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Şahbudak Bal Z, Yildirim Arslan S, Guner Ozenen G, Şener Okur D, Kılıçaslan Ö, Demirbuga A, Afat Turgut E, Dalgıc N, Belet N, İnceli HB, Elvan-Tuz A, Tural Kara T, Bulbul B, Demirdag T, Çakıcı Ö, Bal A, Ergun D, Altug U, Arslan A, Kizmaz İsancli D, Hancerli Torun S, Çelik Ü, Yasar B, Erbas İC, Karadag Oncel E, Akbas A, Gudeloglu E, Şen S, Kacar P, Dede E, Petmezci E, Aksoy FD, Karbuz A, Öncel S, Tezer H, Devrim İ, Ciftci E, Hacimustafaoglu M, Kurugol Z. Adolescents With Breakthrough COVID-19 Infections Requiring Hospitalization: A Multicenter Retrospective Study. Cureus 2024; 16:e60940. [PMID: 38915988 PMCID: PMC11195320 DOI: 10.7759/cureus.60940] [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] [Accepted: 04/11/2024] [Indexed: 06/26/2024] Open
Abstract
Background Vaccines have the most important role in the battle against the COVID-19 pandemic. With the widespread use of vaccines, COVID-19 has remarkably declined. Adolescents were vaccinated after approvals for this age group, which was later than adults, and a nationwide vaccination program was implemented in August 2021 in Turkey for adolescents ≥12 years of age. Therefore, we aimed to determine the effects of the COVID-19 nationwide adolescent vaccination program on adolescent hospitalizations due to COVID-19 and multisystem inflammatory syndrome in children (MIS-C) by comparing two periods, including the vaccination period (VP) and the pre-VP (PVP). The second aim of this study is to compare the clinical features and disease severity of vaccine-breakthrough COVID-19 hospitalizations with unvaccinated individuals in the VP. Methods A retrospective multicenter study was conducted to determine and compare the number of hospitalizations due to COVID-19 and MIS-C between the VP (September 1, 2021, to August 31, 2022) and PVP (September 1, 2020, to August 31, 2021). We also compared the characteristics, risk factors, and outcomes of breakthrough infections of adolescents aged 12-18, which required hospitalization with the same age group of unvaccinated hospitalized individuals during the VP. Results During the study period, 3967 children (0-18 years) were hospitalized in the PVP and 5143 (0-18 years) in the VP. Of them, 35.4% were adolescents (12-18 years) in the PVP, and this rate was 18.6% in the VP; relative risk was 0.6467 (95% confidence interval [CI]: 0.6058-0.6904; p < 0.001). Patients with breakthrough COVID-19 were older (201 vs. 175 months, p < 0.001) and less commonly hospitalized for COVID-19 (81.5% vs. 60.4%, p < 0.001, odds ratio [OR]: 0.347 [95% CI: 0.184-0.654]). The majority of these infections were asymptomatic and mild (32% vs.72.9%: p < 0.001, OR: 5.718 [95% CI: 2.920-11.200]), and PICU admission was less frequently required (p = 0.011, OR: 0.188 [95% CI: 0.045-0.793]). Most breakthrough COVID-19 infections occurred within three months after the last vaccine dose (54.2%). Conclusions This study demonstrated a significant decrease in adolescent hospitalizations due to COVID-19 and MIS-C after implementing COVID-19 vaccines in Turkey. Breakthrough cases were less severe and mostly occurred three months after the last dose. This study emphasizes the importance of COVID-19 vaccines and that parents' decisions may be changed, particularly those who hesitate to or refuse vaccination.
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Affiliation(s)
- Zümrüt Şahbudak Bal
- Department of Pediatric Infectious Diseases, Ege University Faculty of Medicine, İzmir, TUR
| | - Sema Yildirim Arslan
- Department of Pediatric Infectious Diseases, Ege University Faculty of Medicine, İzmir, TUR
| | - Gizem Guner Ozenen
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, TUR
| | - Dicle Şener Okur
- Department of Pediatric Infectious Diseases, Pamukkale University, Denizli, TUR
| | - Önder Kılıçaslan
- Department of Pediatric Infectious Diseases, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, TUR
| | - Asuman Demirbuga
- Department of Pediatric Infectious Diseases, Istanbul University School of Medicine, İstanbul, TUR
| | - Elif Afat Turgut
- Department of Pediatric Infectious Diseases, Adana City Training Hospital, Adana, TUR
| | - Nazan Dalgıc
- Department of Pediatrics, Division of Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, TUR
| | - Nursen Belet
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Dokuz Eylül University, İzmir, TUR
| | - Hatice Belkis İnceli
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Ankara University, Ankara, TUR
| | - Aysegul Elvan-Tuz
- Department of Pediatrics, Division of Infectious Diseases, Health Sciences University Tepecik Training and Research Hospital, İzmir, TUR
| | - Tugce Tural Kara
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Akdeniz University, Antalya, TUR
| | - Beyhan Bulbul
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Uludag University, Bursa, TUR
| | - Tugba Demirdag
- Department of Pediatric Infectious Diseases, Gazi University, Ankara, TUR
| | - Özlem Çakıcı
- Department of Pediatrics and Child Health, Division of Pediatric Infectious Diseases, Section of Internal Medical Sciences, Faculty of Medicine, Kocaeli University, Izmit, TUR
| | - Alkan Bal
- Department of Pediatric Emergency, Manisa Celal Bayar University Faculty of Medicine, Manisa, TUR
| | - Deniz Ergun
- Department of Pediatrics, Division of Infectious Diseases, University of Health Sciences Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, TUR
| | - Umut Altug
- Department of Pediatrics, Medical School of Pamukkale University, Denizli, TUR
| | - Asli Arslan
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Ege University, İzmir, TUR
| | - Didem Kizmaz İsancli
- Department of Pediatrics, Division of Infectious Diseases, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, TUR
| | - Selda Hancerli Torun
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Istanbul University, İstanbul, TUR
| | - Ümit Çelik
- Department of Pediatrics, Division of Infectious Diseases, Adana City Hospital, Adana, TUR
| | - Belma Yasar
- Department of Pediatrics, Division of Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, TUR
| | - İrem Ceren Erbas
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Dokuz Eylül University, İzmir, TUR
| | - Eda Karadag Oncel
- Department of Pediatrics, Division of Infectious Diseases, Health Sciences University Tepecik Training and Research Hospital, İzmir, TUR
| | - Ali Akbas
- Department of Pediatrics, Medical School of Akdeniz University, Antalya, TUR
| | - Elif Gudeloglu
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Gazi University, Ankara, TUR
| | - Semra Şen
- Department of Pediatrics, Division of Infectious Diseases, Manisa Celal Bayar University, Manisa, TUR
| | - Pelin Kacar
- Department of Pediatrics, Division of Infectious Diseases, University of Health Sciences Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, TUR
| | - Elif Dede
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Istanbul University, İstanbul, TUR
| | - Ercument Petmezci
- Department of Pediatrics, Division of Intensive Care Unit, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, TUR
| | - Fatma Dilsad Aksoy
- Department of Pediatrics, Medical School of Uludag University, Bursa, TUR
| | - Adem Karbuz
- Department of Pediatric Infectious Diseases, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, TUR
| | - Selim Öncel
- Department of Pediatrics and Child Health, Division of Pediatric Infectious Diseases, Section of Internal Medical Sciences, Faculty of Medicine, Kocaeli University, Izmit, TUR
| | - Hasan Tezer
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Gazi University, Ankara, TUR
| | - İlker Devrim
- Department of Pediatrics, Division of Infectious Diseases, University of Health Sciences Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, TUR
| | - Ergin Ciftci
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Ankara University, Ankara, TUR
| | | | - Zafer Kurugol
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Ege University, İzmir, TUR
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Porru S, Monaco MGL, Spiteri G, Carta A, Caliskan G, Violán C, Torán-Monserrat P, Vimercati L, Tafuri S, Boffetta P, Violante FS, Sala E, Sansone E, Gobba F, Casolari L, Wieser A, Janke C, Tardon A, Rodriguez-Suarez MM, Liviero F, Scapellato ML, dell'Omo M, Murgia N, Mates D, Calota VC, Strhársky J, Mrázová M, Pira E, Godono A, Magnano GC, Negro C, Verlato G. Incidence and Determinants of Symptomatic and Asymptomatic SARS-CoV-2 Breakthrough Infections After Booster Dose in a Large European Multicentric Cohort of Health Workers-ORCHESTRA Project. J Epidemiol Glob Health 2023; 13:577-588. [PMID: 37480426 PMCID: PMC10468456 DOI: 10.1007/s44197-023-00139-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/05/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND SARS-CoV-2 breakthrough infections (BI) after vaccine booster dose are a relevant public health issue. METHODS Multicentric longitudinal cohort study within the ORCHESTRA project, involving 63,516 health workers (HW) from 14 European settings. The study investigated the cumulative incidence of SARS-CoV-2 BI after booster dose and its correlation with age, sex, job title, previous infection, and time since third dose. RESULTS 13,093 (20.6%) BI were observed. The cumulative incidence of BI was higher in women and in HW aged < 50 years, but nearly halved after 60 years. Nurses experienced the highest BI incidence, and administrative staff experienced the lowest. The BI incidence was higher in immunosuppressed HW (28.6%) vs others (24.9%). When controlling for gender, age, job title and infection before booster, heterologous vaccination reduced BI incidence with respect to the BNT162b2 mRNA vaccine [Odds Ratio (OR) 0.69, 95% CI 0.63-0.76]. Previous infection protected against asymptomatic infection [Relative Risk Ratio (RRR) of recent infection vs no infection 0.53, 95% CI 0.23-1.20] and even more against symptomatic infections [RRR 0.11, 95% CI 0.05-0.25]. Symptomatic infections increased from 70.5% in HW receiving the booster dose since < 64 days to 86.2% when time elapsed was > 130 days. CONCLUSIONS The risk of BI after booster is significantly reduced by previous infection, heterologous vaccination, and older ages. Immunosuppression is relevant for increased BI incidence. Time elapsed from booster affects BI severity, confirming the public health usefulness of booster. Further research should focus on BI trend after 4th dose and its relationship with time variables across the epidemics.
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Affiliation(s)
- Stefano Porru
- Section of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, 37134, Verona, Italy
- Occupational Medicine Unit, University Hospital of Verona, 37134, Verona, Italy
| | | | - Gianluca Spiteri
- Occupational Medicine Unit, University Hospital of Verona, 37134, Verona, Italy.
| | - Angela Carta
- Section of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, 37134, Verona, Italy
- Occupational Medicine Unit, University Hospital of Verona, 37134, Verona, Italy
| | - Gulser Caliskan
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134, Verona, Italy
| | - Concepción Violán
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Unitat de Suport a la Recerca Metropolitana Nord, Mare de Déu de Guadalupe 2, Planta 1ª, Mataro, 08303, Barcelona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Camí de les Escoles, S/N, Badalona, 08916, Barcelona, Spain
| | - Pere Torán-Monserrat
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Unitat de Suport a la Recerca Metropolitana Nord, Mare de Déu de Guadalupe 2, Planta 1ª, Mataro, 08303, Barcelona, Spain
- Germans Trias i Pujol Research Institute (IGTP), Camí de les Escoles, S/N, Badalona, 08916, Barcelona, Spain
| | - Luigi Vimercati
- Interdisciplinary Department of Medicine, University of Bari, 70124, Bari, Italy
| | - Silvio Tafuri
- Interdisciplinary Department of Medicine, University of Bari, 70124, Bari, Italy
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Emma Sala
- Unit of Occupational Health, Hygiene, Toxicology and Prevention, University Hospital ASST Spedali Civili, 25123, Brescia, Italy
| | - Emanuele Sansone
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Occupational Health and Industrial Hygiene, University of Brescia, 25123, Brescia, Italy
| | - Fabriziomaria Gobba
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125, Modena, Italy
| | - Loretta Casolari
- Health Surveillance Service, University Hospital of Modena, 41125, Modena, Italy
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site , 81377, Munich, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, 80799, Munich, Germany
- Max Von Pettenkofer Institute, Faculty of Medicine, LMU Munich, 80336, Munich, Germany
| | - Christian Janke
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, 80802, Munich, Germany
| | - Adonina Tardon
- University of Oviedo, Health Research Institute of Asturias (ISPA) and CIBERESP, Asturias, Spain
| | | | - Filippo Liviero
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padua, Italy
- University Hospital of Padova, 35128, Padua, Italy
| | - Maria Luisa Scapellato
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padua, Italy
- University Hospital of Padova, 35128, Padua, Italy
| | - Marco dell'Omo
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, Department of Medicine and Surgery, University of Perugia, 06123, Perugia, Italy
| | - Nicola Murgia
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121, Ferrara, Italy
| | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | | | - Jozef Strhársky
- Medical Microbiology Department, Regional Authority of Public Health, 97556, Banská Bystrica, Slovakia
| | - Mariana Mrázová
- Public Health Institute, St. Elizabeth University of Health and Social Work, 81106, Bratislava, Slovakia
| | - Enrico Pira
- Department of Public Health and Pediatrics, University of Torino, 10126, Turin, Italy
| | - Alessandro Godono
- Department of Public Health and Pediatrics, University of Torino, 10126, Turin, Italy
| | - Greta Camilla Magnano
- Department of Medical Sciences, Unit of Occupational Medicine, University of Trieste, 34129, Trieste, Italy
| | - Corrado Negro
- Department of Medical Sciences, Unit of Occupational Medicine, University of Trieste, 34129, Trieste, 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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