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Sacco C, Manica M, Marziano V, Fabiani M, Mateo-Urdiales A, Guzzetta G, Merler S, Pezzotti P. The impact of underreported infections on vaccine effectiveness estimates derived from retrospective cohort studies. Int J Epidemiol 2024; 53:dyae077. [PMID: 38847783 PMCID: PMC11157963 DOI: 10.1093/ije/dyae077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 05/30/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Surveillance data and vaccination registries are widely used to provide real-time vaccine effectiveness (VE) estimates, which can be biased due to underreported (i.e. under-ascertained and under-notified) infections. Here, we investigate how the magnitude and direction of this source of bias in retrospective cohort studies vary under different circumstances, including different levels of underreporting, heterogeneities in underreporting across vaccinated and unvaccinated, and different levels of pathogen circulation. METHODS We developed a stochastic individual-based model simulating the transmission dynamics of a respiratory virus and a large-scale vaccination campaign. Considering a baseline scenario with 22.5% yearly attack rate and 30% reporting ratio, we explored fourteen alternative scenarios, each modifying one or more baseline assumptions. Using synthetic individual-level surveillance data and vaccination registries produced by the model, we estimated the VE against documented infection taking as reference either unvaccinated or recently vaccinated individuals (within 14 days post-administration). Bias was quantified by comparing estimates to the known VE assumed in the model. RESULTS VE estimates were accurate when assuming homogeneous reporting ratios, even at low levels (10%), and moderate attack rates (<50%). A substantial downward bias in the estimation arose with homogeneous reporting and attack rates exceeding 50%. Mild heterogeneities in reporting ratios between vaccinated and unvaccinated strongly biased VE estimates, downward if cases in vaccinated were more likely to be reported and upward otherwise, particularly when taking as reference unvaccinated individuals. CONCLUSIONS In observational studies, high attack rates or differences in underreporting between vaccinated and unvaccinated may result in biased VE estimates. This study underscores the critical importance of monitoring data quality and understanding biases in observational studies, to more adequately inform public health decisions.
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Affiliation(s)
- Chiara Sacco
- ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Mattia Manica
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
| | | | - Massimo Fabiani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Giorgio Guzzetta
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
| | - Stefano Merler
- Center for Health Emergencies, Fondazione Bruno Kessler, Trento, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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2
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Nogareda F, Regan AK, Couto P, Fowlkes AL, Gharpure R, Loayza S, Leite JA, Rodríguez A, Vicari A, Azziz-Baumgartner E, Salas D. Effectiveness of COVID-19 vaccines against hospitalisation in Latin America during three pandemic waves, 2021-2022: a test-negative case-control design. LANCET REGIONAL HEALTH. AMERICAS 2023; 27:100626. [PMID: 38035125 PMCID: PMC10682274 DOI: 10.1016/j.lana.2023.100626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/10/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023]
Abstract
Background Vaccine effectiveness (VE) is essential to monitor the performance of vaccines and generate strategic information to guide decision making. We pooled data from six Latin American countries to estimate the effectiveness of COVID-19 vaccines in preventing laboratory-confirmed SARS-CoV-2 hospitalisation during three different pandemic waves from February 2021 to September 2022. Methods We used a test-negative case-control design in hospitalised adults in Chile, Costa Rica, Ecuador, Guatemala, Paraguay, and Uruguay. We estimated adjusted VE by age group (18-64 and ≥65 years), vaccine type and product for primary series vaccination and booster vaccination and by time since last dose during the Omicron variant dominant period. We used mixed effects logistic regression models adjusting for sex, age, week of onset of symptom onset and pre-existing conditions with country fit as a random effect term. Findings We included 15,241 severe acute respiratory infection (SARI) patients in the analysis. Among adults 18-64 years, VE estimates for primary series vaccination during pre-Delta and Delta periods ranged by product from 66.5% to 95.1% and from 33.5% to 88.2% for older adults. During the Omicron period, VE estimates for primary series were lower and decreased by time since last vaccination, but VE increased to between 26.4% and 57.4% when a booster was administered. Interpretation mRNA and viral vector vaccines presented higher VE for both primary series and booster. While VE decreased over time, protection against severe COVID-19-associated hospitalisation increased when booster doses were administered. Vaccination with additional doses should be recommended, particularly for persons at increased risk of developing severe COVID-19. Funding This work was supported by a grant from the U.S. Centers for Disease Control and Prevention (CDC) through cooperative agreements with the Pan American Health Organization/World Health Organization.
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Affiliation(s)
| | - Annette K. Regan
- Pan American Health Organization, Washington, DC, USA
- School of Nursing and Health Professions, University of San Francisco, USA
- Fielding School of Public Health, University of California Los Angeles, USA
| | - Paula Couto
- Pan American Health Organization, Washington, DC, USA
| | - Ashley L. Fowlkes
- National Center for Immunization and Respiratory Diseases, U.S. CDC, USA
| | - Radhika Gharpure
- National Center for Immunization and Respiratory Diseases, U.S. CDC, USA
| | - Sergio Loayza
- Pan American Health Organization, Washington, DC, USA
| | | | | | - Andrea Vicari
- Pan American Health Organization, Washington, DC, USA
| | | | - Daniel Salas
- Pan American Health Organization, Washington, DC, USA
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3
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Vila-Candel R, Martin-Arribas A, Castro-Sánchez E, Escuriet R, Martin-Moreno JM. Perinatal Outcomes at Birth in Women Infected and Non-Infected with SARS-CoV-2: A Retrospective Study. Healthcare (Basel) 2023; 11:2833. [PMID: 37957979 PMCID: PMC10648606 DOI: 10.3390/healthcare11212833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) was declared as a pandemic and public health emergency on 11 March 2020 by the World Health Organization. Different clinical trials on the efficacy of mRNA vaccination have excluded pregnant women, leading to a lack of empirical evidence on the efficacy of the vaccine in this population. The aim of the study was to examine the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at birth and adverse perinatal outcomes in infected and non-infected women from a university hospital in Spain. METHODS The data were obtained from electronic health records from 1 March 2020 to 28 February 2022. A bivariate descriptive analysis was performed, comparing women with and without confirmed SARS-CoV-2 infection during pregnancy using the chi-square test. A multivariate logistic regression was complementarily conducted to determine whether SARS-CoV-2 infection increases the risk of adverse obstetric and perinatal outcomes. RESULTS A total of 2676 women were divided into two groups: non-infected with SARS-CoV-2 (n = 2624) and infected with SARS-CoV-2 (n = 52). Infected women were primarily multiparous (p < 0.03) and had received an incomplete vaccination regimen (p < 0.001). A greater incidence of premature rupture of membranes (p < 0.04) was observed among the non-infected women. Pertaining to perinatal outcomes, there was a notable rise in NICU admissions (p < 0.014), coupled with an extended duration of stay (p < 0.04), for neonates born to infected mothers in comparison to their non-infected counterparts. CONCLUSION Although SARS-CoV-2 infection may pose significant risks to pregnant women and their infants, adverse obstetrical/puerperal outcomes do not significantly differ between women infected and non-infected to SARS-CoV-2 in our study. NICU admissions were higher for neonates born to infected mothers. Additionally, coronavirus disease 2019 vaccination during pregnancy is not associated with severe adverse perinatal outcomes.
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Affiliation(s)
- Rafael Vila-Candel
- Sciences Faculty, Universidad Internacional de Valencia-VIU, 46002 Valencia, Spain
- Department of Obstetrics and Gynecology, Hospital Universitario de la Ribera, 46600 Alzira, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46020 Valencia, Spain
| | - Anna Martin-Arribas
- Ghenders Research Group, School of Health Sciences Blanquerna, Universitat Ramon Lull, 08025 Barcelona, Spain
| | - Enrique Castro-Sánchez
- College of Business, Arts, and Social Sciences, Brunel University London, Uxbridge UB8 3PH, UK
- Health Protection Research Unit, Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College London, London SW7 2BX, UK
- Research Group on Global Health and Human Development, University of the Balearic Islands, 07122 Palma de Mallorca, Spain
| | - Ramón Escuriet
- Ghenders Research Group, School of Health Sciences Blanquerna, Universitat Ramon Lull, 08025 Barcelona, Spain
- Catalan Health Service, Government of Barcelona, 08014 Barcelona, Spain
| | - Jose M Martin-Moreno
- Department of Preventive Medicine and Public Health, Universitat de València, 46010 Valencia, Spain
- Biomedical Research Institute INCLIVA, Clinic University Hospital, 46010 Valencia, Spain
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4
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Mateo-Urdiales A, Sacco C, Petrone D, Bella A, Riccardo F, Del Manso M, Bressi M, Siddu A, Brusaferro S, Palamara AT, Rezza G, Pezzotti P, Fabiani M. Estimated Effectiveness of a Primary Cycle of Protein Recombinant Vaccine NVX-CoV2373 Against COVID-19. JAMA Netw Open 2023; 6:e2336854. [PMID: 37792377 PMCID: PMC10551773 DOI: 10.1001/jamanetworkopen.2023.36854] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/24/2023] [Indexed: 10/05/2023] Open
Abstract
Importance Protein recombinant vaccine NVX-CoV2373 (Novavax) against COVID-19 was authorized for its use in adults in late 2021, but evidence on its estimated effectiveness in a general population is lacking. Objective To estimate vaccine effectiveness of a primary cycle with NVX-CoV2373 against SARS-CoV-2 infection and symptomatic COVID-19. Design, Setting, and Participants Retrospective cohort study linking data from the national vaccination registry and the COVID-19 surveillance system in Italy during a period of Omicron predominance. All adults starting a primary vaccination with NVX-CoV2373 between February 28 and September 4, 2022, were included, with follow-up ending on September 25, 2022. Data were analyzed in February 2023. Exposures Partial (1 dose only) vaccination and full vaccination (2 doses) with NVX-CoV-2373. Main Outcomes and Measures Notified SARS-CoV-2 infection and symptomatic COVID-19. Poisson regression models were used to estimate effectiveness against both outcomes. Adjusted estimated vaccine effectiveness was calculated as (1 - incidence rate ratio) × 100. Results The study included 20 903 individuals who started the primary cycle during the study period. Median (IQR) age of participants was 52 (39-61) years, 10 794 (51.6%) were female, and 20 592 participants (98.5%) had no factors associated with risk for severe COVID-19. Adjusted estimated vaccine effectiveness against notified SARS-CoV-2 infection in those partially vaccinated with NVX-CoV2373 was 23% (95% CI, 13%-33%) and was 31% (95% CI, 22%-39%) in those fully vaccinated. Estimated vaccine effectiveness against symptomatic COVID-19 was 31% (95% CI, 16%-44%) in those partially vaccinated and 50% (95% CI, 40%-58%) in those fully vaccinated. Estimated effectiveness during the first 4 months after completion of the primary cycle decreased against SARS-CoV-2 infection but remained stable against symptomatic COVID-19. Conclusions and Relevance This cohort study found that, in an Omicron-dominant period, protein recombinant vaccine NVX-CoV2373 was associated with protection against SARS-CoV-2 infection and symptomatic COVID-19. The use of this vaccine could remain an important element in reducing the impact of the SARS-CoV-2 pandemic.
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Affiliation(s)
| | - Chiara Sacco
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
- European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Daniele Petrone
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Flavia Riccardo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Martina Del Manso
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Bressi
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Andrea Siddu
- General Directorate of Prevention, Ministero della Salute, Rome, Italy
| | | | | | - Giovanni Rezza
- General Directorate of Prevention, Ministero della Salute, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo Fabiani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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5
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Mauriz E, Fernández-Vázquez JP, Díez-Flecha C, Reguero-Celada S, Fernández-Villa T, Fernández-Somoano A, Caylà JA, Lozano-García JA, Vázquez-Casares AM, Martín-Sánchez V. Impact of a COVID-19 Outbreak in an Elderly Care Home after Primary Vaccination. Vaccines (Basel) 2023; 11:1382. [PMID: 37631950 PMCID: PMC10459698 DOI: 10.3390/vaccines11081382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023] Open
Abstract
Elderly care home residents are particularly vulnerable to COVID-19 due to immune-senescence, pre-existing medical conditions, and the risk of transmission from staff and visitors. This study aimed to describe the outcomes of a COVID-19 outbreak in a long-term care facility for elderly persons following the initial vaccination. A single-center, retrospective, observational design was used to analyze the variables associated with hospitalization and death rate by logistic regression. Adjusted odds ratios (aOR) and their 95% confidence intervals (CI) were calculated. Sixty-eight residents received the first dose of the COVID-19 vaccine. Despite being negative six days after vaccination, the performance of a second test 4 days later revealed 51 positives (75.0%) among residents and 18 among workers (56.3%). A total of 65 of the 68 residents (95.58%) had positive results with symptoms, whereas 34.9% required hospitalization, and 25.8% died. The best-fitting model to explain the distribution of cases reflects three points at the time of infection.. The time from vaccination to symptom onset explains the hospitalization and mortality rates since a day elapsed halves the risk of hospitalization (aOR = 0.57; CI = 0.38-0.75) and the risk of death by a quarter (aOR = 0.74; CI = 0.63-0.88). Nursing homes present an elevated risk of transmission and severity of SARS-CoV-2 infection. Although vaccination reduces the risk of hospitalization and death, extreme prevention and control measures are essential in these institutions despite the high vaccination coverage.
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Affiliation(s)
- Elba Mauriz
- ALINS, Food Nutrition and Safety Group, ICTAL Universidad de León, 24007 Leon, Spain
- Department of Nursing and Physiotherapy, Campus de Vegazana, Universidad de León, s/n, 24071 Leon, Spain;
| | | | | | - Sofía Reguero-Celada
- Health Center San Andrés de Rabanedo, Primary Health Care Management SACYL, 24191 Leon, Spain;
| | - Tania Fernández-Villa
- Group of Investigation in Interactions Gene-Environment and Health (GIIGAS), Institute of Biomedicine (IBIOMED), Universidad de León, 24071 Leon, Spain; (T.F.-V.); (V.M.-S.)
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain;
| | - Ana Fernández-Somoano
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain;
- IUOPA–Department of Medicine, University of Oviedo, Julián Clavería Street s/n, 33006 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Roma Avenue s/n, 33001 Oviedo, Spain
| | - Joan A. Caylà
- Tuberculosis Research Unit Foundation of Barcelona, 08008 Barcelona, Spain;
| | | | - Ana M. Vázquez-Casares
- Department of Nursing and Physiotherapy, Campus de Vegazana, Universidad de León, s/n, 24071 Leon, Spain;
| | - Vicente Martín-Sánchez
- Group of Investigation in Interactions Gene-Environment and Health (GIIGAS), Institute of Biomedicine (IBIOMED), Universidad de León, 24071 Leon, Spain; (T.F.-V.); (V.M.-S.)
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain;
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6
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Calabrò GE, Pappalardo C, D'Ambrosio F, Vece M, Lupi C, Lontano A, Di Russo M, Ricciardi R, de Waure C. The Impact of Vaccination on COVID-19 Burden of Disease in the Adult and Elderly Population: A Systematic Review of Italian Evidence. Vaccines (Basel) 2023; 11:vaccines11051011. [PMID: 37243115 DOI: 10.3390/vaccines11051011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 05/28/2023] Open
Abstract
COVID-19 is a major global health threat, with millions of confirmed cases and deaths worldwide. Containment and mitigation strategies, including vaccination, have been implemented to reduce transmission and protect the population. We conducted two systematic reviews to collect nonrandomized studies investigating the effects of vaccination on COVID-19-related complications and deaths in the Italian population. We considered studies conducted in Italian settings and written in English that contained data on the effects of vaccination on COVID-19-related mortality and complications. We excluded studies that pertained to the pediatric population. In total, we included 10 unique studies in our two systematic reviews. The results showed that fully vaccinated individuals had a lower risk of death, severe symptoms, and hospitalization compared to unvaccinated individuals. The review also looked at the impact of vaccination on post-COVID-19 syndrome, the effectiveness of booster doses in older individuals, and nationwide adverse events. Our work highlights the crucial role that vaccination campaigns have played in reducing the burden of COVID-19 disease in the Italian adult population, positively impacting the pandemic trajectory in Italy.
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Affiliation(s)
- Giovanna Elisa Calabrò
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ciro Pappalardo
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Floriana D'Ambrosio
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Michele Vece
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Chiara Lupi
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| | - Alberto Lontano
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Mattia Di Russo
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberto Ricciardi
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
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7
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Si X, Ma X, Wang Y, Li Y, Liu L, Yang Y, Guo Z, Liang Y, Pan G. Efficacy and safety of Jinhua Qinggan granules in the treatment of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33545. [PMID: 37058020 PMCID: PMC10100637 DOI: 10.1097/md.0000000000033545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/27/2023] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVE To evaluate, using meta-analysis, the efficacy and safety profile of Jinhua Qinggan granules (JHQG) in the treatment of novel coronavirus pneumonia. METHODS We screened multiple publication databases (PubMed, Embase, The Cochrane Library, Web of Science, CNKI, WanFang, and VIP), using parameters designed to identify articles detailing randomized controlled trials relating to the treatment of novel coronavirus pneumonia with JHQG. The inclusion period for each search was the point of database inception to November 2022. Each piece of literature identified in our initial screening was independently reviewed by 2 researchers, who extracted the relevant data and evaluated the bias risk associated with the study. The data was split in 2: the control group (containing patients who had received routine treatment or placebo) and the experimental group (containing patients treated with JHQG). The meta-analysis was performed using Revman 5.4 software. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Four articles were selected for this study and combined included a total of 582 patients, which were subdivided into experimental (n = 347) and control (n = 235) groups. The results showed that treatment with JHQG could significantly: enhance the improvement rate of primary symptoms [relative ratio (RR) = 1.26,95% confidence interval (CI) (1.07, 1.49), P = .007] and fever [RR = 1.48, 95% CI (1.07, 2.04), P = .02]; decrease the viral nucleic acid in patients with coronavirus disease 2019 (COVID-19) [RR = 2.04, 95% CI (1.15, 3.62), P = .02] and reduce the progression of pneumonia [RR = 0.34, 95% CI (0.17, 0.67), P = .002]. However, there was no significant difference between the 2 groups with regards to: the improvement rate of cough, nausea and vomiting, fatigue, computed tomography, or frequency of adverse reactions. CONCLUSIONS Current evidence indicates that JHQG is effective in treating COVID-19, increasing the rate of improvement for fever, increasing the negative rate of viral nucleic acid in patients with COVID-19 and reducing the aggravation rate of pneumonia. These conclusions need to be verified by further rigorous studies, as the existing results were limited by the number and quality of the included studies.
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Affiliation(s)
- Xiuying Si
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiaoxue Ma
- Jinan Zhangqiu District Hospital of Traditional Chinese Medicine, Jinan, China
| | - Youpeng Wang
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yongjun Li
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Lujia Liu
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yang Yang
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Zheng Guo
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yuan Liang
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Guangxia Pan
- Heilongjiang University of Chinese Medicine, Harbin, China
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8
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Sansone E, Collatuzzo G, Renzetti S, Ditano G, Bonfanti C, Sala E, Terlenghi L, Matteelli A, Abedini M, Asafo SS, Boffetta P, De Palma G. The Effect of the Immunization Schedule and Antibody Levels (Anti-S) on the Risk of SARS-CoV-2 Infection in a Large Cohort of Healthcare Workers in Northern Italy. Vaccines (Basel) 2023; 11:vaccines11040746. [PMID: 37112658 PMCID: PMC10144408 DOI: 10.3390/vaccines11040746] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Given their occupational risk profile, HCWs were the first to receive anti-SARS-CoV-2 vaccination. However, breakthrough infections remained common, mainly sustained by new SARS-CoV-2 variants of concern (VOCs) that rapidly spread one after another in Italy. Evidence suggests that the measured level of anti-SARS-CoV-2 antibodies does not clearly predict the level of protection conferred by either natural infection or vaccine-induced immunization, highlighting the need for further study on the diversity in susceptibility to SARS-CoV-2 infection. The present study aimed to characterize different risk profiles for SARS-CoV-2 infection in HCWs who had recently received the booster dose, and who were classified according to their immunization profile. The very small number of workers infected during the 8 months following the primary-cycle administration represents proof of the vaccine’s effectiveness against non-omicron strains. The comparison among different immunization profiles showed that hybrid immunization (vaccine plus natural infection) elicits higher antibody levels. However, hybrid immunization does not always provide better protection against reinfection, thus suggesting that the immunization profile plays a major role as a virus–host interaction modifier. Despite the high resistance to the reinfection, the peri-booster infection had a not-neglectable infection rate (5.6%), this further reinforcing the importance of preventive measures.
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9
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Bermingham C, Morgan J, Ayoubkhani D, Glickman M, Islam N, Sheikh A, Sterne J, Walker AS, Nafilyan V. Estimating the Effectiveness of First Dose of COVID-19 Vaccine Against Mortality in England: A Quasi-Experimental Study. Am J Epidemiol 2023; 192:267-275. [PMID: 36065824 PMCID: PMC9494386 DOI: 10.1093/aje/kwac157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 07/08/2022] [Accepted: 08/30/2022] [Indexed: 02/07/2023] Open
Abstract
Estimating real-world vaccine effectiveness is vital to assessing the coronavirus disease 2019 (COVID-19) vaccination program and informing the ongoing policy response. However, estimating vaccine effectiveness using observational data is inherently challenging because of the nonrandomized design and potential for unmeasured confounding. We used a regression discontinuity design to estimate vaccine effectiveness against COVID-19 mortality in England using the fact that people aged 80 years or older were prioritized for the vaccine rollout. The prioritization led to a large discrepancy in vaccination rates among people aged 80-84 years compared with those aged 75-79 at the beginning of the vaccination campaign. We found a corresponding difference in COVID-19 mortality but not in non-COVID-19 mortality, suggesting that our approach appropriately addressed the issue of unmeasured confounding factors. Our results suggest that the first vaccine dose reduced the risk of COVID-19 death by 52.6% (95% confidence limits: 15.7, 73.4) in those aged 80 years, supporting existing evidence that a first dose of a COVID-19 vaccine had a strong protective effect against COVID-19 mortality in older adults. The regression discontinuity model's estimate of vaccine effectiveness is only slightly lower than those of previously published studies using different methods, suggesting that these estimates are unlikely to be substantially affected by unmeasured confounding factors.
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Affiliation(s)
| | | | | | | | - Nazrul Islam
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Health Data Research UK BREATHE Hub
| | | | - A Sarah Walker
- Nuffield department of Medicine, University of Oxford, Oxford, UK
| | - Vahé Nafilyan
- Office for National Statistics, Newport, UK
- London School of Hygiene and Tropical Medicine, London, UK
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10
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Ernst C, Pires-Afonso Y, Bejko D, Huberty C, Dentzer TG, Wienecke-Baldacchino A, Hugoson E, Alvarez D, Weydert M, Vergison A, Mossong J. A Molecular and Epidemiological Investigation of a Large SARS-CoV-2 Outbreak in a Long-Term Care Facility in Luxembourg, 2021. Geriatrics (Basel) 2023; 8:geriatrics8010019. [PMID: 36826361 PMCID: PMC9957261 DOI: 10.3390/geriatrics8010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
In spring 2021, a long-term care facility (LTCF) of 154 residents in Luxembourg experienced a large severe, acute respiratory-syndrome coronavirus 2 (SARS-CoV-2) outbreak a few days after a vaccination campaign. We conducted an outbreak investigation and a serosurvey two months after the outbreak, compared attack rates (AR) among residents and staff, and calculated hospitalization and case-fatality rates (CFR). Whole genome sequencing (WGS) was performed to detect variants in available samples and results were compared to genomes published on GISAID. Eighty-four (55%) residents and forty-five (26%) staff members tested positive for SARS-CoV-2; eighteen (21%) residents and one (2.2%) staff member were hospitalized, and twenty-three (CFR: 27%) residents died. Twenty-seven (21% of cases) experienced a reinfection. Sequencing identified seventy-seven cases (97% of sequenced cases) with B.1.1.420 and two cases among staff with B.1.351. The outbreak strain B.1.1.420 formed a separate cluster from cases from other European countries. Convalescent and vaccinated residents had higher anti-SARS-CoV-2 IgG antibody concentrations than vaccinated residents without infection (98% vs. 52%, respectively, with >120 RU/mL, p < 0.001). We documented an extensive outbreak of SARS-CoV-2 in an LTCF due to the presence of a specific variant leading to high CFR. Infection in vaccinated residents increased antibody responses. A single vaccine dose was insufficient to mitigate the outbreak.
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Affiliation(s)
- Corinna Ernst
- Luxembourg Health Directorate, L-1273 Luxembourg, Luxembourg
- Correspondence:
| | | | - Dritan Bejko
- Luxembourg Health Directorate, L-1273 Luxembourg, Luxembourg
| | - Conny Huberty
- Luxembourg Health Directorate, L-1273 Luxembourg, Luxembourg
| | | | | | - Eric Hugoson
- Laboratoire National de Santé, L-3583 Dudelange, Luxembourg
| | - Daniel Alvarez
- Laboratoire National de Santé, L-3583 Dudelange, Luxembourg
| | | | - Anne Vergison
- Luxembourg Health Directorate, L-1273 Luxembourg, Luxembourg
| | - Joël Mossong
- Luxembourg Health Directorate, L-1273 Luxembourg, Luxembourg
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11
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De León AM, Aban I, McPherson T, Granit V, Benatar M, Cutter G, Lee I. Impact of the COVID-19 pandemic on patients with myasthenia gravis: A survey of the Myasthenia Gravis Foundation of America MG patient registry. Muscle Nerve 2023; 67:25-32. [PMID: 36324261 PMCID: PMC9877793 DOI: 10.1002/mus.27743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION/AIMS Factors associated with coronavirus disease 2019 (COVID-19) infection among the myasthenia gravis (MG) population are incompletely understood. This study aimed to characterize the behavior of MG patients during the pandemic and to examine risk factors associated with COVID-19 infection. METHODS A "COVID-19 Survey" was sent to MG Patient Registry participants in the summer of 2020 (CSS20) and winter of 2021 (CWS21). Survey results were summarized descriptively. Demographics, disease characteristics, medication use, and survey results were compared between those reporting COVID-19 diagnosis (COVID), COVID-19 like symptoms without diagnosis (COVID-Like), and asymptomatic participants. RESULTS A total of 454 and 665 participants completed the CSS20 and CWS21 surveys respectively; 326 participants completed both. Most continued follow-up visits and MG treatments. The frequency of COVID-like symptoms was similar between CSS20 and CWS21, while COVID-19 exposure (6% vs. 27%), COVID-19 testing among symptomatic individuals (35% vs. 78%), and COVID-19 diagnosis (0.2% vs. 6%) were higher in the CWS21. Cough, fever, fatigue, myalgia, anosmia/ageusia, and hospital and intensive care unit (ICU) admissions were more frequent in the COVID compared to the COVID-Like group. COVID-19 exposure (odds ratio [OR] 7.88), number of people in the household (OR 1.31), and report of MG exacerbation before the pandemic (OR 2.6) were independently associated with COVID-19 infection. DISCUSSION COVID-19 affected MG patients increasingly through the early pandemic. While face-to-face contact with a COVID-19 infected individual was an obvious risk factor, MG patients who had more people in the household and unstable disease were at elevated risk for COVID-19 infection.
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Affiliation(s)
| | - Inmaculada Aban
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Tarrant McPherson
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Volkan Granit
- Department of NeurologyUniversity of MiamiMiamiFloridaUSA
| | | | - Gary Cutter
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Ikjae Lee
- Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
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12
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Ben Fredj S, Ghammem R, Zammit N, Maatouk A, Haddad N, Haddad N, Kachroudi M, Rebai S, Laadhari H, Ghodhbani MM, Maatoug J, Ghannem H. Risk factors for severe Covid-19 breakthrough infections: an observational longitudinal study. BMC Infect Dis 2022; 22:894. [DOI: 10.1186/s12879-022-07859-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
The drive to vaccinate large populations is nowadays the main instrument for combating the pandemic and preventing serious disease and death. However, breakthrough infection (post-vaccination infection) still happens after vaccination among fully vaccinated people. We aimed to assess the severity outcomes and to determine its associated factors among vaccinated COVID-19 cases in the governorate of Sousse, Tunisia.
Methods
We carried out a five-month observational longitudinal study including all the population of Sousse. Confirmed infections of SARS-CoV-2 and the vaccination status are recorded in the daily COVID- 19 database of the Regional Office of the Tunisian Ministry of Health. We included all post-vaccination COVID-19 cases for the analysis of the COVID-19 serious outcomes. Data were collected via 15-min telephonic call interviews conducted by trained interviewers. Descriptive analysis with calculating incidence rates of confirmed COVID-19 cases per 100,000 inhabitants was conducted. In binary logistic regression, adjusted odds ratios along with 95% intervals confidence were performed to determine factors related to severe or critical COVID-19.
Results
As of 31 July 2021, 107,545 persons over 19 years old have received at least one dose of COVID-19 vaccination. Among the vaccinated population, we traced and included 765 breakthrough infection cases, and the incidence rate was 711.3 per week. The majority were female (sex-ratio = 0.8), and the average age of the overall cases was 55.7 years. The prevalence of severe or critical cases in vaccinated COVID-19 patients occurs in 10.8% of cases. Patients with a medical history of cardiovascular diseases had more than two times increased odds to have a severe or critical disease. We also found the highest self-estimation of adherence to preventive measures was inversely correlated to serious cases and having an incomplete vaccination schema was strongly associated with complications.
Conclusions
We tried to provide evidence about the breakthrough infections to improve measures of prevention and control of COVID-19. Boosting immunity for vulnerable patients added to maintaining and promoting preventive measures are not only essential to prevent severe cases of breakthrough infections of COVID-19, but also other influenza-like diseases.
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13
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Xu R, Wang W, Zhang W. As the SARS-CoV-2 virus evolves, should Omicron subvariant BA.2 be subjected to quarantine, or should we learn to live with it? Front Public Health 2022; 10:1039123. [PMID: 36504951 PMCID: PMC9730036 DOI: 10.3389/fpubh.2022.1039123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
It has been nearly 35 months since the COVID-19 outbreak. The pathogen SARS-CoV-2 has evolved into several variants. Among them, Omicron is the fifth variant of concern which have rapidly spread globally during the past 8 months. Omicron variant shows different characteristics from previous variants, which is highly infectious, highly transmissible, minimally pathogenic, vaccine and antibody tolerant; however, it is less likely to cause severe illness, resulting in fewer deaths. Omicron has evolved into five main lineages, including BA.1, BA.2, BA.3, BA.4, and BA.5. Before BA.5, Omicron BA.2 sublineage was the dominant strain all over the world for several months. The experience of prevention and treatment against BA.2 is worth studying and learning for overcoming other Omicron subvariants. Although the Omicron subvariant BA.2 is significantly less severe than that caused by ancestral strains, it is still far more dangerous than influenza, and its long-term sequelae are unknown. Effective treatments are currently limited; therefore, effective defense may be the key to controlling the epidemic today, rather than just "living with" the virus.
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Affiliation(s)
- Ren Xu
- Pulmonary and Critical Care Medicine Department, First Hospital of Jilin University, Changchun, China
| | - Wanning Wang
- Nephrology Department, First Hospital of Jilin University, Changchun, China
| | - Wenlong Zhang
- Department of Hematology and Oncology, China-Japan Union Hospital of Jilin University, Changchun, China
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14
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Rosen B, Davidovitch N, Chodick G, Israeli A. The role of Israeli researchers in the scientific literature regarding COVID-19 vaccines. Isr J Health Policy Res 2022; 11:39. [PMID: 36419188 PMCID: PMC9684862 DOI: 10.1186/s13584-022-00548-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/03/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The accurate and timely publication of scientific findings is a key component of the global response to the COVID-19 pandemic. This article explores the role of Israeli researchers in the scientific literature regarding COVID-19 vaccines. METHODS Content and bibliometric analysis of articles included in the Web of Science database regarding COVID-19 vaccines, that were published between January 2020 and June 2022. RESULTS The Web of Science includes 18,596 articles regarding COVID-19 vaccines that were published between January 2020 and June 2022. 536 (3%) of those articles had at least one Israeli author. These "Israeli articles" accounted for 11% of the NEJM articles on COVID-19 vaccines, 9% of such articles in Nature Medicine, and 4% of such articles in the Lancet. 80 of the 536 Israeli articles (15%) were recognized as "Highly Cited Papers" (articles that rank in the top 1% by citations for field and publication year). Most of the Israeli Highly Cited Papers (HCPs) analyzed the safety and/or efficacy of the COVID-19 vaccine developed by Pfizer and BioNTech (BNT162b2). Most of the Israeli HCPs made use of detailed and comprehensive individual data available from Israel's health plans, hospitals, or Ministry of Health. The 15% HCP rate (i.e., the number of HCPs divided by the number of all articles) for the Israeli articles was triple the HCP rate for all articles on COVID-19 vaccines (5%). A key factor contributing to Israel's prominent role in rapid publication of vaccination impact studies was Israel's being a world leader in the initial vaccination rollout, the administration of boosters, and the vaccination of pregnant women. Other contributing factors include Israeli researchers' access to well-developed electronic health record systems linking vaccinations and outcomes, the analytic strengths of leading Israeli researchers and research institutions, collaborations with leading research institutions in other countries, and the ability to quickly identify emerging research opportunities and mobilize accordingly. Recent developments in the priorities and selection criteria of leading journals have also played a role; these include an increased openness to well-designed observational studies and to manuscripts from outside of Europe and North America. CONCLUSIONS Israeli researchers, Israeli research institutions, and the Israeli government can, and should, take concrete steps to build upon lessons learned in the course of the recent surge of high-quality publications related to COVID-19 vaccines (such as the value of linking data across organizations). These lessons can be applied to a wide range of fields, including fields that go well beyond vaccines and pandemic responses.
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Affiliation(s)
- Bruce Rosen
- grid.419640.e0000 0001 0845 7919Myers-JDC-Brookdale Institute, Jerusalem, Israel ,grid.9619.70000 0004 1937 0538Paul Baerwald School of Social Work and Social Welfare, Hebrew University, Jerusalem, Israel
| | - Nadav Davidovitch
- grid.7489.20000 0004 1937 0511School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheva, Israel ,Taub Center for Social Policy Studies in Israel, Jerusalem, Israel
| | - Gabriel Chodick
- grid.425380.8Maccabi Healthcare Services, Tel Aviv, Israel ,grid.12136.370000 0004 1937 0546Tel Aviv University, Tel Aviv, Israel
| | - Avi Israeli
- grid.9619.70000 0004 1937 0538Hebrew University Hadassah Medical School, Jerusalem, Israel ,grid.414840.d0000 0004 1937 052XMinistry of Health, Jerusalem, Israel
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15
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Sharifi H, Hsu J. COVID-19 Pneumonia: Clinical Manifestations. Clin Chest Med 2022; 44:227-237. [PMID: 37085216 PMCID: PMC9682061 DOI: 10.1016/j.ccm.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Coronavirus disease-2019 (COVID-19) pneumonia has diverse clinical manifestations, which have shifted throughout the pandemic. Formal classifications include presymptomatic infection and mild, moderate, severe, and critical illness. Social risk factors are numerous, with Black, Hispanic, and Native American populations in the United States having suffered disproportionately. Biological risk factors such as age, sex, underlying comorbid burden, and certain laboratory metrics can assist the clinician in triage and management. Guidelines for classifying radiographic findings have been proposed and may assist in prognosis. In this article, we review the risk factors, clinical course, complications, and imaging findings of COVID-19 pneumonia.
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Affiliation(s)
- Husham Sharifi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA.
| | - Joe Hsu
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
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16
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Panahi Y, Einollahi B, Beiraghdar F, Darvishi M, Fathi S, Javanbakht M, Shafiee S, Akhavan-Sigari R. Fully understanding the efficacy profile of the COVID-19 vaccination and its associated factors in multiple real-world settings. Front Immunol 2022; 13:947602. [PMID: 36389777 PMCID: PMC9641184 DOI: 10.3389/fimmu.2022.947602] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/25/2022] [Indexed: 09/29/2023] Open
Abstract
We performed a review study according to recent COVID-19 vaccines' real-world data to provide comparisons between COVID-19 vaccines regarding their relative efficacy. Although most vaccine platforms showed comparable effectiveness and efficacy, we highlight critical points and recent developments generated in studies that might affect vaccine efficacy including population-dependent effects of the vaccine (transplantation, adiposity, and specific comorbidities, as well as older age, male sex, ethnicity, and prior infection), vaccine type, variants of concern (VOC), and an extended vaccine schedule. Owing to these factors, community-based trials can be of great importance in determining vaccine effectiveness in a systematic manner; thus, uncertainty remains regarding vaccine efficacy. Long immune protection of vaccination with BNT162b2 or ChAdOx1 nCoV-19 has been demonstrated to be up to 61 months and 5-12 months after the previous infection, and boosting infection-acquired immunity for both the first and second doses of the BNT162b2 and ChAdOx1 nCoV-19 vaccines was correlated with high and durable protection. However, large cohort and longitudinal studies are required for the evaluation of immunity dynamics and longevity in unvaccinated, vaccinated, and infected individuals, as well as vaccinated convalescent individuals in real-world settings. Regarding the likelihood of vaccine escape variants evolving, an ongoing examination of the protection conferred against an evolving virus (new variant) by an extended schedule can be crucial.
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Affiliation(s)
- Yunes Panahi
- Pharmacotherapy Department, Faculty of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Behzad Einollahi
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Fatemeh Beiraghdar
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammad Darvishi
- Infectious Diseases and Tropical Medicine Research Center (IDTMRC), Department of Aerospace and Subaquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Saeid Fathi
- Department of Parasite Vaccine Research and Production, Razi Vaccine and Serum Research Institute, Agriculture Research, Education and Extension Organization (AREEO), Karaj, Iran
| | - Mohammad Javanbakht
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sepehr Shafiee
- Department of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Akhavan-Sigari
- Department of Neurosurgery, University Medical Center Tuebingen, Tuebingen, Germany
- Department of Health Care Management and Clinical Research, Collegium Humanum Warsaw Management University, Warsaw, Poland
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17
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A Comprehensive Review on the Current Vaccines and Their Efficacies to Combat SARS-CoV-2 Variants. Vaccines (Basel) 2022; 10:vaccines10101655. [PMID: 36298520 PMCID: PMC9611209 DOI: 10.3390/vaccines10101655] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
Since the first case of Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 2019, SARS-CoV-2 infection has affected many individuals worldwide. Eventually, some highly infectious mutants-caused by frequent genetic recombination-have been reported for SARS-CoV-2 that can potentially escape from the immune responses and induce long-term immunity, linked with a high mortality rate. In addition, several reports stated that vaccines designed for the SARS-CoV-2 wild-type variant have mixed responses against the variants of concern (VOCs) and variants of interest (VOIs) in the human population. These results advocate the designing and development of a panvaccine with the potential to neutralize all the possible emerging variants of SARS-CoV-2. In this context, recent discoveries suggest the design of SARS-CoV-2 panvaccines using nanotechnology, siRNA, antibodies or CRISPR-Cas platforms. Thereof, the present comprehensive review summarizes the current vaccine design approaches against SARS-CoV-2 infection, the role of genetic mutations in the emergence of new viral variants, the efficacy of existing vaccines in limiting the infection of emerging SARS-CoV-2 variants, and efforts or challenges in designing SARS panvaccines.
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18
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Schulenburg A, Cota W, Costa GS, Ferreira SC. Effects of infection fatality ratio and social contact matrices on vaccine prioritization strategies. CHAOS (WOODBURY, N.Y.) 2022; 32:093102. [PMID: 36182373 DOI: 10.1063/5.0096532] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/01/2022] [Indexed: 06/16/2023]
Abstract
Effective strategies of vaccine prioritization are essential to mitigate the impacts of severe infectious diseases. We investigate the role of infection fatality ratio (IFR) and social contact matrices on vaccination prioritization using a compartmental epidemic model fueled by real-world data of different diseases and countries. Our study confirms that massive and early vaccination is extremely effective to reduce the disease fatality if the contagion is mitigated, but the effectiveness is increasingly reduced as vaccination beginning delays in an uncontrolled epidemiological scenario. The optimal and least effective prioritization strategies depend non-linearly on epidemiological variables. Regions of the epidemiological parameter space, in which prioritizing the most vulnerable population is more effective than the most contagious individuals, depend strongly on the IFR age profile being, for example, substantially broader for COVID-19 in comparison with seasonal influenza. Demographics and social contact matrices deform the phase diagrams but do not alter their qualitative shapes.
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Affiliation(s)
- Arthur Schulenburg
- Departamento de Física, Universidade Federal de Viçosa, Viçosa, Minas Gerais 36570-900, Brazil
| | - Wesley Cota
- Departamento de Física, Universidade Federal de Viçosa, Viçosa, Minas Gerais 36570-900, Brazil
| | - Guilherme S Costa
- Departamento de Física, Universidade Federal de Viçosa, Viçosa, Minas Gerais 36570-900, Brazil
| | - Silvio C Ferreira
- Departamento de Física, Universidade Federal de Viçosa, Viçosa, Minas Gerais 36570-900, Brazil
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19
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Sinclair JE, Mayfield HJ, Short KR, Brown SJ, Puranik R, Mengersen K, Litt JCB, Lau CL. A Bayesian network analysis quantifying risks versus benefits of the Pfizer COVID-19 vaccine in Australia. NPJ Vaccines 2022; 7:93. [PMID: 35953502 PMCID: PMC9371378 DOI: 10.1038/s41541-022-00517-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/26/2022] [Indexed: 11/09/2022] Open
Abstract
The Pfizer COVID-19 vaccine is associated with increased myocarditis incidence. Constantly evolving evidence regarding incidence and case fatality of COVID-19 and myocarditis related to infection or vaccination, creates challenges for risk-benefit analysis of vaccination. Challenges are complicated further by emerging evidence of waning vaccine effectiveness, and variable effectiveness against variants. Here, we build on previous work on the COVID-19 Risk Calculator (CoRiCal) by integrating Australian and international data to inform a Bayesian network that calculates probabilities of outcomes for the delta variant under different scenarios of Pfizer COVID-19 vaccine coverage, age groups (≥12 years), sex, community transmission intensity and vaccine effectiveness. The model estimates that in a population where 5% were unvaccinated, 5% had one dose, 60% had two doses and 30% had three doses, there was a substantially greater probability of developing (239–5847 times) and dying (1430–384,684 times) from COVID-19-related than vaccine-associated myocarditis (depending on age and sex). For one million people with this vaccine coverage, where transmission intensity was equivalent to 10% chance of infection over 2 months, 68,813 symptomatic COVID-19 cases and 981 deaths would be prevented, with 42 and 16 expected cases of vaccine-associated myocarditis in males and females, respectively. These results justify vaccination in all age groups as vaccine-associated myocarditis is generally mild in the young, and there is unequivocal evidence for reduced mortality from COVID-19 in older individuals. The model may be updated to include emerging best evidence, data pertinent to different countries or vaccines and other outcomes such as long COVID.
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Affiliation(s)
- Jane E Sinclair
- School of Chemistry and Molecular Biosciences, Faculty of Science, The University of Queensland, Brisbane, QLD, Australia
| | - Helen J Mayfield
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Kirsty R Short
- School of Chemistry and Molecular Biosciences, Faculty of Science, The University of Queensland, Brisbane, QLD, Australia
| | - Samuel J Brown
- School of Chemistry and Molecular Biosciences, Faculty of Science, The University of Queensland, Brisbane, QLD, Australia
| | - Rajesh Puranik
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kerrie Mengersen
- School of Mathematical Sciences, Faculty of Science, Queensland University of Technology, Brisbane, QLD, Australia
| | - John C B Litt
- Discipline of General Practice, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Scientific Advisory Committee, Immunisation Coalition, Melbourne, VIC, Australia
| | - Colleen L Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
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20
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Rennert L, Ma Z, McMahan CS, Dean D. Effectiveness and protection duration of Covid-19 vaccines and previous infection against any SARS-CoV-2 infection in young adults. Nat Commun 2022; 13:3946. [PMID: 35803915 PMCID: PMC9263799 DOI: 10.1038/s41467-022-31469-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/19/2022] [Indexed: 12/12/2022] Open
Abstract
Data on effectiveness and protection duration of Covid-19 vaccines and previous infection against general SARS-CoV-2 infection in general populations are limited. Here we evaluate protection from Covid-19 vaccination (primary series) and previous infection in 21,261 university students undergoing repeated surveillance testing between 8/8/2021-12/04/2021, during which B.1.617 (delta) was the dominant SARS-CoV-2 variant. Estimated mRNA-1273, BNT162b2, and AD26.COV2.S effectiveness against any SARS-CoV-2 infection is 75.4% (95% CI: 70.5-79.5), 65.7% (95% CI: 61.1-69.8), and 42.8% (95% CI: 26.1-55.8), respectively. Among previously infected individuals, protection is 72.9% when unvaccinated (95% CI: 66.1-78.4) and increased by 22.1% with full vaccination (95% CI: 15.8-28.7). Statistically significant decline in protection is observed for mRNA-1273 (P < .001), BNT162b2 (P < .001), but not Ad26.CoV2.S (P = 0.40) or previous infection (P = 0.12). mRNA vaccine protection dropped 29.7% (95% CI: 17.9-41.6) six months post- vaccination, from 83.2% to 53.5%. We conclude that the 2-dose mRNA vaccine series initially offers strong protection against general SARS-CoV-2 infection caused by the delta variant in young adults, but protection substantially decreases over time. These findings indicate that vaccinated individuals may still contribute to community spread. While previous SARS-CoV-2 infection consistently provides moderately strong protection against repeat infection from delta, vaccination yields a substantial increase in protection.
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Affiliation(s)
- Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA.
| | - Zichen Ma
- Department of Public Health Sciences, Clemson University, Clemson, SC, USA
| | - Christopher S McMahan
- School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC, USA
| | - Delphine Dean
- Department of Bioengineering, Clemson University, Clemson, SC, USA
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21
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Fabiani M, Puopolo M, Filia A, Sacco C, Mateo-Urdiales A, Spila Alegiani S, Del Manso M, D’Ancona F, Vescio F, Bressi M, Petrone D, Spuri M, Rota MC, Massari M, Da Cas R, Morciano C, Stefanelli P, Bella A, Tallon M, Proietti V, Siddu A, Battilomo S, Palamara AT, Popoli P, Brusaferro S, Rezza G, Riccardo F, Menniti Ippolito F, Pezzotti P. Effectiveness of an mRNA vaccine booster dose against SARS-CoV-2 infection and severe COVID-19 in persons aged ≥60 years and other high-risk groups during predominant circulation of the delta variant in Italy, 19 July to 12 December 2021. Expert Rev Vaccines 2022; 21:975-982. [PMID: 35389748 PMCID: PMC9115794 DOI: 10.1080/14760584.2022.2064280] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/06/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Consolidated information on the effectiveness of COVID-19 booster vaccination in Europe are scarce. RESEARCH DESIGN AND METHODS We assessed the effectiveness of a booster dose of an mRNA vaccine against any SARS-CoV-2 infection (symptomatic or asymptomatic) and severe COVID-19 (hospitalization or death) after over two months from administration among priority target groups (n = 18,524,568) during predominant circulation of the Delta variant in Italy (July-December 2021). RESULTS Vaccine effectiveness (VE) against SARS-CoV-2 infection and, to a lesser extent, against severe COVID-19, among people ≥60 years and other high-risk groups (i.e. healthcare workers, residents in long-term-care facilities, and persons with comorbidities or immunocompromised), peaked in the time-interval 3-13 weeks (VE against infection = 67.2%, 95% confidence interval (CI): 62.5-71.3; VE against severe disease = 89.5%, 95% CI: 86.1-92.0) and then declined, waning 26 weeks after full primary vaccination (VE against infection = 12.2%, 95% CI: -4.7-26.4; VE against severe disease = 65.3%, 95% CI: 50.3-75.8). After 3-10 weeks from the administration of a booster dose, VE against infection and severe disease increased to 76.1% (95% CI: 70.4-80.7) and 93.0% (95% CI: 90.2-95.0), respectively. CONCLUSIONS These results support the ongoing vaccination campaign in Italy, where the administration of a booster dose four months after completion of primary vaccination is recommended.
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Affiliation(s)
- Massimo Fabiani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Puopolo
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Antonietta Filia
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Chiara Sacco
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Martina Del Manso
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Fortunato D’Ancona
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Fenicia Vescio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Bressi
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Daniele Petrone
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Matteo Spuri
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Cristina Rota
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Massari
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Da Cas
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Cristina Morciano
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Tallon
- Department of Informatics, Istituto Superiore di Sanità, Rome, Italy
| | - Valeria Proietti
- Directorate of Digitalisation, Health Information System and Statistics, Italian Ministry of Health, Rome, Italy
| | - Andrea Siddu
- General Directorate of Health Prevention, Italian Ministry of Health, Rome, Italy
| | - Serena Battilomo
- Directorate of Digitalisation, Health Information System and Statistics, Italian Ministry of Health, Rome, Italy
| | | | - Patrizia Popoli
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | | | - Giovanni Rezza
- General Directorate of Health Prevention, Italian Ministry of Health, Rome, Italy
| | - Flavia Riccardo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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22
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Stefanelli P, Rezza G. COVID-19 Vaccination Strategies and Their Adaptation to the Emergence of SARS-CoV-2 Variants. Vaccines (Basel) 2022; 10:905. [PMID: 35746513 PMCID: PMC9229267 DOI: 10.3390/vaccines10060905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/09/2022] [Accepted: 05/25/2022] [Indexed: 02/05/2023] Open
Abstract
About one year after the identification of the first cases of pneumonia due to a novel coronavirus in Wuhan, several vaccines against SARS-CoV-2/COVID-19 started to be approved for emergency use or authorized for early or limited use. The rapid development of effective vaccines based on different technological platforms represents an unprecedented success for vaccinology, providing a unique opportunity for a successful public health intervention. However, it is widely known that only a limited number of vaccine doses are usually available at the beginning of vaccination campaigns against an emerging virus; in this phase, protecting health care workers and reducing mortality rates is the priority. When a larger number of vaccines become available, the identification of the drivers of virus circulation coupled with the use of transmission blocking vaccines are key to achieve epidemic control through population immunity. However, as we learned during the vaccination campaigns against the pandemic coronavirus, several factors may hamper this process. Thus, flexible plans are required to obtain the best sustainable result with available tools, modulating vaccination strategies in accordance with improved scientific knowledge, and taking into account the duration of protective immune response, virus evolution, and changing epidemic dynamics.
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Affiliation(s)
- Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Giovanni Rezza
- Directorate of Health Prevention, Ministry of Health, 00144 Rome, Italy;
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23
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Rangsrisaeneepitak V, Porntharukchareon T, Dechates B, Sirisreetreerux S, Tawinprai K. Antibody levels in people with diabetes after one dose of the ChAdOx1 nCoV-19 (AZD1222) vaccine. Diabetol Int 2022; 13:637-643. [PMID: 35528950 PMCID: PMC9068501 DOI: 10.1007/s13340-022-00582-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
Patients with diabetes and coexistent coronavirus disease 2019 (COVID-19) have a higher risk of COVID-19 complications. Therefore, it is critical that sustained and effective immunogenicity against COVID-19 is achieved in such patients. This study evaluates the antibody response for 56 days after the first dose of the AZD1222 vaccine in subjects with and without diabetes to assess the potential risk of delaying the second dose. This study included 282 people who received one dose of AZD1222. The geometric mean concentration of antibodies specific for severe acute respiratory syndrome coronavirus 2 IgG at 56 days was significantly (P < 0.001) lower in people with type 2 diabetes mellitus (T2D; 15.13 BAU/mL, 95% confidence interval [CI] = 10.7–21.4) than in those without diabetes (40.20 BAU/mL, 95% CI = 33.43–48.36), as confirmed by a geometric mean ratio of 0.37 (95% CI = 0.25–0.54). Weaker immune responses were also observed in diabetic patients ≥ 65 years old (10.09 BAU/mL, 95% CI = 6.09–16.71) compared with their younger counterparts (22.31 BAU/mL, 95% CI = 13.98–35.59, P = 0.034). People with T2D had weaker antibody responses than those without diabetes after the first dose of AZD1222. Older age was associated with weaker antibody responses in elderly patients with diabetes.
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Affiliation(s)
- Vimonsri Rangsrisaeneepitak
- Endocrinology and Metabolism Unit, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Thachanun Porntharukchareon
- Endocrinology and Metabolism Unit, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Bothamai Dechates
- Endocrinology and Metabolism Unit, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Supamas Sirisreetreerux
- Endocrinology and Metabolism Unit, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Kriangkrai Tawinprai
- Infectious Disease Unit, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
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24
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Valles TE, Shoenhard H, Zinski J, Trick S, Porter MA, Lindstrom MR. Networks of necessity: Simulating COVID-19 mitigation strategies for disabled people and their caregivers. PLoS Comput Biol 2022; 18:e1010042. [PMID: 35584133 PMCID: PMC9232173 DOI: 10.1371/journal.pcbi.1010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/24/2022] [Accepted: 03/21/2022] [Indexed: 01/08/2023] Open
Abstract
A major strategy to prevent the spread of COVID-19 is the limiting of in-person contacts. However, limiting contacts is impractical or impossible for the many disabled people who do not live in care facilities but still require caregivers to assist them with activities of daily living. We seek to determine which interventions can best prevent infections of disabled people and their caregivers. To accomplish this, we simulate COVID-19 transmission with a compartmental model that includes susceptible, exposed, asymptomatic, symptomatically ill, hospitalized, and removed/recovered individuals. The networks on which we simulate disease spread incorporate heterogeneity in the risk levels of different types of interactions, time-dependent lockdown and reopening measures, and interaction distributions for four different groups (caregivers, disabled people, essential workers, and the general population). Of these groups, we find that the probability of becoming infected is largest for caregivers and second largest for disabled people. Consistent with this finding, our analysis of network structure illustrates that caregivers have the largest modal eigenvector centrality of the four groups. We find that two interventions-contact-limiting by all groups and mask-wearing by disabled people and caregivers-most reduce the number of infections in disabled and caregiver populations. We also test which group of people spreads COVID-19 most readily by seeding infections in a subset of each group and comparing the total number of infections as the disease spreads. We find that caregivers are the most potent spreaders of COVID-19, particularly to other caregivers and to disabled people. We test where to use limited infection-blocking vaccine doses most effectively and find that (1) vaccinating caregivers better protects disabled people from infection than vaccinating the general population or essential workers and that (2) vaccinating caregivers protects disabled people from infection about as effectively as vaccinating disabled people themselves. Our results highlight the potential effectiveness of mask-wearing, contact-limiting throughout society, and strategic vaccination for limiting the exposure of disabled people and their caregivers to COVID-19.
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Affiliation(s)
- Thomas E Valles
- Department of Mathematics, University of California, San Diego, San Diego, California, United States of America
- Department of Mathematics, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Hannah Shoenhard
- Department of Cell and Developmental Biology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Joseph Zinski
- Department of Cell and Developmental Biology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sarah Trick
- Assistant Editor at tvo.org (TVOntario), Toronto, Ontario, Canada
| | - Mason A Porter
- Department of Mathematics, University of California, Los Angeles, Los Angeles, California, United States of America
- Santa Fe Institute, Santa Fe, New Mexico, United States of America
| | - Michael R Lindstrom
- Department of Mathematics, University of California, Los Angeles, Los Angeles, California, United States of America
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25
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Barbosa Libotte G, dos Anjos L, Célia Cerqueira de Almeida R, Mara Cardoso Malta S, de Andrade Medronho R. Impacts of a delayed and slow-paced vaccination on cases and deaths during the COVID-19 pandemic: a modelling study. J R Soc Interface 2022; 19:20220275. [PMID: 35611617 PMCID: PMC9131126 DOI: 10.1098/rsif.2022.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/03/2022] [Indexed: 11/21/2022] Open
Abstract
In Brazil, vaccination has always cut across party political and ideological lines, which has delayed its start and brought the whole process into disrepute. Such divergences put the immunization of the population in the background and create additional hurdles beyond the pandemic, mistrust and scepticism over vaccines. We conduct a mathematical modelling study to analyse the impacts of late vaccination along with slowly increasing coverage, as well as how harmful it would be if part of the population refused to get vaccinated or missed the second dose. We analyse data from confirmed cases, deaths and vaccination in the state of Rio de Janeiro in the period between 10 March 2020 and 27 October 2021. We estimate that if the start of vaccination had been 30 days earlier, combined with efforts to drive vaccination rates up, about 31 657 deaths could have been avoided. In addition, the slow pace of vaccination and the low demand for the second dose could cause a resurgence of cases as early as 2022. Even when reaching the expected vaccination coverage for the first dose, it is still challenging to increase adherence to the second dose and maintain a high vaccination rate to avoid new outbreaks.
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Affiliation(s)
| | - Lucas dos Anjos
- National Laboratory for Scientific Computing, Petrópolis, Rio de Janeiro, 25651-075 Brazil
| | | | | | - Roberto de Andrade Medronho
- Institute of Collective Health, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, 21941-598 Brazil
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26
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Flego D, Cesaroni S, Romiti GF, Corica B, Marrapodi R, Scafa N, Maiorca F, Lombardi L, Pallucci D, Pulcinelli F, Raparelli V, Visentini M, Cangemi R, Piconese S, Alvaro D, Polimeni A, Basili S, Stefanini L. Platelet and immune signature associated with a rapid response to the BNT162b2 mRNA COVID-19 vaccine. J Thromb Haemost 2022; 20:961-974. [PMID: 35032087 PMCID: PMC9302646 DOI: 10.1111/jth.15648] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND A rapid immune response is critical to ensure effective protection against COVID-19. Platelets are first-line sentinels of the vascular system able to rapidly alert and stimulate the immune system. However, their role in the immune response to vaccines is not known. OBJECTIVE To identify features of the platelet-immune crosstalk that would provide an early readout of vaccine efficacy in adults who received the mRNA-based COVID-19 vaccine (BNT162b2). METHODS We prospectively enrolled 11 young healthy volunteers (54% females, median age: 28 years) who received two doses of BNT162b2, 21 days apart, and we studied their platelet and immune response before and after each dose of the vaccine (3 and 10 ± 2 days post-injection), in relation to the kinetics of the humoral response. RESULTS Participants achieving an effective level of neutralizing antibodies before the second dose of the vaccine (fast responders) had a higher leukocyte count, mounted a rapid cytokine response that incremented further after the second dose, and an elevated platelet turnover that ensured platelet count stability. Their circulating platelets were not more reactive but expressed lower surface levels of the immunoreceptor tyrosine-based inhibitory motif (ITIM)-coupled receptor CD31 (PECAM-1) compared to slow responders, and formed specific platelet-leukocyte aggregates, with B cells, just 3 days after the first dose, and with non-classical monocytes and eosinophils. CONCLUSION We identified features of the platelet-immune crosstalk that are associated with the development of a rapid humoral response to an mRNA-based vaccine (BNT162b2) and that could be exploited as early biomarkers of vaccine efficacy.
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Affiliation(s)
- Davide Flego
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Simone Cesaroni
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giulio F Romiti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Bernadette Corica
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Ramona Marrapodi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Noemi Scafa
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesca Maiorca
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Ludovica Lombardi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Davide Pallucci
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabio Pulcinelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Marcella Visentini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Roberto Cangemi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Silvia Piconese
- Department of Internal Clinical Sciences, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Domenico Alvaro
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Stefania Basili
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Lucia Stefanini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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27
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Kaura A, Trickey A, Shah ASV, Benedetto U, Glampson B, Mulla A, Mercuri L, Gautama S, Costelloe CE, Goodman I, Redhead J, Saravanakumar K, Mayer E, Mayet J. Comparing the longer-term effectiveness of a single dose of the Pfizer-BioNTech and Oxford-AstraZeneca COVID-19 vaccines across the age spectrum. EClinicalMedicine 2022; 46:101344. [PMID: 35295900 PMCID: PMC8918854 DOI: 10.1016/j.eclinm.2022.101344] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A single dose strategy may be adequate to confer population level immunity and protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, especially in low- and middle-income countries where vaccine supply remains limited. We compared the effectiveness of a single dose strategy of the Oxford-AstraZeneca or Pfizer-BioNTech vaccines against SARS-CoV-2 infection across all age groups and over an extended follow-up period. METHODS Individuals vaccinated in North-West London, UK, with either the first dose of the Oxford-AstraZeneca or Pfizer-BioNTech vaccines between January 12, 2021 and March 09, 2021, were matched to each other by demographic and clinical characteristics. Each vaccinated individual was additionally matched to an unvaccinated control. Study outcomes included SARS-CoV-2 infection of any severity, COVID-19 hospitalisation, COVID-19 death, and all-cause mortality. FINDINGS Amongst matched individuals, 63,608 were in each of the vaccine groups and 127,216 were unvaccinated. Between 14 and 84 days of follow-up after matching, there were 534 SARS-CoV-2 infections, 65 COVID-19 hospitalisations, and 190 deaths, of which 29 were categorized as due to COVID-19. The incidence rate ratio (IRR) for SARS-CoV-2 infection was 0.85 (95% confidence interval [CI], 0.69 to 1.05) for Oxford-Astra-Zeneca, and 0.69 (0.55 to 0.86) for Pfizer-BioNTech. The IRR for both vaccines was the same at 0.25 (0.09 to 0.55) and 0.14 (0.02 to 0.58) for reducing COVID-19 hospitalization and COVID-19 mortality, respectively. The IRR for all-cause mortality was 0.25 (0.15 to 0.39) and 0.18 (0.10 to 0.30) for the Oxford-Astra-Zeneca and Pfizer-BioNTech vaccines, respectively. Age was an effect modifier of the association between vaccination and SARS-CoV-2 infection of any severity; lower hazard ratios for increasing age. INTERPRETATION A single dose strategy, for both vaccines, was effective at reducing COVID-19 mortality and hospitalization rates. The magnitude of vaccine effectiveness was comparatively lower for SARS-CoV-2 infection, although this was variable across the age range, with higher effectiveness seen with older adults. Our results have important implications for health system planning -especially in low resource settings where vaccine supply remains constrained.
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Affiliation(s)
- Amit Kaura
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
- Corresponding author at: Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK.
| | - Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Anoop S V Shah
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Umberto Benedetto
- Population Health Sciences, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Neuroscience, Imaging and Clinical Science, University Chieti-Pescara, G. d'Annunzio, Italy
| | - Ben Glampson
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Abdulrahim Mulla
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Luca Mercuri
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Sanjay Gautama
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Ceire E Costelloe
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - Ian Goodman
- North West London Collaboration of Clinical Commissioning Groups and Whole Systems Integrated Care, London, UK
| | - Julian Redhead
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Kavitha Saravanakumar
- North West London Collaboration of Clinical Commissioning Groups and Whole Systems Integrated Care, London, UK
| | - Erik Mayer
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Jamil Mayet
- Hammersmith Hospital, National Heart and Lung Institute, Imperial College London, Du Cane Road, London W12 0HS, UK
- NIHR Imperial Biomedical Research Centre, Imperial College Healthcare NHS Trust, London, UK
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28
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Goldberg Y, Mandel M, Woodbridge Y, Fluss R, Novikov I, Yaari R, Ziv A, Freedman L, Huppert A. Similarity of Protection Conferred by Previous SARS-CoV-2 Infection and by BNT162b2 Vaccine: A 3-Month Nationwide Experience From Israel. Am J Epidemiol 2022; 191:1420-1428. [PMID: 35355048 PMCID: PMC8992290 DOI: 10.1093/aje/kwac060] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 03/01/2022] [Accepted: 03/25/2022] [Indexed: 01/28/2023] Open
Abstract
The worldwide shortage of vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection while the pandemic still remains uncontrolled has led many countries to the dilemma of whether or not to vaccinate previously infected persons. Understanding the level of protection conferred by previous infection compared with that of vaccination is important for policy-making. We analyzed an updated individual-level database of the entire population of Israel to assess the protection provided by both prior infection and vaccination in preventing subsequent SARS-CoV-2 infection, hospitalization with coronavirus disease 2019 (COVID-19), severe disease, and death due to COVID-19. Outcome data were collected from December 20, 2020, to March 20, 2021. Vaccination was highly protective, with overall estimated effectiveness of 94.5% (95% confidence interval (CI): 94.3, 94.7) for documented infection, 95.8% (95% CI: 95.2, 96.2) for hospitalization, 96.3% (95% CI: 95.7, 96.9) for severe illness, and 96.0% (95% CI: 94.9, 96.9) for death. Similarly, the overall estimated level of protection provided by prior SARS-CoV-2 infection was 94.8% (95% CI: 94.4, 95.1) for documented infection, 94.1% (95% CI: 91.9, 95.7) for hospitalization, and 96.4% (95% CI: 92.5, 98.3) for severe illness. Our results should be considered by policy-makers when deciding whether or not to prioritize vaccination of previously infected adults.
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Affiliation(s)
- Yair Goldberg
- Correspondence Address: Correspondence to Dr. Yair Goldberg, Faculty of Industrial Engineering and Management, Technion - Israel Institute of Technology, Haifa, Israel 3200003. (E-mail: )
| | | | - Yonatan Woodbridge
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Israel
| | - Ronen Fluss
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Israel
| | - Ilya Novikov
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Israel
| | - Rami Yaari
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Israel
| | - Arnona Ziv
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Israel
| | - Laurence Freedman
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Israel
| | - Amit Huppert
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Israel,The Sackler Faculty of Medicine, Tel Aviv University, Israel
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29
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Au J. Higher vaccination rates predict reduction in SARS-CoV-2 transmission across the United States. Infection 2022; 50:1255-1266. [PMID: 35314944 PMCID: PMC8938221 DOI: 10.1007/s15010-022-01802-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/07/2022] [Indexed: 11/27/2022]
Abstract
Purpose The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began proliferating widely throughout the world in late 2019/early 2020, creating a global pandemic and health crisis. Although vaccines became available to the public approximately 1 year after the onset of the pandemic, there still remains much hesitancy surrounding vaccination. One key concern comes from reports of breakthrough infections among the vaccinated that show comparable levels of peak viral load as the unvaccinated, calling into question the ability of vaccines to prevent transmission. Therefore young, healthy individuals who are at low risk of serious complications themselves have little incentive to receive a vaccine that they are not convinced will protect others around them. To address this important concern, this study aimed to evaluate the extent to which vaccination rates are associated with reduced SARS-CoV-2 transmission among the unvaccinated population. Methods An observational study was conducted in the United States of America throughout the months of June through September, 2021. Vaccination rate and incidence of coronavirus disease 2019 (COVID-19) were obtained for each state, along with a number of important control variables. Panel data regression was used to predict incidence among the unvaccinated based on each state’s vaccination rate. Results States with a higher proportion of fully vaccinated individuals reported fewer new cases among the remaining unvaccinated population. Conclusion These data add to accumulating evidence that COVID-19 vaccinations can indeed slow the spread of SARS-CoV-2, and are an important tool in society’s arsenal to put this pandemic behind us. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-022-01802-1.
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Affiliation(s)
- Jacky Au
- School of Education, University of California, Irvine, 3200 Education Building, Irvine, CA, 92697, USA.
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Fano V, Crielesi A, Coviello E, Fabiani M, Salvatore Miglietta A, Colaiocco G, Moretti I, Pasqua C, Vivaldi F, De Angelis G, Cerimele M. Effectiveness of the Comirnaty and the Vaxzevria vaccines in preventing SARS-CoV-2 infection among residents in Lazio region (Italy). Vaccine 2022; 40:2540-2545. [PMID: 35341646 PMCID: PMC8938180 DOI: 10.1016/j.vaccine.2022.02.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 12/24/2022]
Abstract
We estimated the effectiveness of Comirnaty and Vaxzevria vaccines among 371,423 residents in Lazio Region (Italy) vaccinated since 27/12/2020, and followed until diagnosis of SARS-CoV-2 infection or 25/4/2021, whichever came first. By the end of follow-up most of the Comirnaty-cohort (60%) had received the second dose at recommended time of 21 days (98%), while the Vaxzevria-cohort had received only one dose. Adjusted hazard ratios of SARS-CoV-2 infection at weekly intervals since the first dose were estimated through a Cox regression model using 0–13 days as reference time-interval. An increase in effectiveness with increasing time since administration was observed for Comirnaty (five-weeks = 81%, 95 %CI 71–88%; three-months = 94%, 95 %CI 84–98%). One dose of Vaxzevria showed an effectiveness of 63% (95 %CI 25–82%) after 7 weeks, although further analyses are needed after complete vaccination with two doses. These results could support the ongoing vaccination campaign by reinforcing evidence-based communication aimed at reducing vaccine hesitancy.
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Affiliation(s)
| | | | | | - Massimo Fabiani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Irene Moretti
- Department of Economics and Law, Sapienza University, Rome, Italy
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Waning of SARS-CoV-2 booster viral-load reduction effectiveness. Nat Commun 2022; 13:1237. [PMID: 35246560 PMCID: PMC8897467 DOI: 10.1038/s41467-022-28936-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/18/2022] [Indexed: 01/07/2023] Open
Abstract
The BNT162b2 COVID-19 vaccine has been shown to reduce viral load of breakthrough infections (BTIs), an important factor affecting infectiousness. This viral-load protective effect has been waning with time post the second vaccine and later restored with a booster shot. It is currently unclear though for how long this regained effectiveness lasts. Analyzing Ct values of SARS-CoV-2 qRT-PCR tests of over 22,000 infections during a Delta-variant-dominant period in Israel, we find that this viral-load reduction effectiveness significantly declines within months post the booster dose. Adjusting for age, sex and calendric date, Ct values of RdRp gene initially increases by 2.7 [CI: 2.3-3.0] relative to unvaccinated in the first month post the booster dose, yet then decays to a difference of 1.3 [CI: 0.7-1.9] in the second month and becomes small and insignificant in the third to fourth months. The rate and magnitude of this post-booster decline in viral-load reduction effectiveness mirror those observed post the second vaccine. These results suggest rapid waning of the booster’s effectiveness in reducing infectiousness, possibly affecting community-level spread of the virus. The BNT162b2 COVID-19 vaccine has been shown to reduce viral load of breakthrough infections (BTIs). Here, analyzing viral loads of BTIs post third vaccine shot, Levine-Tiefenbrun et al. show waning of the booster’s effectiveness in reducing infectiousness within months, mirroring the rate and magnitude of decline observed post the second shot.
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Abd-Elsayed A, D'Souza RS. The Burden of Coronavirus Disease 2019-Related Cases, Hospitalizations, and Mortality Based on Vaccination Status and Mandated Mask Use: Statewide Data From Wisconsin and Narrative Review of the Literature. Anesth Analg 2022; 134:524-531. [PMID: 35180169 DOI: 10.1213/ane.0000000000005858] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) cases continue to surge in the United States with the emergence of new variants. Statewide variability and inconsistency in implementing risk mitigation strategies are widespread, particularly in regards to enforcing mask mandates and encouraging the public to become fully vaccinated. METHODS This is a cross-sectional study conducted on July 31, 2021, utilizing publicly available data from the Wisconsin Department of Health Services. The authors abstracted data on total COVID-19-related cases, hospitalizations, and deaths in the state of Wisconsin. The primary objective was comparison of total COVID-19-related cases, hospitalizations, and deaths in vaccinated versus unvaccinated people in the state of Wisconsin over a 31-day period (July 2021). Furthermore, we also performed a narrative review of the literature on COVID-19-related outcomes based on mask use and vaccination status. RESULTS In the state of Wisconsin during July 2021, total COVID-19 cases was 125.4 per 100,000 fully vaccinated people versus 369.2 per 100,000 not fully vaccinated people (odds ratio [OR] = 0.34, 95% confidence interval [CI], 0.33-0.35; P < .001). Total COVID-19 hospitalizations was 4.9 per 100,000 fully vaccinated people versus 18.2 per 100,000 not fully vaccinated people (OR = 0.27, 98% CI, 0.22-0.32; P < .001). Total COVID-19 deaths was 0.1 per 100,000 fully vaccinated people versus 1.1 per 100,000 not fully vaccinated people (OR = 0.09, 95% CI, 0.03-0.29; P < .001). Narrative review of the literature demonstrated high vaccine effectiveness against COVID-19 infection prevention (79%-100% among fully vaccinated people), COVID-19-related hospitalization (87%-98% among fully vaccinated people), and COVID-19-related death (96.7%-98% among fully vaccinated people). Studies have also generally reported that mask use was associated with increased effectiveness in preventing COVID-19 infection ≤70%. CONCLUSIONS Strict adherence to public mask use and fully vaccinated status are associated with improved COVID-19-related outcomes and can mitigate the spread, morbidity, and mortality of COVID-19. Anesthesiologists and intensivists should adhere to evidence-based guidelines in their approach and management of patients to help mitigate spread.
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Affiliation(s)
- Alaa Abd-Elsayed
- From the Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin
| | - Ryan S D'Souza
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, Minnesota
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Fabiani M, Puopolo M, Morciano C, Spuri M, Spila Alegiani S, Filia A, D'Ancona F, Del Manso M, Riccardo F, Tallon M, Proietti V, Sacco C, Massari M, Da Cas R, Mateo-Urdiales A, Siddu A, Battilomo S, Bella A, Palamara AT, Popoli P, Brusaferro S, Rezza G, Menniti Ippolito F, Pezzotti P. Effectiveness of mRNA vaccines and waning of protection against SARS-CoV-2 infection and severe covid-19 during predominant circulation of the delta variant in Italy: retrospective cohort study. BMJ 2022; 376:e069052. [PMID: 35144968 PMCID: PMC8829820 DOI: 10.1136/bmj-2021-069052] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To estimate the effectiveness of mRNA vaccines against SARS-CoV-2 infection and severe covid-19 at different time after vaccination. DESIGN Retrospective cohort study. SETTING Italy, 27 December 2020 to 7 November 2021. PARTICIPANTS 33 250 344 people aged ≥16 years who received a first dose of BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine and did not have a previous diagnosis of SARS-CoV-2 infection. MAIN OUTCOME MEASURES SARS-CoV-2 infection and severe covid-19 (admission to hospital or death). Data were divided by weekly time intervals after vaccination. Incidence rate ratios at different time intervals were estimated by multilevel negative binomial models with robust variance estimator. Sex, age group, brand of vaccine, priority risk category, and regional weekly incidence in the general population were included as covariates. Geographic region was included as a random effect. Adjusted vaccine effectiveness was calculated as (1-IRR)×100, where IRR=incidence rate ratio, with the time interval 0-14 days after the first dose of vaccine as the reference. RESULTS During the epidemic phase when the delta variant was the predominant strain of the SARS-CoV-2 virus, vaccine effectiveness against SARS-CoV-2 infection significantly decreased (P<0.001) from 82% (95% confidence interval 80% to 84%) at 3-4 weeks after the second dose of vaccine to 33% (27% to 39%) at 27-30 weeks after the second dose. In the same time intervals, vaccine effectiveness against severe covid-19 also decreased (P<0.001), although to a lesser extent, from 96% (95% to 97%) to 80% (76% to 83%). High risk people (vaccine effectiveness -6%, -28% to 12%), those aged ≥80 years (11%, -15% to 31%), and those aged 60-79 years (2%, -11% to 14%) did not seem to be protected against infection at 27-30 weeks after the second dose of vaccine. CONCLUSIONS The results support the vaccination campaigns targeting high risk people, those aged ≥60 years, and healthcare workers to receive a booster dose of vaccine six months after the primary vaccination cycle. The results also suggest that timing the booster dose earlier than six months after the primary vaccination cycle and extending the offer of the booster dose to the wider eligible population might be warranted.
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Affiliation(s)
| | - Maria Puopolo
- Italian National Institute of Health (ISS), Rome, Italy
| | | | - Matteo Spuri
- Italian National Institute of Health (ISS), Rome, Italy
| | | | | | | | | | | | - Marco Tallon
- Italian National Institute of Health (ISS), Rome, Italy
| | | | - Chiara Sacco
- Italian National Institute of Health (ISS), Rome, Italy
| | - Marco Massari
- Italian National Institute of Health (ISS), Rome, Italy
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Porru S, Spiteri G, Monaco MGL, Valotti A, Carta A, Lotti V, Diani E, Lippi G, Gibellini D, Verlato G. Post-Vaccination SARS-CoV-2 Infections among Health Workers at the University Hospital of Verona, Italy: A Retrospective Cohort Survey. Vaccines (Basel) 2022; 10:vaccines10020272. [PMID: 35214733 PMCID: PMC8879605 DOI: 10.3390/vaccines10020272] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 01/19/2023] Open
Abstract
Background: The SARS-CoV-2 vaccination campaign began on 27 December 2020 in Europe, primarily involving health workers. This study aimed to assess the SARS-CoV-2 vaccination effectiveness, as assessed by reductions in incidence, symptom severity, and further infection spreading. Methods: A retrospective cohort study was conducted on 9811 health workers operating at the Verona University Hospital, Italy, from 27 December 2020 to 3 May 2021. All health workers were offered vaccination with Comirnaty (BNT162b2, BioNTech/Pfizer, Mainz, Germany/New York, United States), and a health surveillance program was implemented with periodical swab testing. Vaccination status and clinical data were collected using an ad hoc semi-structured questionnaire and health surveillance charts. Results: As of 3rd of May, 82.5% of health workers had been vaccinated against SAR-CoV-2, and 177 (1.8%) had tested positive for SARS-CoV-2. Vaccination more than halved the cumulative incidence of SARS-CoV-2 infection and reduced by two-thirds the cumulative incidence of symptomatic subjects. In detail, most unvaccinated HWs were symptomatic; 50% reported fever, 45% reported ageusia/anosmia, and nearly 20% reported dyspnea. These percentages were much lower in HWs who had been vaccinated for at least 14 days (18% for fever and anosmia, 6% for dyspnea and ageusia). Moreover, cases of vaccine breakthrough were sixfold less likely to further spread the infection than unvaccinated HWs. Conclusions: SARS-CoV-2 vaccination reduced the infection frequency among HWs, further spreading of the infection, and the presence, severity, and duration of COVID-19-related symptoms.
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Affiliation(s)
- Stefano Porru
- Section of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (S.P.); (A.C.)
- Clinical Unit of Occupational Medicine, University Hospital of Verona, 37134 Verona, Italy;
| | - Gianluca Spiteri
- Clinical Unit of Occupational Medicine, University Hospital of Verona, 37134 Verona, Italy;
| | - Maria Grazia Lourdes Monaco
- Clinical Unit of Occupational Medicine, University Hospital of Verona, 37134 Verona, Italy;
- Correspondence: ; Tel.: +39-0458123946
| | - Alessandro Valotti
- Postgraduate School of Occupational Medicine, University of Verona, 37134 Verona, Italy;
| | - Angela Carta
- Section of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (S.P.); (A.C.)
- Clinical Unit of Occupational Medicine, University Hospital of Verona, 37134 Verona, Italy;
| | - Virginia Lotti
- Section of Microbiology, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (V.L.); (E.D.); (D.G.)
| | - Erica Diani
- Section of Microbiology, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (V.L.); (E.D.); (D.G.)
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, 37134 Verona, Italy;
| | - Davide Gibellini
- Section of Microbiology, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (V.L.); (E.D.); (D.G.)
- Unit of Microbiology and Virology, University Hospital of Verona, 37134 Verona, Italy
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy;
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Ismail AlHosani F, Eduardo Stanciole A, Aden B, Timoshkin A, Najim O, Abbas Zaher W, AlSayedsaleh AlDhaheri F, Al Mazrouie S, Rizvi TA, Mustafa F. Impact of the Sinopharm’s BBIBP-CorV vaccine in preventing hospital admissions and death in infected vaccinees: Results from a retrospective study in the emirate of Abu Dhabi, United Arab Emirates (UAE). Vaccine 2022; 40:2003-2010. [PMID: 35193793 PMCID: PMC8857641 DOI: 10.1016/j.vaccine.2022.02.039] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 12/13/2022]
Abstract
Background This is a community-based, retrospective, observational study conducted to determine effectiveness of the BBIBP-CorV inactivated vaccine in the real-world setting against hospital admissions and death. Study Design Study participants were selected from 214,940 PCR-positive cases of COVID-19 reported to the Department of Health, Abu Dhabi Emirate, United Arab Emirates (UAE) between September 01, 2020 and May 1, 2021. Of these, 176,640 individuals were included in the study who were aged ≥ 15 years with confirmed COVID-19 positive status who had records linked to their vaccination status. Those with incomplete or missing records were excluded (n = 38,300). Study participants were divided into three groups depending upon their vaccination status: fully vaccinated (two doses), partially vaccinated (single dose), and non-vaccinated. Study outcomes included COVID-19-related admissions to hospital general and critical care wards and death. Vaccine effectiveness for each outcome was based on the incidence density per 1000 person-years. Results The fully-, partially- and non-vaccinated groups included 62,931, 21,768 and 91,941 individuals, respectively. Based on the incidence rate ratios, the vaccine effectiveness in fully vaccinated individuals was 80%, 92%, and 97% in preventing COVID-19-related hospital admissions, critical care admissions, and death, respectively, when compared to the non-vaccinated group. No protection was observed for critical and non-critical care hospital admissions for the partially vaccinated group, while some protection against death was apparent, although statistically insignificant. Conclusions In a COVID-19 pandemic, use of the Sinopharm BBIBP-CorV inactivated vaccine is effective in preventing severe disease and death in a two-dose regimen. Lack of protection with the single dose may be explained by insufficient seroconversion and/or neutralizing antibody responses, behavioral factors (i.e., false sense of protection), and/or other biological factors (emergence of variants, possibility of reinfection, duration of vaccine protection, etc.).
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The Population-Wide Risk-Benefit Profile of Extending the Primary COVID-19 Vaccine Course Compared with an mRNA Booster Dose Program. Vaccines (Basel) 2022; 10:vaccines10020140. [PMID: 35214599 PMCID: PMC8880242 DOI: 10.3390/vaccines10020140] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/05/2022] [Accepted: 01/14/2022] [Indexed: 12/10/2022] Open
Abstract
The vaccination program is reducing the burden of COVID-19. However, recently, COVID-19 infections have been increasing across Europe, providing evidence that vaccine efficacy is waning. Consequently, booster doses are required to restore immunity levels. However, the relative risk–benefit ratio of boosters, compared to pursuing a primary course in the unvaccinated population, remains uncertain. In this study, a susceptible-exposed-infectious-recovered (SEIR) transmission model of SARS-CoV-2 was used to investigate the impact of COVID-19 vaccine waning on disease burden, the benefit of a booster vaccine program compared to targeting the unvaccinated population, and the population-wide risk–benefit profile of vaccination. Our data demonstrates that the rate of vaccine efficacy waning has a significant impact on COVID-19 hospitalisations with the greatest effect in populations with lower vaccination coverage. There was greater benefit associated with a booster vaccination strategy compared to targeting the unvaccinated population, once >50% of the population had received their primary vaccination course. The population benefits of vaccination (reduced hospitalisations, long-COVID and deaths) outweighed the risks of myocarditis/pericarditis by an order of magnitude. Vaccination is important in ending the COVID-19 pandemic sooner, and the reduction in hospitalisations, death and long-COVID associated with vaccination significantly outweigh any risks. Despite these obvious benefits some people are vaccine reluctant, and as such remain unvaccinated. However, when most of a population have been vaccinated, a focus on a booster vaccine strategy for this group is likely to offer greater value, than targeting the proportion of the population who choose to remain unvaccinated.
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Teerawattananon Y, Anothaisintawee T, Pheerapanyawaranun C, Botwright S, Akksilp K, Sirichumroonwit N, Budtarad N, Isaranuwatchai W. A systematic review of methodological approaches for evaluating real-world effectiveness of COVID-19 vaccines: Advising resource-constrained settings. PLoS One 2022; 17:e0261930. [PMID: 35015761 PMCID: PMC8752025 DOI: 10.1371/journal.pone.0261930] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/13/2021] [Indexed: 01/19/2023] Open
Abstract
Real-world effectiveness studies are important for monitoring performance of COVID-19 vaccination programmes and informing COVID-19 prevention and control policies. We aimed to synthesise methodological approaches used in COVID-19 vaccine effectiveness studies, in order to evaluate which approaches are most appropriate to implement in low- and middle-income countries (LMICs). For this rapid systematic review, we searched PubMed and Scopus for articles published from inception to July 7, 2021, without language restrictions. We included any type of peer-reviewed observational study measuring COVID-19 vaccine effectiveness, for any population. We excluded randomised control trials and modelling studies. All data used in the analysis were extracted from included papers. We used a standardised data extraction form, modified from STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). Study quality was assessed using the REal Life EVidence AssessmeNt Tool (RELEVANT) tool. This study is registered with PROSPERO, CRD42021264658. Our search identified 3,327 studies, of which 42 were eligible for analysis. Most studies (97.5%) were conducted in high-income countries and the majority assessed mRNA vaccines (78% mRNA only, 17% mRNA and viral vector, 2.5% viral vector, 2.5% inactivated vaccine). Thirty-five of the studies (83%) used a cohort study design. Across studies, short follow-up time and limited assessment and mitigation of potential confounders, including previous SARS-CoV-2 infection and healthcare seeking behaviour, were major limitations. This review summarises methodological approaches for evaluating real-world effectiveness of COVID-19 vaccines and highlights the lack of such studies in LMICs, as well as the importance of context-specific vaccine effectiveness data. Further research in LMICs will refine guidance for conducting real-world COVID-19 vaccine effectiveness studies in resource-constrained settings.
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Affiliation(s)
- Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Thunyarat Anothaisintawee
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Siobhan Botwright
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- * E-mail:
| | - Katika Akksilp
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Nuttakarn Budtarad
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
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Shen CJ, Fu YC, Lin YP, Shen CF, Sun DJ, Chen HY, Cheng CM. Evaluation of Transplacental Antibody Transfer in SARS-CoV-2-Immunized Pregnant Women. Vaccines (Basel) 2022; 10:101. [PMID: 35062762 PMCID: PMC8778956 DOI: 10.3390/vaccines10010101] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy could result in adverse perinatal outcome. Clinical data on the assessment of the immune response in vaccinated pregnant women and subsequent transplacental antibody transfer are quite limited. OBJECTIVE To assess maternal and neonatal neutralizing antibody levels against both wildtype and Delta (B.1.617.2) variants after maternal mRNA vaccination. STUDY DESIGN This cohort study was conducted 29 pregnant women who were vaccinated at least one dose of Moderna (mRNA-1273) vaccine. Both neutralizing antibody (wildtype and Delta variant) and S1 receptor binding domain IgG antibody levels were evaluated in maternal and cord blood on the day of delivery. RESULTS Superiority of antibody level was significant in fully vaccinated women compared with the one-dose group (maternal sera, median, 97.46%; cord sera, median, 97.37% versus maternal sera, median, 4.01%; cord sera, median, 1.44%). No difference in antibody level was noted in relation to interval of second immunization to delivery in the two-dose group (95.99% in 0-2 weeks, 97.45% in 2-4 weeks, 97.48% in 4-8 weeks, 97.72% in 8-10 weeks). The most pronounced reduction was observed for the Delta variant. The wildtype neutralizing antibody level of full-vaccinated women was not influenced by the pertussis vaccination. CONCLUSION The data underscore the importance of full vaccination in pregnancy and support the recommendation of COVID-19 immunization for pregnant women. The lower level of vaccine-induced neutralizing antibodies for the Delta variant indicates insufficient protection for mother and newborn and highlights the need for development of effective vaccine strategies.
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Affiliation(s)
- Ching-Ju Shen
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yi-Chen Fu
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan; (Y.-C.F.); (Y.-P.L.)
| | - Yen-Pin Lin
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan; (Y.-C.F.); (Y.-P.L.)
| | - Ching-Fen Shen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Der-Ji Sun
- Department of Obstetrics and Gynecology, Pojen Hospital, Kaohsiung 804, Taiwan;
| | - Huan-Yun Chen
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
| | - Chao-Min Cheng
- Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu 300, Taiwan; (Y.-C.F.); (Y.-P.L.)
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Zheng C, Shao W, Chen X, Zhang B, Wang G, Zhang W. Real-world effectiveness of COVID-19 vaccines: a literature review and meta-analysis. Int J Infect Dis 2022; 114:252-260. [PMID: 34800687 PMCID: PMC8595975 DOI: 10.1016/j.ijid.2021.11.009] [Citation(s) in RCA: 327] [Impact Index Per Article: 163.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/21/2021] [Accepted: 11/05/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To estimate the coronavirus disease 2019 (COVID-19) vaccine effectiveness (VE) against concerned outcomes in real-world settings. METHODS Studies reporting COVID-19 VE from August 6, 2020 to October 6, 2021 were included. The summary VE (with 95% confidence intervals (95% CI)) against disease related to COVID-19 was estimated. The results were presented in forest plots. Predefined subgroup analyses and sensitivity analyses were also performed. RESULTS A total of 51 records were included in this meta-analysis. In fully vaccinated populations, the VE against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, COVID-19-related hospitalization, admission to the intensive care unit, and death was 89.1% (95% CI 85.6-92.6%), 97.2% (95% CI 96.1-98.3%), 97.4% (95% CI 96.0-98.8%), and 99.0% (95% CI 98.5-99.6%), respectively. The VE against infection in the general population aged ≥16 years, the elderly, and healthcare workers was 86.1% (95% CI 77.8-94.4%), 83.8% (95% CI 77.1-90.6%), and 95.3% (95% CI 92.0-98.6%), respectively. For those fully vaccinated against infection, the observed effectiveness of the Pfizer-BioNTech vaccine was 91.2% and of the Moderna vaccine was 98.1%, while the effectiveness of the CoronaVac vaccine was found to be 65.7%. CONCLUSIONS The COVID-19 vaccines are highly protective against SARS-CoV-2-related diseases in real-world settings.
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Affiliation(s)
| | | | | | | | | | - Weidong Zhang
- Corresponding author: Weidong Zhang, Department of Epidemiology, School of Public Health, Zhengzhou University, Zhengzhou, Henan, 450001, China. Tel: +86-0371-67781964
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Clemens J, Aziz AB, Tadesse BT, Kang S, Marks F, Kim J. Evaluation of protection by COVID-19 vaccines after deployment in low and lower-middle income countries. EClinicalMedicine 2022; 43:101253. [PMID: 34977517 PMCID: PMC8703050 DOI: 10.1016/j.eclinm.2021.101253] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/02/2021] [Accepted: 12/10/2021] [Indexed: 12/20/2022] Open
Abstract
The availability and use of vaccines for the coronavirus disease 2019 (COVID-19) in low and middle-income countries (L/MICs) lags far behind more affluent countries, and vaccines currently used in L/MICs are predominantly of lower efficacy. As vaccines continue to be rolled out in L/MICs, successful control of COVID-19 by vaccines requires monitoring both of vaccine protection of vaccinees (effectiveness) and of the entire targeted populations, including vaccine herd protection of non-vaccinees (impact). To be of greatest relevance to L/MICs, there is the need to address the distinctive medical and demographic features of populations, health systems, and demography that may greatly affect vaccine performance in these settings. We identified 58 published studies that included 85 evaluations of the effectiveness of different COVID-19 vaccines globally. Only three were done in L/MICs, and no impact studies were identified in these settings. Post-deployment studies of the protection by COVID-19 vaccines rolled out in L/MICs constitute an important but currently neglected global priority.
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Affiliation(s)
- John Clemens
- International Vaccine Institute, Seoul, South Korea
- UCLA Fielding School of Public Health, Los Angeles, United States
| | - Asma Binte Aziz
- International Vaccine Institute, Seoul, South Korea
- Institute of Clinical Medicine, University of Oslo, Norway
| | | | - Sophie Kang
- International Vaccine Institute, Seoul, South Korea
| | - Florian Marks
- International Vaccine Institute, Seoul, South Korea
- University of Cambridge, United Kingdom
- University of Antananarivo, Antananarivo, Madagascar
| | - Jerome Kim
- International Vaccine Institute, Seoul, South Korea
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López F, Català M, Prats C, Estrada O, Oliva I, Prat N, Isnard M, Vallès R, Vilar M, Clotet B, Argimon JM, Aran A, Ara J. A Cost-Benefit Analysis of COVID-19 Vaccination in Catalonia. Vaccines (Basel) 2021; 10:59. [PMID: 35062719 PMCID: PMC8780175 DOI: 10.3390/vaccines10010059] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: In epidemiological terms, it has been possible to calculate the savings in health resources and the reduction in the health effects of COVID vaccines. Conducting an economic evaluation, some studies have estimated its cost-effectiveness; the vaccination shows highly favorable results, cost-saving in some cases. (2) Methods: Cost-benefit analysis of the vaccination campaign in the North Metropolitan Health Region (Catalonia). An epidemiological model based on observational data and before and after comparison is used. The information on the doses used and the assigned resources (conventional hospital beds, ICU, number of tests) was extracted from administrative data from the largest primary care provider in the region (Catalan Institute of Health). A distinction was made between the social perspective and the health system. (3) Results: the costs of vaccination are estimated at 137 million euros (€48.05/dose administered). This figure is significantly lower than the positive impacts of the vaccination campaign, which are estimated at 470 million euros (€164/dose administered). Of these, 18% corresponds to the reduction in ICU discharges, 16% to the reduction in conventional hospital discharges, 5% to the reduction in PCR tests and 1% to the reduction in RAT tests. The monetization of deaths and cases that avoid sequelae account for 53% and 5% of total savings, respectively. The benefit/cost ratio is estimated at 3.4 from a social perspective and 1.4 from a health system perspective. The social benefits of vaccination are estimated at €116.67 per vaccine dose (€19.93 from the perspective of the health system). (4) Conclusions: The mass vaccination campaign against COVID is cost-saving. From a social perspective, most of these savings come from the monetization of the reduction in mortality and cases with sequelae, although the intervention is equally widely cost-effective from the health system perspective thanks to the reduction in the use of resources. It is concluded that, from an economic perspective, the vaccination campaign has high social returns.
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Affiliation(s)
- Francesc López
- Directorate for Innovation and Interdisciplinary Cooperation, North Metropolitan Territorial Authority, Catalan Institute of Health, 08006 Barcelona, Spain; (O.E.); (I.O.); (J.A.)
- Centre for Research in Health and Economics, Pompeu Fabra University, 08002 Barcelona, Spain
- Fight AIDS and Infectious Diseases Foundation, 08916 Barcelona, Spain;
| | - Martí Català
- Comparative Medicine and Bioimage Centre of Catalonia (CMCiB), Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, 08916 Barcelona, Spain; (M.C.); (C.P.)
| | - Clara Prats
- Comparative Medicine and Bioimage Centre of Catalonia (CMCiB), Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, 08916 Barcelona, Spain; (M.C.); (C.P.)
- BIOCOM-SC, Physics Department, Universitat Politècnica de Catalunya, 08034 Barcelona, Spain
| | - Oriol Estrada
- Directorate for Innovation and Interdisciplinary Cooperation, North Metropolitan Territorial Authority, Catalan Institute of Health, 08006 Barcelona, Spain; (O.E.); (I.O.); (J.A.)
| | - Irene Oliva
- Directorate for Innovation and Interdisciplinary Cooperation, North Metropolitan Territorial Authority, Catalan Institute of Health, 08006 Barcelona, Spain; (O.E.); (I.O.); (J.A.)
- Centre for Research in Health and Economics, Pompeu Fabra University, 08002 Barcelona, Spain
| | - Núria Prat
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08006 Barcelona, Spain; (N.P.); (M.I.); (R.V.); (M.V.)
| | - Mar Isnard
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08006 Barcelona, Spain; (N.P.); (M.I.); (R.V.); (M.V.)
| | - Roser Vallès
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08006 Barcelona, Spain; (N.P.); (M.I.); (R.V.); (M.V.)
| | - Marc Vilar
- North Metropolitan Primary Care Directorate, Catalan Institute of Health, 08006 Barcelona, Spain; (N.P.); (M.I.); (R.V.); (M.V.)
| | - Bonaventura Clotet
- Fight AIDS and Infectious Diseases Foundation, 08916 Barcelona, Spain;
- IrsiCaixa AIDS Research Institute, University Hospital Germans Trias i Pujol, 08916 Barcelona, Spain
| | | | - Anna Aran
- Catalan Health Service, Ministry of Health, 08007 Barcelona, Spain;
| | - Jordi Ara
- Directorate for Innovation and Interdisciplinary Cooperation, North Metropolitan Territorial Authority, Catalan Institute of Health, 08006 Barcelona, Spain; (O.E.); (I.O.); (J.A.)
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Cerqueira-Silva T, Oliveira VDA, Boaventura VS, Pescarini JM, Júnior JB, Machado TM, Flores-Ortiz R, Penna GO, Ichihara MY, de Barros JV, Barreto ML, Werneck GL, Barral-Netto M. Influence of age on the effectiveness and duration of protection of Vaxzevria and CoronaVac vaccines: A population-based study. LANCET REGIONAL HEALTH. AMERICAS 2021; 6:100154. [PMID: 34957437 PMCID: PMC8692070 DOI: 10.1016/j.lana.2021.100154] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Aging influences COVID-19 severity and response to vaccination, but previous vaccine effectiveness (VE) analyzes lack the power to evaluate its role in subgroups within the elderly age group. Here we analyzed the impact of age on viral vector and inactivated virus vaccines' effectiveness, the main platforms used in low- and middle-income countries. METHODS We report a retrospective longitudinal study of 75,919,840 Brazilian vaccinees from January 18 to July 24, 2021, evaluating documented infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19-related hospitalisation, ICU admission, and death. Negative binomial regression models adjusted for sociodemographic characteristics were used for VE estimation. FINDINGS The overall analyzes of full vaccination showed VE against hospitalisation, ICU admission, and death of 91·4% (95%CI:90·1-92·5), 91·1% (95%CI:88·9-92·9) and 92·3% (95%CI:90·5-93·7) for Vaxzevria and 71·2% (95%CI:70·0-72·4), 72·2% (95%CI:70·2-74·0) and 73·7% (95%CI:72·1-75·2) for CoronaVac, respectively. VE for all outcomes is progressively lower with age. In fully-Vaxzevria-vaccinated individuals aged <60 years, VE against death was 96.5% (95%CI:82.1-99.3) versus 68·5% (95%CI:40·0-83·4) in those ≥90 years. Among fully-CoronaVac-vaccinated individuals, VE against death was 84.8% (95%CI:77.1-89.9) in those <60 years compared to 63.5 (95%CI 58.7-67.7) for vaccinees aged 80-89 years and 48·6%; (95%CI:35·0-59·3) for individuals aged ≥90 years. Post-vaccination daily cumulative incidence curves for all outcomes showed increased risk from younger to elder decades of life. There was no increase in the incidence of hospitalisation for individuals <60 years vaccinated during the same period as those aged ≥90 years. INTERPRETATION Although both vaccines have been effective in protecting against infection, hospitalization and death; Vaxzevria and CoronaVac demonstrated high effectiveness against severe outcomes for individuals up to 79 years of age. Our results reinforce the idea that booster doses should be carefully considered in elders. FUNDING This study was partially supported by a donation from the "Fazer o bem faz bem" program.
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Affiliation(s)
- Thiago Cerqueira-Silva
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil,Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Vinicius de Araújo Oliveira
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil,Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil,Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz, Salvador, BA, Brazil
| | - Viviane S. Boaventura
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil,Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Julia M. Pescarini
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz, Salvador, BA, Brazil,London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Juracy Bertoldo Júnior
- Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil,Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz, Salvador, BA, Brazil
| | | | - Renzo Flores-Ortiz
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz, Salvador, BA, Brazil
| | - Gerson O. Penna
- Escola Fiocruz de Governo, Núcleo de Medicina Tropical, Universidade de Brasília, Fiocruz Brasilia, Brasilia, DF, Brazil
| | - Maria Yury Ichihara
- Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz, Salvador, BA, Brazil
| | - Jacson Venâncio de Barros
- Departamento de Patologia da Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, SP, Brazil
| | - Mauricio L. Barreto
- Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil,Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz, Salvador, BA, Brazil
| | | | - Manoel Barral-Netto
- LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil,Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil,Center of Data and Knowledge Integration for Health (Cidacs), Fiocruz, Salvador, BA, Brazil,Corresponding author at: LIB and LEITV Laboratories, Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil.
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Cheng CJ, Lu CY, Chang YH, Sun Y, Chu HJ, Lee CY, Liu CH, Lin CH, Lu CJ, Li CY. Effectiveness of the WHO-Authorized COVID-19 Vaccines: A Rapid Review of Global Reports till 30 June 2021. Vaccines (Basel) 2021; 9:1489. [PMID: 34960235 PMCID: PMC8708265 DOI: 10.3390/vaccines9121489] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/01/2021] [Accepted: 12/13/2021] [Indexed: 01/06/2023] Open
Abstract
Large clinical trials have proven the efficacy of the COVID-19 vaccine, and the number of studies about the effectiveness rapidly grew in the first half of the year after mass vaccination was administrated globally. This rapid review aims to provide evidence syntheses as a means to complement the current evidence on the vaccine effectiveness (VE) against various outcomes in real-world settings. Databases (PubMed, EMBASE, and MedRxiv) were searched up to 30 June 2021, (PROSPERO ID: 266866). A total of 39 studies were included, covering over 15 million participants from 11 nations. Among the general population being fully vaccinated, the VE against symptomatic SARS-CoV-2 infection was estimated at 89-97%, 92% (95% CI, 78-97%), and 94% (95% CI, 86-97%) for BNT162b2, ChAdOx1, and mRNA-1273, respectively. As for the protective effects against B.1.617.2-related symptomatic infection, the VE was 88% (95% CI, 85.3-90.1%) by BNT162b2 and 67.0% (95% CI, 61.3-71.8%) by ChAdOx1 after full vaccination. This review revealed a consistently high effectiveness of certain vaccines among the general population in real-world settings. However, scarce data on the major variants of SARS-CoV-2 and the shortness of the study time may limit the conclusions to the mRNA vaccines and ChAdOx1.
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Affiliation(s)
- Chang-Jie Cheng
- Department of Neurology, En Chu Kong Hospital, New Taipei City 237, Taiwan; (C.-J.C.); (H.-J.C.); (C.-Y.L.); (C.-H.L.); (C.-H.L.); (C.-J.L.)
- Department of Neurology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chun-Yi Lu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei 100, Taiwan;
- College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
| | - Yu Sun
- Department of Neurology, En Chu Kong Hospital, New Taipei City 237, Taiwan; (C.-J.C.); (H.-J.C.); (C.-Y.L.); (C.-H.L.); (C.-H.L.); (C.-J.L.)
- Department of Neurology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Hai-Jui Chu
- Department of Neurology, En Chu Kong Hospital, New Taipei City 237, Taiwan; (C.-J.C.); (H.-J.C.); (C.-Y.L.); (C.-H.L.); (C.-H.L.); (C.-J.L.)
- Department of Neurology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chun-Yu Lee
- Department of Neurology, En Chu Kong Hospital, New Taipei City 237, Taiwan; (C.-J.C.); (H.-J.C.); (C.-Y.L.); (C.-H.L.); (C.-H.L.); (C.-J.L.)
- Department of Neurology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chang-Hsiu Liu
- Department of Neurology, En Chu Kong Hospital, New Taipei City 237, Taiwan; (C.-J.C.); (H.-J.C.); (C.-Y.L.); (C.-H.L.); (C.-H.L.); (C.-J.L.)
| | - Cheng-Huai Lin
- Department of Neurology, En Chu Kong Hospital, New Taipei City 237, Taiwan; (C.-J.C.); (H.-J.C.); (C.-Y.L.); (C.-H.L.); (C.-H.L.); (C.-J.L.)
| | - Chien-Jung Lu
- Department of Neurology, En Chu Kong Hospital, New Taipei City 237, Taiwan; (C.-J.C.); (H.-J.C.); (C.-Y.L.); (C.-H.L.); (C.-H.L.); (C.-J.L.)
- Department of Neurology, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
- Department of Public Health, College of Public Health, China Medical University, Taichung 404, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
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Group Vaccination Five Days before a COVID-19 Outbreak in a Long-Term Care Facility. Vaccines (Basel) 2021; 9:vaccines9121450. [PMID: 34960196 PMCID: PMC8707282 DOI: 10.3390/vaccines9121450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022] Open
Abstract
Rapid vaccination may be of benefit in long-term care facilities (LTCF) that are affected by an ongoing COVID-19 outbreak. However, there are concerns regarding the safety and effectiveness of such an approach, particularly regarding the vaccination of pre-symptomatic patients. Here, we report the effectiveness of vaccination in a German LTCF hit by an outbreak that was detected 5 days after the first vaccine doses were administered. In detail, 66.7% of the unvaccinated patients experienced an unfavorable course; this proportion was much lower (33.3%) among the vaccinated patients. Even though this study is limited by a small number of patients, the observation and the comparison with related published data shows that vaccination (i) is safe and (ii) may still be of benefit when given shortly before an infection or even in pre-symptomatic LTCF-patients.
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Trunfio M, Verga F, Ghisetti V, Burdino E, Emanuele T, Bonora S, Di Perri G, Calcagno A. Clinical Phenotype and Contagiousness of Early Breakthrough SARS-CoV-2 Infections after BNT162b2 COVID-19 mRNA Vaccine: A Parallel Cohort Study in Healthcare Workers. Vaccines (Basel) 2021; 9:vaccines9121377. [PMID: 34960123 PMCID: PMC8705309 DOI: 10.3390/vaccines9121377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 01/19/2023] Open
Abstract
We evaluated the clinical protection of BNT162b2 mRNA vaccine in healthcare workers (HCWs) and how COVID-19 manifestations and contagiousness change as the time since first dose increases. A matched (1:2 ratio) parallel cohort study was performed. During the first three months of vaccination campaign, HCWs of the entire health district ASL Città di Torino (Turin, Italy) were classified according to SARS-CoV-2-positivity in respect of the vaccination schedule: post-first-dose (fHCWs, <12 days), partially (PHCWs, ≥12 from first dose to ≤7 days after the second), and totally vaccinated (THCWs, ≥8 days after the second dose). Age-/sex-matched unvaccinated controls were randomly selected from all the SARS-CoV-2-positivity detected in the same district and period. Previous infections were excluded. Clinical and virologic data (ORF1ab gene cycle threshold values, Ct) were recorded. In total, 6800 HCWs received at least one dose, and 55 tested positive subsequently: 20 fHCWs, 25 PHCWs, 10 THCWs. Furthermore, 21.8% of breakthrough infections were in male, with a median age of 49 years (32–56), and 51.4% occurred while SARS-CoV-2 B.1.1.7 variant was predominant. The incident relative risk was 0.13 (0.12–0.15) for PHCWs and 0.06 (0.05–0.07) for THCWs. Compared to controls (n = 110), no difference was observed in fHCWs, while PHCWs and THCWs showed higher prevalence of asymptomatic infections, fewer signs/symptoms with a milder systemic involvement, and significantly higher Ct values (PHCWs 30.3 (24.1–35.5) vs. 22.3 (19.6–30.6), p = 0.023; THCWs 35.0 (31.3–35.9) vs. 22.5 (18.2–30.6), p = 0.024). Duration of symptoms was also shorter in THCWs (5 days (3–6) vs. 9 (7–14), p = 0.028). A linear increase of 3.81 points in Ct values was observed across the groups by vaccination status (p = 0.001) after adjusting for age, sex, comorbidities, and time between COVID-19 onset and swab collection. BNT162b2 decreased the risk of PCR-confirmed infections and severe disease, and was associated with a virologic picture of lesser epidemiologic concern as soon as 12 days after the first vaccine dose.
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Affiliation(s)
- Mattia Trunfio
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Corso Svizzera 164, 10159 Torino, Italy; (S.B.); (G.D.P.); (A.C.)
- Correspondence: ; Tel.: +39-011-439-3884
| | - Federica Verga
- Occupational Medicine Unit, Maria Vittoria Hospital, 10159 Torino, Italy; (F.V.); (T.E.)
| | - Valeria Ghisetti
- Microbiology and Molecular Biology Unit, Amedeo di Savoia Hospital, 10159 Torino, Italy; (V.G.); (E.B.)
| | - Elisa Burdino
- Microbiology and Molecular Biology Unit, Amedeo di Savoia Hospital, 10159 Torino, Italy; (V.G.); (E.B.)
| | - Teresa Emanuele
- Occupational Medicine Unit, Maria Vittoria Hospital, 10159 Torino, Italy; (F.V.); (T.E.)
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Corso Svizzera 164, 10159 Torino, Italy; (S.B.); (G.D.P.); (A.C.)
| | - Giovanni Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Corso Svizzera 164, 10159 Torino, Italy; (S.B.); (G.D.P.); (A.C.)
| | - Andrea Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Corso Svizzera 164, 10159 Torino, Italy; (S.B.); (G.D.P.); (A.C.)
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Kandimalla R, Chakraborty P, Vallamkondu J, Chaudhary A, Samanta S, Reddy PH, De Feo V, Dewanjee S. Counting on COVID-19 Vaccine: Insights into the Current Strategies, Progress and Future Challenges. Biomedicines 2021; 9:1740. [PMID: 34829969 PMCID: PMC8615473 DOI: 10.3390/biomedicines9111740] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 12/27/2022] Open
Abstract
The emergence of a novel coronavirus viz., severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late 2019 and its subsequent substantial spread produced the coronavirus disease 2019 (COVID-19) pandemic worldwide. Given its unprecedented infectivity and pathogenicity, the COVID-19 pandemic had a devastating impact on human health, and its clinical management has been a great challenge, which has led to the development and speedy trials of several vaccine candidates against SARS-CoV-2 at an exceptional pace. As a result, several COVID-19 vaccines were made commercially available in the first half of 2021. Although several COVID-19 vaccines showed promising results, crucial insights into their epidemiology, protective mechanisms, and the propensities of reinfection are not largely reviewed. In the present report, we provided insights into the prospects of vaccination against COVID-19 and assessed diverse vaccination strategies including DNA, mRNA, protein subunits, vector-based, live attenuated, and inactivated whole/viral particle-based vaccines. Next, we reviewed major aspects of various available vaccines approved by the World Health Organization and by the local administrations to use against COVID-19. Moreover, we comprehensively assessed the success of these approved vaccines and also their untoward effects, including the possibility of reinfection. We also provided an update on the vaccines that are under development and could be promising candidates in the future. Conclusively, we provided insights into the COVID-19 vaccine epidemiology, their potency, and propensity for SARS-CoV-2 reinfection, while a careful review of their current status, strategies, success, and future challenges was also presented.
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Affiliation(s)
- Ramesh Kandimalla
- Applied Biology, CSIR-Indian Institute of Technology, Uppal Road, Tarnaka, Hyderabad 500007, Telangana, India
- Department of Biochemistry, Kakatiya Medical College, Warangal 506007, Telangana, India
| | - Pratik Chakraborty
- Advanced Pharmacognosy Research Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata 700032, West Bengal, India;
| | | | - Anupama Chaudhary
- Orinin-BioSystems, LE-52, Lotus Road 4, CHD City, Karnal 132001, Haryana, India;
| | - Sonalinandini Samanta
- Department of Dermatology (Skin & Venereology), ESIC Medical College & Hospital, Patna 801103, Bihar, India;
| | - P. Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA;
- Department of Neuroscience & Pharmacology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Neurology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Public Health Department of Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
- Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Vincenzo De Feo
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy
| | - Saikat Dewanjee
- Advanced Pharmacognosy Research Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata 700032, West Bengal, India;
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Machado BAS, Hodel KVS, Fonseca LMDS, Mascarenhas LAB, Andrade LPCDS, Rocha VPC, Soares MBP, Berglund P, Duthie MS, Reed SG, Badaró R. The Importance of RNA-Based Vaccines in the Fight against COVID-19: An Overview. Vaccines (Basel) 2021; 9:1345. [PMID: 34835276 PMCID: PMC8623509 DOI: 10.3390/vaccines9111345] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/02/2021] [Accepted: 11/15/2021] [Indexed: 12/23/2022] Open
Abstract
In recent years, vaccine development using ribonucleic acid (RNA) has become the most promising and studied approach to produce safe and effective new vaccines, not only for prophylaxis but also as a treatment. The use of messenger RNA (mRNA) as an immunogenic has several advantages to vaccine development compared to other platforms, such as lower coast, the absence of cell cultures, and the possibility to combine different targets. During the COVID-19 pandemic, the use of mRNA as a vaccine became more relevant; two out of the four most widely applied vaccines against COVID-19 in the world are based on this platform. However, even though it presents advantages for vaccine application, mRNA technology faces several pivotal challenges to improve mRNA stability, delivery, and the potential to generate the related protein needed to induce a humoral- and T-cell-mediated immune response. The application of mRNA to vaccine development emerged as a powerful tool to fight against cancer and non-infectious and infectious diseases, for example, and represents a relevant research field for future decades. Based on these advantages, this review emphasizes mRNA and self-amplifying RNA (saRNA) for vaccine development, mainly to fight against COVID-19, together with the challenges related to this approach.
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Affiliation(s)
- Bruna Aparecida Souza Machado
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador 41650-010, Brazil; (K.V.S.H.); (L.M.d.S.F.); (L.A.B.M.); (L.P.C.d.S.A.); (V.P.C.R.); (M.B.P.S.); (R.B.)
| | - Katharine Valéria Saraiva Hodel
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador 41650-010, Brazil; (K.V.S.H.); (L.M.d.S.F.); (L.A.B.M.); (L.P.C.d.S.A.); (V.P.C.R.); (M.B.P.S.); (R.B.)
| | - Larissa Moraes dos Santos Fonseca
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador 41650-010, Brazil; (K.V.S.H.); (L.M.d.S.F.); (L.A.B.M.); (L.P.C.d.S.A.); (V.P.C.R.); (M.B.P.S.); (R.B.)
| | - Luís Alberto Brêda Mascarenhas
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador 41650-010, Brazil; (K.V.S.H.); (L.M.d.S.F.); (L.A.B.M.); (L.P.C.d.S.A.); (V.P.C.R.); (M.B.P.S.); (R.B.)
| | - Leone Peter Correia da Silva Andrade
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador 41650-010, Brazil; (K.V.S.H.); (L.M.d.S.F.); (L.A.B.M.); (L.P.C.d.S.A.); (V.P.C.R.); (M.B.P.S.); (R.B.)
| | - Vinícius Pinto Costa Rocha
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador 41650-010, Brazil; (K.V.S.H.); (L.M.d.S.F.); (L.A.B.M.); (L.P.C.d.S.A.); (V.P.C.R.); (M.B.P.S.); (R.B.)
| | - Milena Botelho Pereira Soares
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador 41650-010, Brazil; (K.V.S.H.); (L.M.d.S.F.); (L.A.B.M.); (L.P.C.d.S.A.); (V.P.C.R.); (M.B.P.S.); (R.B.)
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador 40296-710, Brazil
| | - Peter Berglund
- HDT Bio, 1616 Eastlake Ave E, Seattle, WA 98102, USA; (P.B.); (M.S.D.); (S.G.R.)
| | - Malcolm S. Duthie
- HDT Bio, 1616 Eastlake Ave E, Seattle, WA 98102, USA; (P.B.); (M.S.D.); (S.G.R.)
| | - Steven G. Reed
- HDT Bio, 1616 Eastlake Ave E, Seattle, WA 98102, USA; (P.B.); (M.S.D.); (S.G.R.)
| | - Roberto Badaró
- SENAI Institute of Innovation (ISI) in Health Advanced Systems (CIMATEC ISI SAS), University Center SENAI/CIMATEC, Salvador 41650-010, Brazil; (K.V.S.H.); (L.M.d.S.F.); (L.A.B.M.); (L.P.C.d.S.A.); (V.P.C.R.); (M.B.P.S.); (R.B.)
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48
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Talic S, Shah S, Wild H, Gasevic D, Maharaj A, Ademi Z, Li X, Xu W, Mesa-Eguiagaray I, Rostron J, Theodoratou E, Zhang X, Motee A, Liew D, Ilic D. Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis. BMJ 2021; 375:e068302. [PMID: 34789505 PMCID: PMC9423125 DOI: 10.1136/bmj-2021-068302] [Citation(s) in RCA: 259] [Impact Index Per Article: 86.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To review the evidence on the effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, Embase, CINAHL, Biosis, Joanna Briggs, Global Health, and World Health Organization COVID-19 database (preprints). ELIGIBILITY CRITERIA FOR STUDY SELECTION Observational and interventional studies that assessed the effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality. MAIN OUTCOME MEASURES The main outcome measure was incidence of covid-19. Secondary outcomes included SARS-CoV-2 transmission and covid-19 mortality. DATA SYNTHESIS DerSimonian Laird random effects meta-analysis was performed to investigate the effect of mask wearing, handwashing, and physical distancing measures on incidence of covid-19. Pooled effect estimates with corresponding 95% confidence intervals were computed, and heterogeneity among studies was assessed using Cochran's Q test and the I2 metrics, with two tailed P values. RESULTS 72 studies met the inclusion criteria, of which 35 evaluated individual public health measures and 37 assessed multiple public health measures as a "package of interventions." Eight of 35 studies were included in the meta-analysis, which indicated a reduction in incidence of covid-19 associated with handwashing (relative risk 0.47, 95% confidence interval 0.19 to 1.12, I2=12%), mask wearing (0.47, 0.29 to 0.75, I2=84%), and physical distancing (0.75, 0.59 to 0.95, I2=87%). Owing to heterogeneity of the studies, meta-analysis was not possible for the outcomes of quarantine and isolation, universal lockdowns, and closures of borders, schools, and workplaces. The effects of these interventions were synthesised descriptively. CONCLUSIONS This systematic review and meta-analysis suggests that several personal protective and social measures, including handwashing, mask wearing, and physical distancing are associated with reductions in the incidence covid-19. Public health efforts to implement public health measures should consider community health and sociocultural needs, and future research is needed to better understand the effectiveness of public health measures in the context of covid-19 vaccination. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020178692.
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Affiliation(s)
- Stella Talic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
- Monash Outcomes Research and health Economics (MORE) Unit, Monash University, VIC, Australia
| | - Shivangi Shah
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
| | - Holly Wild
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
- Torrens University, VIC, Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ashika Maharaj
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
- Monash Outcomes Research and health Economics (MORE) Unit, Monash University, VIC, Australia
| | - Xue Li
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Public Health and The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Xu
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ines Mesa-Eguiagaray
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jasmin Rostron
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Evropi Theodoratou
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Xiaomeng Zhang
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ashmika Motee
- Centre for Global Health, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
- Monash Outcomes Research and health Economics (MORE) Unit, Monash University, VIC, Australia
| | - Dragan Ilic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004 VIC, Australia
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49
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Au J. Higher Vaccination Rate Predicts Reduction in SARS-CoV-2 Transmission across the United States. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.11.14.21266325. [PMID: 34816265 PMCID: PMC8609904 DOI: 10.1101/2021.11.14.21266325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began proliferating widely throughout the world in late 2019/early 2020, creating a global pandemic and health crisis. Although vaccines became available to the public approximately one year after the onset of the pandemic, there still remains much hesitancy surrounding vaccination even two years into the pandemic. One key concern comes from reports of breakthrough infections among the vaccinated that show comparable levels of peak viral load as the unvaccinated, calling into question the ability of vaccines to slow or prevent transmission. Therefore young, healthy individuals who are at low risk of serious complications themselves have little incentive to receive a vaccine that they are not convinced will protect others around them. To address this important concern, this article analyzes COVID-19 incidence in the United States as a function of each state's vaccination rate. Results show that states with higher percentages of fully vaccinated individuals report fewer new cases among the remaining unvaccinated population. These data add to accumulating evidence that COVID-19 vaccinations can indeed slow the spread of SARS-CoV-2, and are an important tool in society's arsenal to put this pandemic behind us.
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Affiliation(s)
- Jacky Au
- School of Education, University of California, Irvine, Irvine CA, 92697, USA
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50
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Ting M, Suzuki JB. SARS-CoV-2: Overview and Its Impact on Oral Health. Biomedicines 2021; 9:biomedicines9111690. [PMID: 34829919 PMCID: PMC8615973 DOI: 10.3390/biomedicines9111690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 12/23/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its virulent variants causing coronavirus disease 2019 (COVID-19) COVID-19 has spread rapidly worldwide, and is highly contagious. A comprehensive search was conducted for the most current published information about SARS-CoV-2, COVID-19, and oral health. Clinical studies, case reports, in vivo studies, and any current published evidence on SARS-CoV-2 and COVID-19 were included in this review. Survival against SARS-CoV-2 infection may be partially dependent on periodontal health, good oral hygiene, and access to dental care. Optimum oral health, maintaining good systemic health, and elimination of smoking habits may be beneficial for the prevention and management of COVID-19 infections.
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Affiliation(s)
- Miriam Ting
- Think Dental Learning Institute, Paoli, PA 19301, USA
- Correspondence: ; Tel.: +1-610-601-8898
| | - Jon B. Suzuki
- School of Medicine and School of Dentistry, University of Maryland, Baltimore, MD 20742, USA;
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