1
|
Chemaitelly H, Akhtar N, Jerdi SA, Kamran S, Joseph S, Morgan D, Uy R, Abid FB, Al-Khal A, Bertollini R, Abou-Samra AB, Butt AA, Abu-Raddad LJ. Association between COVID-19 vaccination and stroke: a nationwide case-control study in Qatar. Int J Infect Dis 2024; 145:107095. [PMID: 38777080 DOI: 10.1016/j.ijid.2024.107095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE This study investigated the association between Coronavirus Disease 2019 mRNA vaccination and stroke in Qatar. METHODS Between December 1, 2020, and April 11, 2023, a matched case-control study was conducted to investigate the association between 3036 acute stroke cases and 3036 controls drawn from the entire population of Qatar. RESULTS The adjusted odds ratio (aOR) for vaccination among cases compared to controls was 0.87 (95% CI: 0.75-1.00). The aOR was 0.74 (95% CI: 0.45-1.23) for a single vaccine dose, 0.87 (95% CI: 0.73-1.04) for primary-series vaccination (two doses), and 0.91 (95% CI: 0.66-1.25) for booster vaccination (three or more doses). The aOR was 0.87 (95% CI: 0.72-1.04) for BNT162b2 and 0.86 (95% CI: 0.67-1.11) for mRNA-1273. Subgroup analyses, considering different durations since vaccination, also demonstrated no association. Subgroup analyses based on nationality, age, number of coexisting conditions, or prior infection status yielded similar results. Subgroup analysis, stratified by stroke type, suggested an association between vaccination and cerebral venous sinus thrombosis (aOR of 2.50 [95% CI: 0.97-6.44]), but it did not reach statistical significance. CONCLUSION There was no evidence of an increased risk of stroke following vaccination, both in the short term and in the long term, extending beyond a year after receiving the vaccine.
Collapse
Affiliation(s)
- Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Naveed Akhtar
- Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar
| | - Salman Al Jerdi
- Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar; Department of Medical Education, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Saadat Kamran
- Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ryan Uy
- Neurosciences Institute, Hamad Medical Corporation, Doha, Qatar
| | - Fatma B Abid
- Department of Medical Education, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; Infectious Disease Division, Hamad Medical Corporation, Doha, Qatar; College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | | | - Abdul-Badi Abou-Samra
- Corporate Quality and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar
| | - Adeel A Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA; Corporate Quality and Patient Safety Department, Hamad Medical Corporation, Doha, Qatar; Department of Medicine, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York, USA; Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar; College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar.
| |
Collapse
|
2
|
Tang J, Wang Y, Lu W, Gao Z, Xu M, Wu L, Jin J. High SARS-CoV-2 infection rate in children unvaccinated with COVID-19 vaccine in Changzhou, China, shortly after lifting zero-COVID-19 policy in December 2022. BMC Infect Dis 2024; 24:560. [PMID: 38840046 PMCID: PMC11151613 DOI: 10.1186/s12879-024-09445-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND China experienced an overwhelming COVID-19 pandemic from middle December 2022 to middle January 2023 after lifting the zero-COVID-19 policy on December 7, 2022. However, the infection rate was less studied. We aimed to investigate the SARS-CoV-2 infection rate in children shortly after discontinuation of the zero-COVID-19 policy. METHODS From February 20 to April 10, 2023, we included 393 children aged 8 months to less than 3 years who did not receive COVID-19 vaccination and 114 children aged 3 to 6 years who received inactivated COVID-19 vaccines based on the convenience sampling in this cross-sectional study. IgG and IgM antibodies against nucleocapsid (N) and subunit 1 of spike (S1) of SARS-CoV-2 (anti-N/S1) were measured with commercial kits (Shenzhen YHLO Biotech, China). RESULTS Of the 393 unvaccinated children (1.5 ± 0.6 years; 52.2% boys), 369 (93.9%) were anti-N/S1 IgG positive. Of the 114 vaccinated children (5.3 ± 0.9 years; 48.2% boys), 112 (98.2%) were anti-N/S1 IgG positive. None of the unvaccinated or vaccinated children was anti-N/S1 IgM positive. The median IgG antibody titers in vaccinated children (344.91 AU/mL) were significantly higher than that in unvaccinated children (42.80 AU/mL) (P < 0.0001). The positive rates and titers of anti-N/S1 IgG had no significant difference between boys and girls respectively. CONCLUSION Vast majority of children were infected with SARS-CoV-2 shortly after ending zero-COVID-19 policy in China. Whether these unvaccinated infected children should receive COVID-19 vaccine merits further investigation.
Collapse
Affiliation(s)
- Jie Tang
- Department of Obstetrics and Gynecology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, 213017, China.
- Department of Obstetrics and Gynecology, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, 213017, China.
| | - Yong Wang
- Department of Clinical Laboratory, Wujin People's hospital, Changzhou, Jiangsu, 213017, China
| | - Weiqin Lu
- Department of Respiratory Diseases, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, Jiangsu, 213003, China
| | - Zhihong Gao
- Department of Clinical Laboratory, Wujin People's hospital, Changzhou, Jiangsu, 213017, China
| | - Mingfeng Xu
- Department of Pediatrics, Wujin People's hospital, Changzhou, Jiangsu, 213017, China
| | - Lin Wu
- Department of Infection Management, Changzhou Hospital of Traditional Chinese Medicine, Changzhou, Jiangsu, 213003, China
| | - Jianhua Jin
- Department of Oncology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, 213017, China.
| |
Collapse
|
3
|
Sukik L, Chemaitelly H, Ayoub HH, Coyle P, Tang P, Yassine HM, Al Thani AA, Hasan MR, Al-Kanaani Z, Al-Kuwari E, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Abdul-Rahim HF, Nasrallah GK, Al-Kuwari MG, Butt AA, Al-Romaihi HE, Al-Thani MH, Al-Khal A, Bertollini R, Abdel-Rahman ME, Abu-Raddad LJ. Effectiveness of two and three doses of COVID-19 mRNA vaccines against infection, symptoms, and severity in the pre-omicron era: A time-dependent gradient. Vaccine 2024; 42:3307-3320. [PMID: 38616439 DOI: 10.1016/j.vaccine.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Vaccines were developed and deployed to combat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to characterize patterns in the protection provided by the BNT162b2 and mRNA-1273 mRNA vaccines against a spectrum of SARS-CoV-2 infection symptoms and severities. METHODS A national, matched, test-negative, case-control study was conducted in Qatar between January 1 and December 18, 2021, utilizing a sample of 238,896 PCR-positive tests and 6,533,739 PCR-negative tests. Vaccine effectiveness was estimated against asymptomatic, symptomatic, severe coronavirus disease 2019 (COVID-19), critical COVID-19, and fatal COVID-19 infections. Data sources included Qatar's national databases for COVID-19 laboratory testing, vaccination, hospitalization, and death. RESULTS Effectiveness of two-dose BNT162b2 vaccination was 75.6% (95% CI: 73.6-77.5) against asymptomatic infection and 76.5% (95% CI: 75.1-77.9) against symptomatic infection. Effectiveness against each of severe, critical, and fatal COVID-19 infections surpassed 90%. Immediately after the second dose, all categories-namely, asymptomatic, symptomatic, severe, critical, and fatal COVID-19-exhibited similarly high effectiveness. However, from 181 to 270 days post-second dose, effectiveness against asymptomatic and symptomatic infections declined to below 40%, while effectiveness against each of severe, critical, and fatal COVID-19 infections remained consistently high. However, estimates against fatal COVID-19 often had wide 95% confidence intervals. Analogous patterns were observed in three-dose BNT162b2 vaccination and two- and three-dose mRNA-1273 vaccination. Sensitivity analyses confirmed the results. CONCLUSION A gradient in vaccine effectiveness exists and is linked to the symptoms and severity of infection, providing higher protection against more symptomatic and severe cases. This gradient intensifies over time as vaccine immunity wanes after the last vaccine dose. These patterns appear consistent irrespective of the vaccine type or whether the vaccination involves the primary series or a booster.
Collapse
Affiliation(s)
- Layan Sukik
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Houssein H Ayoub
- Mathematics Program, Department of Mathematics and Statistics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Peter Coyle
- Hamad Medical Corporation, Doha, Qatar; Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar; Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, United Kingdom
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Asmaa A Al Thani
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Mohammad R Hasan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | | | | | | | | | | | | | - Hanan F Abdul-Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Gheyath K Nasrallah
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | | | - Adeel A Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA; Hamad Medical Corporation, Doha, Qatar; Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | | | | | | | | | - Manar E Abdel-Rahman
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA; College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar.
| |
Collapse
|
4
|
Chemaitelly H, Ayoub HH, Tang P, Yassine HM, Al Thani AA, Hasan MR, Coyle P, Al-Kanaani Z, Al-Kuwari E, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Abdul-Rahim HF, Nasrallah GK, Al-Kuwari MG, Butt AA, Al-Romaihi HE, Al-Thani MH, Al-Khal A, Bertollini R, Abu-Raddad LJ. Addressing bias in the definition of SARS-CoV-2 reinfection: implications for underestimation. Front Med (Lausanne) 2024; 11:1363045. [PMID: 38529118 PMCID: PMC10961414 DOI: 10.3389/fmed.2024.1363045] [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: 12/29/2023] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction Reinfections are increasingly becoming a feature in the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, accurately defining reinfection poses methodological challenges. Conventionally, reinfection is defined as a positive test occurring at least 90 days after a previous infection diagnosis. Yet, this extended time window may lead to an underestimation of reinfection occurrences. This study investigated the prospect of adopting an alternative, shorter time window for defining reinfection. Methods A longitudinal study was conducted to assess the incidence of reinfections in the total population of Qatar, from February 28, 2020 to November 20, 2023. The assessment considered a range of time windows for defining reinfection, spanning from 1 day to 180 days. Subgroup analyses comparing first versus repeat reinfections and a sensitivity analysis, focusing exclusively on individuals who underwent frequent testing, were performed. Results The relationship between the number of reinfections in the population and the duration of the time window used to define reinfection revealed two distinct dynamical domains. Within the initial 15 days post-infection diagnosis, almost all positive tests for SARS-CoV-2 were attributed to the original infection. However, surpassing the 30-day post-infection threshold, nearly all positive tests were attributed to reinfections. A 40-day time window emerged as a sufficiently conservative definition for reinfection. By setting the time window at 40 days, the estimated number of reinfections in the population increased from 84,565 to 88,384, compared to the 90-day time window. The maximum observed reinfections were 6 and 4 for the 40-day and 90-day time windows, respectively. The 40-day time window was appropriate for defining reinfection, irrespective of whether it was the first, second, third, or fourth occurrence. The sensitivity analysis, confined to high testers exclusively, replicated similar patterns and results. Discussion A 40-day time window is optimal for defining reinfection, providing an informed alternative to the conventional 90-day time window. Reinfections are prevalent, with some individuals experiencing multiple instances since the onset of the pandemic.
Collapse
Affiliation(s)
- Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Houssein H. Ayoub
- Mathematics Program, Department of Mathematics, Statistics, and Physics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha, Qatar
| | - Hadi M. Yassine
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Asmaa A. Al Thani
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Mohammad R. Hasan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Peter Coyle
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
- Hamad Medical Corporation, Doha, Qatar
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, United Kingdom
| | | | | | | | | | | | | | - Hanan F. Abdul-Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Gheyath K. Nasrallah
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | | | - Adeel A. Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, United States
- Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | | | | | | | | | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, United States
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
| |
Collapse
|
5
|
Atanasov V, Barreto N, Franchi L, Whittle J, Meurer J, Weston BW, Luo Q(E, Yuan AY, Zhang R, Black B. Evidence on COVID-19 Mortality and Disparities Using a Novel Measure, COVID excess mortality percentage: Evidence from Indiana, Wisconsin, and Illinois. PLoS One 2024; 19:e0295936. [PMID: 38295114 PMCID: PMC10829977 DOI: 10.1371/journal.pone.0295936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/30/2023] [Indexed: 02/02/2024] Open
Abstract
COVID-19 mortality rates increase rapidly with age, are higher among men than women, and vary across racial/ethnic groups, but this is also true for other natural causes of death. Prior research on COVID-19 mortality rates and racial/ethnic disparities in those rates has not considered to what extent disparities reflect COVID-19-specific factors, versus preexisting health differences. This study examines both questions. We study the COVID-19-related increase in mortality risk and racial/ethnic disparities in COVID-19 mortality, and how both vary with age, gender, and time period. We use a novel measure validated in prior work, the COVID Excess Mortality Percentage (CEMP), defined as the COVID-19 mortality rate (Covid-MR), divided by the non-COVID natural mortality rate during the same time period (non-Covid NMR), converted to a percentage. The CEMP denominator uses Non-COVID NMR to adjust COVID-19 mortality risk for underlying population health. The CEMP measure generates insights which differ from those using two common measures-the COVID-MR and the all-cause excess mortality rate. By studying both CEMP and COVID-MRMR, we can separate the effects of background health from Covid-specific factors affecting COVID-19 mortality. We study how CEMP and COVID-MR vary by age, gender, race/ethnicity, and time period, using data on all adult decedents from natural causes in Indiana and Wisconsin over April 2020-June 2022 and Illinois over April 2020-December 2021. CEMP levels for racial and ethnic minority groups can be very high relative to White levels, especially for Hispanics in 2020 and the first-half of 2021. For example, during 2020, CEMP for Hispanics aged 18-59 was 68.9% versus 7.2% for non-Hispanic Whites; a ratio of 9.57:1. CEMP disparities are substantial but less extreme for other demographic groups. Disparities were generally lower after age 60 and declined over our sample period. Differences in socio-economic status and education explain only a small part of these disparities.
Collapse
Affiliation(s)
- Vladimir Atanasov
- William & Mary, Mason School of Business, Williamsburg, Virginia, United States of America
| | - Natalia Barreto
- University of Illinois, Champaign-Urbana, Illinois, United States of America
| | - Lorenzo Franchi
- Northwestern University, Evanston, Illinois, United States of America
| | - Jeff Whittle
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - John Meurer
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Benjamin W. Weston
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Qian (Eric) Luo
- George Washington University, Washington, DC, United States of America
| | - Andy Ye Yuan
- Northwestern University, Pritzker School of Law, Evanston, Illinois, United States of America
| | - Ruohao Zhang
- Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Bernard Black
- Northwestern University, Pritzker School of Law and Kellogg School of Management, Evanston, Illinois, United States of America
| |
Collapse
|