune escape. The rapid spread of variants of concern (VOC) in the recent past has created a massive challenge for the control of COVID-19 pandemic via the currently used vaccines. Vaccines that are safe and effective against the current and future variants of SARS-CoV-2 are essential in controlling the COVID-19 pandemic. Rapid production and massive rollout of next-generation vaccines against the variants are key steps to control the COVID-19 pandemic and to help us return to normality. Coordinated surveillance of SARS-CoV-2, rapid redesign of new vaccines and extensive vaccination are needed to counter the current SARS-CoV-2 variants and prevent the emergence of new variants. In this article, we review the latest information on the VOCs and variants of interest (VOIs) and present the information on the clinical trials that are underway on evaluating the effectiveness of COVID-19 vaccines on VOCs. We also discuss the current challenges posed by the VOCs in controlling the COVID-19 pandemic and future strategies to overcome the threat posed by the highly virulent and rapidly transmissible variants of SARS-CoV2.

The Perils of the Pandemic for the Tourism and Hospitality Industries: Envisaging the Combined Effect of COVID-19 Fear and Job Insecurity on Employees' Job Performance in Pakistan

Purpose

This study aims to improve employees' job performance during COVID-19 pandemic circumstances and demonstrates the impact of COVID-19 fear on hospitality employees' job performance under the mediating role of job insecurity changes and job loss insecurity.

Methods

The study adopts a quantitative approach, and data were accumulated through a structured questionnaire. In total, 509 valid questionnaires were received from employees working in Pakistan's hospitality sector. A structural equation model using Smart-PLS software was used to analyze the collected data from the respondents.

Results

The results have identified that COVID-19 fear has a positive and significant influence on job insecurity changes, job loss insecurity, and a negative and significant relationship with job performance. The mediating relationship of job insecurity changes and job loss insecurity negatively significantly influence job performance. Additionally, results indicate a significant relationship between the moderating effect of the COVID-19 vaccines and job insecurity changes, job loss insecurity, and job performance.

Conclusion

The study revealed that employees who perceived their jobs to be insecure during the COVID-19 pandemic tried to cope with the situation, feel healthy, and perform well in their job after getting vaccinated. The study's findings recommend modifying the employees' working pattern for organizations. This study enhances the existing literature on the COVID-19 crisis in Pakistan's hospitality industry. In particular, this study is a novel addition to academia that highlights the impact of the COVID-19 pandemic on the work performance of front desk employees in the hotel and tourism industry.

Acceptance of and Preference for COVID-19 Vaccination in India, the United Kingdom, Germany, Italy, and Spain: An International Cross-Sectional Study

Objective: India and Europe have large populations, a large number of Coronavirus disease 2019 (COVID-19) cases, and different healthcare systems. This study aims to investigate the differences between the hesitancy toward and preference for COVID-19 vaccines in India and four European countries, namely, the United Kingdom (UK), Germany, Italy, and Spain. Methodology: We conducted a cross-national survey for distribution in India, the UK, Germany, Italy, and Spain. More specifically, a discrete choice experiment (DCE) was conducted to evaluate vaccine preferences, and Likert scales were used to probe the underlying factors that contribute to vaccination acceptance. Propensity score matching (PSM) was performed to directly compare India and European countries. Results: A total of 2565 respondents (835 from India and 1730 from the specified countries in Europe) participated in the survey. After PSM, more than 82.5% of respondents from India positively accepted the COVID-19 vaccination, whereas 79.9% of respondents from Europe had a positive attitude; however, the proportion in Europe changed to 81.6% in cases in which the vaccine was recommended by friends, family, or employers. The DCE found that the COVID-19 vaccine efficacy was the most important factor for respondents in India and the four European nations (41.8% in India and 47.77% in Europe), followed by the vaccine cost (28.06% in India and 25.88% in Europe). Conclusion: Although most respondents in both regions showed high acceptance of COVID-19 vaccines, either due to general acceptance or acceptance as a result of social cues, the vaccination coverage rate shows apparent distinctions. Due to the differences in COVID-19 situations, public health systems, cultural backgrounds, and vaccine availability, the strategies for COVID-19 vaccine promotion should be nation-dependent.

What drives willingness to receive a new vaccine that prevents an emerging infectious disease? A discrete choice experiment among university students in Uganda

Background

There is a critical need to identify the drivers of willingness to receive new vaccines against emerging and epidemic diseases. A discrete choice experiment is the ideal approach to evaluating how individuals weigh multiple attributes simultaneously. We assessed the degree to which six attributes were associated with willingness to be vaccinated among university students in Uganda.

Methods

We conducted a single-profile discrete choice experiment at Makerere University in 2019. Participants were asked whether or not they would be vaccinated in 8 unique scenarios where attributes varied by disease risk, disease severity, advice for or against vaccination from trusted individuals, recommendations from influential figures, whether the vaccine induced indirect protection, and side effects. We calculated predicted probabilities of vaccination willingness using mixed logistic regression models, comparing health professional students with all other disciplines.

Findings

Of the 1576 participants, 783 (49.8%) were health professional students and 685 (43.5%) were female. Vaccination willingness was high (78%), and higher among health students than other students. We observed the highest vaccination willingness for the most severe disease outcomes and the greatest exposure risks, along with the Minister of Health’s recommendation or a vaccine that extended secondary protection to others. Mild side effects and recommendations against vaccination diminished vaccination willingness.

Interpretation

Our results can be used to develop evidence-based messaging to encourage uptake for new vaccines. Future vaccination campaigns, such as for COVID-19 vaccines in development, should consider acknowledging individual risk of exposure and disease severity and incorporate recommendations from key health leaders.

Investigate the effect of COVID-19 inactivated vaccine on sperm parameters and embryo quality in in vitro fertilization

Since the reproductive toxicity of COVID‐19 vaccines have not been assessed in previous clinical trials, and studies have shown that SARS‐CoV‐2 is associated with a decrease in sperm parameters. Although it has been reported that the mRNA SARS‐CoV‐2 vaccines do not adversely affect semen parameters, whether this conclusion applies to inactivated vaccines remains unclear. Here, we conducted a study among patients who accepted in vitro fertilization (IVF) at the reproductive centre between June and August of 2021. In the enrolled cases, men who have completed two doses of COVID‐19 inactivated vaccine were included in “vaccine group” (N = 105), and those who were not vaccinated were included in “control group” (N = 155). In this study, we compare the sperm parameters and embryo quality between these two groups. Our data showed that the sperm parameters were similar in terms of volume, sperm concentration, sperm count, progressive motility, total motility and total motile sperm count between these two groups. Similarly, no significant differences were observed in IVF outcomes. The mean number of 2PN, cleavage‐stage embryos, blastocysts, and good‐quality blastocysts was 8.59 ± 4.47, 5.06 ± 3.17 and 2.08 ± 1.79 in vaccine group, 7.75 ± 4.14, 4.34 ± 3.06 and 1.74 ± 1.54 in control group, respectively. The high‐quality blastocyst rate was 41.05% (218 of 531) in vaccine group and 40.03% (269 of 672) in control group (p > 0.05). In addition, no differences were observed in biochemical and clinical pregnancy rates between the two groups. In summary, our results revealed that COVID‐19 inactivated vaccine administration exhibited no negative effect on sperm parameters and embryo quality in IVF.

Pre-clinical non-viral vectors exploited for in vivo CRISPR/Cas9 gene editing: an overview

Clustered regulatory interspaced short palindromic repeats or CRISPR/Cas9 has emerged as a potent and versatile tool for efficient genome editing. This technology has been exploited for several applications including disease modelling, cell therapy, diagnosis, and treatment of many diseases including cancer. The in vivo application of CRISPR/Cas9 is hindered by poor stability, pharmacokinetic profile, and the limited ability of the CRISPR payloads to cross biological barriers. Although viral vectors have been implemented as delivery tools for efficient in vivo gene editing, their application is associated with high immunogenicity and toxicity, limiting their clinical translation. Hence, there is a need to explore new delivery methods that can guarantee safe and efficient delivery of the CRISPR/Cas9 components to target cells. In this review, we first provide a brief history and principles of nuclease-mediated gene editing, we then focus on the different CRISPR/Cas9 formats outlining their potentials and limitations. Finally, we discuss the alternative non-viral delivery strategies currently adopted for in vivo CRISPR/Cas9 gene editing.

Parents' Perceptions and Intention to Vaccinate Their Children Against COVID-19: Results From a Cross-Sectional National Survey in India

Background

Despite the success of adult vaccination against COVID-19, providing vaccines to children remains a challenge for policymakers globally. As parents are primary decision-makers for their children, we aimed to assess parents' perceptions and intentions regarding COVID-19 vaccination in India.

Methods

A cross-sectional web-based study was designed, parents or caregivers (N = 770) were recruited through snowball sampling using Google form. Cross-tabulation was performed by parents' intention to vaccinate their children against COVID-19 virus with sociodemographic characteristics and their risk perception toward COVID-19, trust in the healthcare system, and their history of vaccine hesitancy behavior. Multivariable logistic regression analysis was performed to compute the predictors of child vaccination intention among Indian parents.

Results

Seven hundred and seventy parents across the country have completed the survey. Of the 770 participants, 258 (33.5%) have shown intent to vaccinate their children. The stated likelihood of child vaccination was greater among parents who had a bachelor's degree or higher education (aOR: 1.98, 95% CI: 1.15-3.51); as well as among parents who intended to vaccinate themselves (aOR: 2.35, 95% CI: 1.30-4.67). Parental concerns centered around vaccine safety and side effects.

Conclusion

Indian parents reported high knowledge of the COVID-19 virus and were aware of the development of a vaccine. However, about one-third of parents intended to vaccinate their children, and about half of them were not sure whether to vaccinate their children or not against the COVID-19 virus. The study highlighted the need for health promotion strategies that promote vaccine uptake among parents.

A Review of Different Vaccines and Strategies to Combat COVID-19

In December 2019, an unknown viral infection emerged and quickly spread worldwide, resulting in a global pandemic. This novel virus caused severe pneumonia and acute respiratory distress syndrome caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It has caused 6.25 millions of deaths worldwide and remains a major concern for health, society, and the economy. As vaccination is one of the most efficient ways to combat this pandemic, different vaccines were developed in a short period. This review article discusses how coronavirus affected the top nations of the world and the vaccines being used for the prevention. Amongst the vaccines, some vaccines have already been approved, and some have been involved in clinical studies. The article also provides insight into different COVID-19 vaccine platforms, their preparation, working, efficacy, and side effects.

Untapping host-targeting cross-protective efficacy of anticoagulants against SARS-CoV-2

Responding quickly to emerging respiratory viruses, such as SARS-CoV-2 the causative agent of coronavirus disease 2019 (COVID-19) pandemic, is essential to stop uncontrolled spread of these pathogens and mitigate their socio-economic impact globally. This can be achieved through drug repurposing, which tackles inherent time- and resource-consuming processes associated with conventional drug discovery and development. In this review, we examine key preclinical and clinical therapeutic and prophylactic approaches that have been applied for treatment of SARS-CoV-2 infection. We break these strategies down into virus- versus host-targeting and discuss their reported efficacy, advantages, and disadvantages. Importantly, we highlight emerging evidence on application of host serine protease-inhibiting anticoagulants, such as nafamostat mesylate, as a potentially powerful therapy to inhibit virus activation and offer cross-protection against multiple strains of coronavirus, lower inflammatory response independent of its antiviral effect, and modulate clotting problems seen in COVID-19 pneumonia.

3D-printed simulator for nasopharyngeal swab collection for COVID-19

OBJECTIVES

Diagnosis of COVID-19 is essential to prevent the spread of SARS-CoV-2. Nasopharyngeal swabs (NPS) remain the gold standard in screening, although associated with false negative results (up to 30%). We developed a 3D simulator of the nasal and pharyngeal cavities for the learning and improvement of NPS collection.

PATIENTS AND METHODS

Simulator training sessions were carried out in 11 centers in France. A questionnaire assessing the simulator was administered at the end of the sessions. The study population included both healthcare workers (HCW) and volunteers from the general population.

RESULTS

Out of 589 participants, overall satisfaction was scored 9.0 [8.9-9.1] on a scale of 0 to 10 with excellent results in the 16 evaluation items of each category (HCWs and general population, NPS novices and experienced). The simulator was considered very realistic (95%), easy to use (97%), useful to understand the anatomy (89%) and NPS sampling technique (93%). This educational tool was considered essential (93%). Participants felt their future NPS would be more reliable (72%), less painful (70%), easier to perform (88%) and that they would be carried out more serenely (90%). The mean number of NPS conducted on the simulator to feel at ease was two; technical fluency with the simulator can thus be acquired quickly.

CONCLUSION

Our simulator, whose 3D printing can be reproduced freely using a permanent open access link, is an essential educational tool to standardize the learning and improvement of NPS collection. It should enhance virus detection and thus contribute to better pandemic control.

mRNA vaccines for COVID-19 and diverse diseases

Since its outbreak in late 2019, the novel coronavirus disease 2019 (COVID-19) has spread to every continent on the planet. The global pandemic has affected human health and socioeconomic status around the world. At first, the global response to the pandemic was to isolate afflicted individuals to prevent the virus from spreading, while vaccine development was ongoing. The genome sequence was first presented in early January 2020, and the phase I clinical trial of the vaccine started in March 2020 in the United States using novel lipid-based nanoparticle (LNP), encapsulated with mRNA termed as mRNA-1273. Till now, various mRNA-based vaccines are in development, while one mRNA-based vaccine got market approval from US-FDA for the prevention of COVID-19. Previously, mRNA-based vaccines were thought to be difficult to develop, but the current development is a significant accomplishment. However, widespread production and global availability of mRNA-based vaccinations to combat the COVID-19 pandemic remains a major challenge, especially when the mutations continually occur on the virus (e.g., the recent outbreaks of Omicron variant). This review elaborately discusses the COVID-19 pandemic, the biology of SARS-CoV-2 and the progress of mRNA-based vaccines. Moreover, the review also highlighted a detailed description of mRNA delivery technologies and the application potential in controlling other life-threatening diseases. Therefore, it provides a comprehensive view and multidisciplinary insights into mRNA therapy for broader audiences.

Echinacea Purpurea For the Long-Term Prevention of Viral Respiratory Tract Infections During Covid-19 Pandemic: A Randomized, Open, Controlled, Exploratory Clinical Study

SARS-CoV-2 vaccination is effective in preventing severe Covid-19, but efficacy in reducing viral load and transmission wanes over time. In addition, the emergence of novel SARS-CoV-2 variants increases the threat of uncontrolled dissemination and additional antiviral therapies are urgently needed for effective containment. In previous in vitro studies Echinacea purpurea demonstrated strong antiviral activity against enveloped viruses, including SARS-CoV-2. In this study, we examined the potential of Echinacea purpurea in preventing and treating respiratory tract infections (RTIs) and in particular, SARS-CoV-2 infections. 120 healthy volunteers (m,f, 18-75 years) were randomly assigned to Echinacea prevention or control group without any intervention. After a run-in week, participants went through 3 prevention cycles of 2, 2 and 1 month with daily 2,400 mg Echinacea purpurea extract (Echinaforce®, EF). The prevention cycles were interrupted by breaks of 1 week. Acute respiratory symptoms were treated with 4,000 mg EF for up to 10 days, and their severity assessed via a diary. Naso/oropharyngeal swabs and venous blood samples were routinely collected every month and during acute illnesses for detection and identification of respiratory viruses, including SARS-CoV-2 via RT-qPCR and serology. Summarized over all phases of prevention, 21 and 29 samples tested positive for any virus in the EF and control group, of which 5 and 14 samples tested SARS-CoV-2 positive (RR = 0.37, Chi-square test, p = 0.03). Overall, 10 and 14 symptomatic episodes occurred, of which 5 and 8 were Covid-19 (RR = 0.70, Chi-square test, p > 0.05). EF treatment when applied during acute episodes significantly reduced the overall virus load by at least 2.12 log10 or approx. 99% (t-test, p < 0.05), the time to virus clearance by 8.0 days for all viruses (Wilcoxon test, p = 0.02) and by 4.8 days for SARS-CoV-2 (p > 0.05) in comparison to control. Finally, EF treatment significantly reduced fever days (1 day vs 11 days, Chi-square test, p = 0.003) but not the overall symptom severity. There were fewer Covid-19 related hospitalizations in the EF treatment group (N = 0 vs N = 2). EF exhibited antiviral effects and reduced the risk of viral RTIs, including SARS-CoV-2. By substantially reducing virus loads in infected subjects, EF offers a supportive addition to existing mandated treatments like vaccinations. Future confirmatory studies are warranted.

Moving beyond Titers

Vaccination to prevent and even eliminate disease is amongst the greatest achievements of modern medicine. Opportunities remain in vaccine development to improve protection across the whole population. A next step in vaccine development is the detailed molecular characterization of individual humoral immune responses against a pathogen, especially the rapidly evolving pathogens. New technologies such as sequencing the immune repertoire in response to disease, immunogenomics/vaccinomics, particularly the individual HLA variants, and high-throughput epitope characterization offer new insights into disease protection. Here, we highlight the emerging technologies that could be used to identify variation within the human population, facilitate vaccine discovery, improve vaccine safety and efficacy, and identify mechanisms of generating immunological memory. In today’s vaccine-hesitant climate, these techniques used individually or especially together have the potential to improve vaccine effectiveness and safety and thus vaccine uptake rates. We highlight the importance of using these techniques in combination to understand the humoral immune response as a whole after vaccination to move beyond neutralizing titers as the standard for immunogenicity and vaccine efficacy, especially in clinical trials.

ABO Blood System and COVID-19 Susceptibility: Anti-A and Anti-B Antibodies Are the Key Points

The implication of the ABO blood group in COVID-19 disease was formulated early, at the beginning of the COVID-19 pandemic more than 2 years ago. It has now been established that the A blood group is associated with more susceptibility and severe symptoms of COVID-19, while the O blood group shows protection against viral infection. In this review, we summarize the underlying pathophysiology of ABO blood groups and COVID-19 to explain the molecular aspects behind the protective mechanism in the O blood group. A or B antigens are not associated with a different risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than that of other antigens. In this case, the cornerstone is natural anti-A and anti-B antibodies from the ABO system. They are capable of interfering with the S protein (SARS-CoV-2) and angiotensin-converting enzyme 2 (ACE2; host cell receptor), thereby conferring protection to patients with sufficient antibodies (O blood group). Indeed, the titers of natural antibodies and the IgG isotype (specific to the O blood group) may be determinants of susceptibility and severity. Moreover, older adults are associated with a higher risk of bad outcomes due to the lack of antibodies and the upregulation of ACE2 expression during senescence. A better understanding of the role of the molecular mechanism of ABO blood groups in COVID-19 facilitates better prognostic stratification of the disease. Furthermore, it could represent an opportunity for new therapeutic strategies.

COVID-19 vaccine acceptance among cold-chain workers in Shenzhen, China: A cross-sectional survey

Given the high level of exposure to SARS-CoV-2, cold-chain workers are considered priority vaccination groups. To date, many studies have reported on the willingness within distinct populations to be vaccinated against COVID-19, whereas it has not been reported among cold-chain workers worldwide. To address this void, we conducted a cross-sectional survey to gather general information, COVID-19-related knowledge, attitudes, and practices (KAP), and willingness to receive a COVID-19 vaccine among cold-chain workers in Shenzhen, China. Binary logistic analyses were conducted to explore the associations between COVID-19-related KAP factors and the willingness for COVID-19 vaccination. Among 244 cold-chain workers, 76% indicated that they were willing to be vaccinated. Knowledge about SARS-CoV-2, comprehending the most effective prevention, understanding the transmission routes, and recognizing the priority vaccination groups were positively associated with willingness to be vaccinated against COVID-19. Regarding attitude factors, perceiving the social harmfulness and severity of COVID-19 were related to a higher willingness to vaccination. Participants considering themselves a priority group for COVID-19 vaccination were more likely to get vaccinated. For practice factors, attaining more knowledge and higher self-reported compliance with maintaining adequate ventilation were also positively associated with the dependent variable. Agreement on the importance of COVID-19 vaccination was the most frequent reason for accepting the COVID-19 vaccine; additionally, concerns about side effects and insufficient understanding of efficacy were the main factors contributing to vaccine refusal. Enhancing KAP levels related to COVID-19 helps promote vaccine acceptance. Health authorities should promptly implement educational activities following the updated vaccine status among cold-chain workers.

Willingness to Receive a COVID-19 Vaccine and Associated Factors among Older Adults: A Cross-Sectional Survey in Shanghai, China

Background: Older individuals have a high risk of morbidity and mortality due to COVID-19, and one of the most effective ways to prevent COVID-19 is vaccination. Little is known about older people’s willingness to receive a COVID-19 vaccine. Therefore, the objective of this study was to assess the acceptance of and factors influencing the intention to receive a COVID-19 vaccination among older adults in Shanghai, China. Methods: A cross-sectional study was conducted among older adults (≥60 years old) in Shanghai. Face-to-face interviews with a questionnaire were conducted in community health service centers, recording several parameters: demographic information, health-related factors; perceived likelihood, severity, and burden of COVID-19; perceived safety, effectiveness, necessity, and benefit of the COVID-19 vaccine, as well as their trust in the vaccine delivery system and doctors; willingness to receive a COVID-19 vaccination. Bivariate analysis between several survey items and the willingness to receive a COVID-19 vaccination was conducted using a chi-square test. Logistic regression was used to assess to what degree each variable affected the willingness to receive a COVID-19 vaccination. Results: Of the 1067 participants, 90.91% (970/1067) confirmed that they were willing to receive a COVID-19 vaccination. The participants were more likely to be willing to be vaccinated if they were immigrants (OR = 1.988, 95%CI = 1.062−3.717), had an education level of junior high school (OR = 2.724, 95%CI = 1.000−7.423) or high school or above (OR = 3.993, 95%CI = 1.576−10.119), and had a monthly income of CNY 3000−5000 (OR = 32.770, 95%CI = 1.144−6.711) or CNY >5000 (OR = 2.309, 95%CI = 1.003−5.319). The participants were also more likely to be willing to be vaccinated if they had received a pneumonia vaccination previously (OR = 2.138, 95%CI = 1.016−4.500), perceived the safety of the COVID-19 vaccine (OR = 1.508, 95%CI = 1.073−2.119), perceived the necessity of the COVID-19 vaccine (OR = 2.604, 95%CI = 1.946−3.484), or trusted the suggestions of doctors (OR = 1.706, 95%CI = 1.115−2.618). The participants were less likely to be willing to be vaccinated if they were aged ≥76 years (OR = 0.498, 95%CI = 0.264−0.939), reported a physical health condition of bad or below (OR = 0.229, 95% CI = 0.095−0.549), or were worried about the adverse effects of a COVID-19 vaccination (OR = 0.503, 95%CI = 0.364−0.695). Conclusions: Under the free vaccination policy for COVID-19, older adults have a high intention to be vaccinated to prevent COVID-19 in Shanghai, China. Widely publicizing the safety and necessity of COVID-19 vaccination is necessary.

Delta Variant of SARS-CoV-2 Replacement in Brazil: A National Epidemiologic Surveillance Program

Coronavirus disease 2019 (COVID-19) pandemic has caused immeasurable impacts on the health and socioeconomic system. The real-time identification and characterization of new Variants of Concern (VOCs) are critical to comprehend its emergence and spread worldwide. In this sense, we carried out a national epidemiological surveillance program in Brazil from April to October 2021. Genotyping by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and sequencing were performed to monitor the dynamics and dissemination of VOCs in samples from 15 federative units. Delta VOC was first detected on June 2021 and took sixteen weeks to replace Gamma. To assess the transmissibility potential of Gamma and Delta VOCs, we studied the dynamics of RT-qPCR cycle threshold (Ct) score in the dominance period of each variant. The data suggest that Delta VOC has a higher transmission rate than Gamma VOC. We also compared relevant symptom patterns in individuals infected with both VOCs. The Delta-infected subjects were less likely to have low oxygen saturation or fatigue, altered results on chest computed tomography, and a propensity for altered X-rays. Altogether, we described the replacement of Gamma by Delta, Delta enhanced transmissibility, and differences in symptom presentation.

The COVID-19 Vaccine: Trust, doubt, and hope for a future beyond the pandemic in Germany

Public perceptions of COVID-19 vaccines are critical in reaching protective levels of herd immunity. Vaccine skepticism has always been relatively high in Germany, and surveys suggest that over the course of the pandemic, enthusiasm for the COVID-19 vaccine has dropped. Looking at the period just prior to the approval of the Pfizer/BioNTech and Moderna vaccines in Germany in the latter half of 2020, this paper aims to assess the reasons for and against COVID-19 vaccine uptake among residents of Germany, and to provide in-depth qualitative data to better understand and address concerns surrounding the safety and efficacy of a COVID-19 vaccine. Our findings indicate that there is widespread trust in German institutions and health experts to provide a safe vaccine for those who need it most. However, interviewees also point to the need for more information and the centrality of support from trusted medical authorities in making individual vaccination decisions. We also present the complexity of individual positions on vaccination, and suggest that vaccine hesitancy in relation to COVID-19 needs to be understood as a nuanced, and socially malleable, territory. This indicates that the goal of a vaccination campaign is not only achieving ‘herd immunity,’ but also a social endorsement of the collaborative effort that is required for a vaccine to be successful.

Tracking discussions of complementary, alternative, and integrative medicine in the context of the COVID-19 pandemic: a month-by-month sentiment analysis of Twitter data

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the paucity of evidence, various complementary, alternative and integrative medicines (CAIMs) have been being touted as both preventative and curative. We conducted sentiment and emotion analysis with the intent of understanding CAIM content related to COVID-19 being generated on Twitter across 9 months.

METHODS

Tweets relating to CAIM and COVID-19 were extracted from the George Washington University Libraries Dataverse Coronavirus tweets dataset from March 03 to November 30, 2020. We trained and tested a machine learning classifier using a large, pre-labelled Twitter dataset, which was applied to predict the sentiment of each CAIM-related tweet, and we used a natural language processing package to identify the emotions based on the words contained in the tweets.

RESULTS

Our dataset included 28 713 English-language Tweets. The number of CAIM-related tweets during the study period peaked in May 2020, then dropped off sharply over the subsequent three months; the fewest CAIM-related tweets were collected during August 2020 and remained low for the remainder of the collection period. Most tweets (n = 15 612, 54%) were classified as positive, 31% were neutral (n = 8803) and 15% were classified as negative (n = 4298). The most frequent emotions expressed across tweets were trust, followed by fear, while surprise and disgust were the least frequent. Though volume of tweets decreased over the 9 months of the study, the expressed sentiments and emotions remained constant.

CONCLUSION

The results of this sentiment analysis enabled us to establish key CAIMs being discussed at the intersection of COVID-19 across a 9-month period on Twitter. Overall, the majority of our subset of tweets were positive, as were the emotions associated with the words found within them. This may be interpreted as public support for CAIM, however, further qualitative investigation is warranted. Such future directions may be used to combat misinformation and improve public health strategies surrounding the use of social media information.

Prioritizing Global Public Health Investments for COVID-19 Response in Real Time: Results from a Delphi Exercise

In the first months of the COVID-19 pandemic, there was a lack of guidance on how to channel the unprecedented amount of health financing toward the pandemic response. We employed a multistep, interactive Delphi process to reach consensus on a “menu” of priority COVID-19 response interventions. In all, 27 health security experts—representing national governments, bilateral and multilateral organizations, academia, technical agencies, and nongovernmental organizations—participated in the exercise. The experts rated 11 technical investment areas and 37 interventions on a 5-point scale in terms of their importance to COVID-19 response. Initial findings were discussed at a virtual meeting where experts suggested modifications. A group of 19 experts then rated a revised list of 11 technical areas and 39 interventions. Consensus was defined as at least 80% of experts agreeing on the importance of a technical area or intervention; stability of scores across the rounds was identified using Wilcoxon matched-pairs and unpaired signed rank tests. Between the initial and final menu, 3 technical areas and 7 interventions were slightly modified, 3 interventions were added, and 1 intervention was removed. Consensus was reached on all 11 technical areas and 35 of the final 39 interventions, and between 34 and 37 interventions were stable across rounds depending on the test used. In this exercise, the health security experts agreed that COVID-19 response financing should prioritize interventions that enhance a country's capacity to test, trace, and treat high-risk populations. Simultaneously, supportive systems (eg, risk communication, community engagement, public health infrastructure, information systems, policy and coordination, workforce capacity, other social protections) should be developed to ensure that nonpharmaceutical and medical interventions can maximize the effectiveness of these systems.

Humoral antibody response to the first dose of the ChAdOx1 nCoV-19 vaccine in Asian patients undergoing hemodialysis

Background and objectives

The immunogenicity of vaccines is known to be attenuated in patients with end‐stage kidney disease due to uremia. Patients on dialysis were excluded from coronavirus disease 2019 (COVID‐19) vaccine trials; thus, the effectiveness of vaccines for this population is unclear. The aim of this study was to explore whether Asian dialysis patients can effectively produce an immune response after being vaccinated with the first dose of the ChAdOx1 nCoV‐19 vaccine.

Design setting, participants, and measurements

In this prospective cohort study, we included Asian hemodialysis patients who received the ChAdOx1 nCoV‐19 vaccine. At 3 weeks after the first dose of vaccination, we assessed the humoral immune response by measuring anti‐SARS‐CoV‐2 S antibody titers. The primary outcome was the seropositive rate following vaccination, defined as an antibody titer greater than or equal to 0.8 U/ml. Factors associated with seropositivity were explored in multivariate logistic regression analyses.

Results

In total, 434 participants were included. The mean age was 64 years, the mean dialysis vintage was 6 years, and 61% of the participants were men. At a mean time of 22 days from vaccination, 56% of the participants were seropositive. The vast majority (88%) had low antibody titers (< 15 U/ml). The multivariate logistic regression analyses showed that older age (every increase of 10 years, odds ratio [OR] 0.80, 95% CI 0.65–0.98, p = 0.03) was negatively associated with seropositivity and that higher Kt/V (every increase of 0.1, OR 1.14, 95% CI 1.01–1.28, p = 0.03) and higher serum albumin level (every increase of 0.1 g/dl, OR 1.09, 95% CI 1.02–1.18, p = 0.02) were positively associated with seropositivity.

Conclusions

In Asian hemodialysis patients, the seropositive rate was low, and most had low antibody titers after the first dose of the ChAdOx1 nCoV‐19 vaccine. Younger age, better dialysis adequacy, and higher albumin levels were associated with seropositivity.

A Perspective towards Multi-Hazard Resilient Systems: Natural Hazards and Pandemics

The concept of resilience has been used extensively across the sciences in engineering and the humanities. It is applied to ecology, medicine, economics, and psychology. The novel coronavirus disease (COVID-19) has posed an extraordinary challenge to the resilience of healthcare systems, communities, and nations and has profoundly altered our previous day-to-day operations. This paper presents a discussion of the definitions and characteristics of resilient systems. Scenarios are utilized to qualitatively explore key relationships, responses, and paths for recovery across different system types. The purpose is to develop an integrated approach that can accommodate simultaneous threats to system resilience, in particular, impacts from a natural hazard in conjunction with COVID-19. This manuscript is the first to advocate for more in-depth and quantitative research utilizing transdisciplinary approaches that can accommodate considerations across our built environment and healthcare system infrastructures in pursuit of designing systems that are resilient to both natural hazards and pandemic impacts.

COVID-19 vaccination perceptions and attitudes among Egyptian medical students

Background:

This study aimed to assess perceptions and attitudes toward COVID-19 vaccines among medical students.

Methods:

A consecutive convenient sample of 2100 university students representing the student’s union network were included using an electronic self-administered questionnaire. About 12 items were used to assess attitudes and acceptance of COVID-19 vaccines.

Results:

A total of 2100 volunteers responded to the survey. All ages ranged from 18 to 25 years, 69% were females, and 57.3% were from urban residences. According to their willingness to receive the COVID-19 vaccine, 49.7% accepted, 38.5% hesitated, and 11.8% refused vaccination. Out of 60 scales measuring their attitudes, a median total score of 46.0 (42.0–49.0) differed significantly in relation to genders, residence, and vaccine decision-making groups. Logistic regression analysis showed that participants who consented that COVID-19 mass vaccination could prevent the spread of infection in the community and stop the pandemic have 1.9 higher odds of accepting vaccination ( p = 0.003). Additionally, the participants who believed that the vaccine had no severe infection or side effects were 3.1 and 2.8 higher folds for vaccine acceptance, respectively ( p = 0.001). Moreover, participants who thought it was not too early for clinical trials were 4.3 times more likely to take the vaccine ( p = 0.001). Individuals who agreed that information about vaccine side effects better to discuss openly with the authorities were 2.8 times more likely to accept vaccination than other hesitating/ refusing groups, p-value < 0.001.

Conclusions:

Understanding students’ perspectives of the COVID-19 vaccine and supporting their health engagement and awareness may help plan an adequate response.

A global survey in the developmental landscape of possible vaccination strategies for COVID-19

The development of COVID-19 vaccines was promptly regulated to ensure the best possible approach. By January 2022, 75 candidates reached preclinical evaluation in various animal models, 114 vaccines were in clinical trials on humans, and 48 were in the final testing stages. Vaccine platforms range from whole virus vaccines to nucleic acid vaccines, which are the most promising in prompt availability and safety. The USA and Europe have approved vaccines developed by Pfizer-BioNTech (BNT162b2) and Moderna (mRNa1273). So far, Pfizer-BioNTech, Moderna, Johnson & Johnson, AstraZeneca-University of Oxford, Sinopharm, Sinovac Biotech Gamaleya, Bharat Biotech, and Novavax have documented effective vaccines. Even with technological advances and a fast-paced development approach, many limitations and problems need to be overcome before a large-scale production of new vaccines can start. The Key is to ensure equal and fair distribution globally through regulatory measures. Recent studies link Bacillus Calmette-Guérin (BCG) vaccination programs and lower disease severity.

COVID-19 vaccinations: The unknowns, challenges, and hopes

The entire world has been suffering from the coronavirus disease 2019 (COVID-19) pandemic since March 11, 2020. More than a year later, the COVID-19 vaccination brought hope to control this viral pandemic. Here, we review the unknowns of the COVID-19 vaccination, such as its longevity, asymptomatic spread, long-term side effects, and its efficacy on immunocompromised patients. In addition, we discuss challenges associated with the COVID-19 vaccination, such as the global access and distribution of vaccine doses, adherence to hygiene guidelines after vaccination, the emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, and vaccine resistance. Despite all these challenges and the fact that the end of the COVID-19 pandemic is still unclear, vaccines have brought great hope for the world, with several reports indicating a significant decline in the risk of COVID19-related infection and hospitalizations.

How Implicit Attitudes toward Vaccination Affect Vaccine Hesitancy and Behaviour: Developing and Validating the V-IRAP

Vaccination is one of the most important ways of fighting infectious diseases, such as COVID-19. However, vaccine hesitancy and refusal can reduce adherence to vaccination campaigns, and therefore undermine their effectiveness. Although the scientific community has made great efforts to understand the psychological causes of vaccine hesitancy, studies on vaccine intention have usually relied on traditional detection techniques, such as questionnaires. Probing these constructs explicitly could be problematic due to defense mechanisms or social desirability. Thus, a measure capable of detecting implicit attitudes towards vaccination is needed. To achieve this aim, we designed and validated a new test called the Vaccine-IRAP, or V-IRAP, which is a modified version of the original Implicit Relational Assessment Procedure, or IRAP, task. The V-IRAP allows the unspoken reasons behind vaccine hesitancy to be investigated, and is able to distinguish between positive and negative beliefs on vaccination. The test was assessed in a sample of 151 participants. The V-IRAP showed good internal reliability and convergent validity, with meaningful correlational patterns with explicit measures. Moreover, it revealed incremental validity over such explicit measures. Lastly, the V-IRAP was able to shed light on the implicit attitudes involved in vaccine refusal, revealing negative attitudes relative to vaccine-related risks in non-vaccinated participants. Overall, these results support V-IRAP as a sensitive and reliable tool that could be used in future studies on implicit attitudes toward vaccination.

Assessment of the Citizens’ Perspectives on the COVID-19 Vaccination Process Which Are Ranked Last in The Vaccination Groups: Qualitative Reports from Turkey in the Early Stages of the Vaccination Process

Aim: To evaluate the perspectives of the citizens ranking last in COVID-19 vaccination groups in terms of the vaccination process. Methods: In-depth interviews were carried out with the participants using the video conferencing method. Twenty-eight video conferencing interviews were conducted with citizens who ranked last in the vaccination groups. With the permission of the participants, an audio recording was obtained in all interviews, transcribed verbatim, and checked. A thematic approach was used to analyze the data. Data were collected until saturated. Results: The findings were summarized into three main categories. The first was “Satisfaction.” Participants expressed their satisfaction with process management, home vaccinations, and continuous information. The second theme was "Dissatisfaction.” Some participants expressed their dissatisfaction with the prioritization of elderly people in vaccination and late vaccination of actively working individuals. The third theme was "Reservations." Participants stated that they have reservations regarding a possible complacency in society after vaccinations and a delay in the vaccination of non-prioritized groups. In general, participants stated that they were satisfied with the supply of vaccines and performance. However, actively working individuals think that they should have priority over the elderly in vaccination. Conclusion: To ensure full compliance with the vaccine administration, it is necessary to enlighten all individuals, especially those ranking last in the vaccination groups, about the prioritization process and which variables are considered important. Keywords: COVID-19, qualitative, vaccination, family practice

Sentiment analysis tracking of COVID-19 vaccine through tweets

Recent studies on the COVID-19 pandemic indicated an increase in the level of anxiety, stress, and depression among people of all ages. The World Health Organization (WHO) recently warned that even with the approval of vaccines by the Food and Drug Administration (FDA), population immunity is highly unlikely to be achieved this year. This paper aims to analyze people's sentiments during the pandemic by combining sentiment analysis and natural language processing algorithms to classify texts and extract the polarity, emotion, or consensus on COVID-19 vaccines based on tweets. The method used is based on the collection of tweets under the hashtag #COVIDVaccine while the nltk toolkit parses the texts, and the tf-idf algorithm generates the keywords. Both n-gram keywords and hashtags mentioned in the tweets are collected and counted. The results indicate that the sentiments are divided into positive and negative emotions, with the negative ones dominating.