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Kassanjee R, Davies MA, Heekes A, Mahomed H, Hawkridge AJ, Morden E, Jacobs T, Cohen C, Moultrie H, Lessells RJ, Van Der Walt N, Arendse JO, Wolter N, Walaza S, Jassat W, von Gottberg A, Hannan PL, Feikin DR, Cloete K, Boulle A. COVID-19 Vaccine Uptake and Effectiveness by Time since Vaccination in the Western Cape Province, South Africa: An Observational Cohort Study during 2020-2022. Vaccines (Basel) 2024; 12:628. [PMID: 38932357 PMCID: PMC11209070 DOI: 10.3390/vaccines12060628] [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: 04/14/2024] [Revised: 05/10/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024] Open
Abstract
There are few data on the real-world effectiveness of COVID-19 vaccines and boosting in Africa, which experienced widespread SARS-CoV-2 infection before vaccine availability. We assessed the association between vaccination and severe COVID-19 in the Western Cape, South Africa, in an observational cohort study of >2 million adults during 2020-2022. We described SARS-CoV-2 testing, COVID-19 outcomes, and vaccine uptake over time. We used multivariable cox models to estimate the association of BNT162b2 and Ad26.COV2.S vaccination with COVID-19-related hospitalization and death, adjusting for demographic characteristics, underlying health conditions, socioeconomic status proxies, and healthcare utilization. We found that by the end of 2022, 41% of surviving adults had completed vaccination and 8% had received a booster dose. Recent vaccination was associated with notable reductions in severe COVID-19 during periods dominated by Delta, and Omicron BA.1/2 and BA.4/5 (sub)lineages. During the latest Omicron BA.4/5 wave, within 3 months of vaccination or boosting, BNT162b2 and Ad26.COV2.S were each 84% effective against death (95% CIs: 57-94 and 49-95, respectively). However, distinct reductions of effectiveness occurred at longer times post completing or boosting vaccination. Results highlight the importance of continued emphasis on COVID-19 vaccination and boosting for those at high risk of severe COVID-19, even in settings with widespread infection-induced immunity.
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Affiliation(s)
- Reshma Kassanjee
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (M.-A.D.); (A.H.); (A.B.)
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (M.-A.D.); (A.H.); (A.B.)
- Division of Public Health Medicine, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- Centre for Infectious Diseases Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- Health Intelligence, Western Cape Department of Health and Wellness, Cape Town 8000, South Africa; (E.M.); (T.J.)
| | - Alexa Heekes
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (M.-A.D.); (A.H.); (A.B.)
- Health Intelligence, Western Cape Department of Health and Wellness, Cape Town 8000, South Africa; (E.M.); (T.J.)
| | - Hassan Mahomed
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa; (H.M.); (J.O.A.)
- Metro Health Services, Western Cape Department of Health and Wellness, Cape Town 8000, South Africa
| | - Anthony J. Hawkridge
- Rural Health Services, Western Cape Department of Health and Wellness, Cape Town 8000, South Africa;
| | - Erna Morden
- Health Intelligence, Western Cape Department of Health and Wellness, Cape Town 8000, South Africa; (E.M.); (T.J.)
- School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Theuns Jacobs
- Health Intelligence, Western Cape Department of Health and Wellness, Cape Town 8000, South Africa; (E.M.); (T.J.)
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg 2192, South Africa; (C.C.); (N.W.); (S.W.); (A.v.G.)
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Harry Moultrie
- Centre for Tuberculosis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg 2192, South Africa;
| | - Richard J. Lessells
- KwaZulu-Natal Research Innovation & Sequencing Platform, University of KwaZulu-Natal, Durban 4001, South Africa;
| | - Nicolette Van Der Walt
- Emergency & Clinical Services Support, Western Cape Department of Health and Wellness, Cape Town 8000, South Africa;
| | - Juanita O. Arendse
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa; (H.M.); (J.O.A.)
- Emergency & Clinical Services Support, Western Cape Department of Health and Wellness, Cape Town 8000, South Africa;
| | - Nicole Wolter
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg 2192, South Africa; (C.C.); (N.W.); (S.W.); (A.v.G.)
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Sibongile Walaza
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg 2192, South Africa; (C.C.); (N.W.); (S.W.); (A.v.G.)
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Waasila Jassat
- Health Practice, Genesis Analytics, Johannesburg 2196, South Africa;
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg 2192, South Africa
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg 2192, South Africa; (C.C.); (N.W.); (S.W.); (A.v.G.)
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Patrick L. Hannan
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa;
| | - Daniel R. Feikin
- Department of Immunizations, Vaccines, and Biologicals, World Health Organization, CH-1211 Geneva, Switzerland;
| | - Keith Cloete
- Western Cape Department of Health and Wellness, Cape Town 8000, South Africa;
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa; (M.-A.D.); (A.H.); (A.B.)
- Division of Public Health Medicine, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- Centre for Infectious Diseases Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- Health Intelligence, Western Cape Department of Health and Wellness, Cape Town 8000, South Africa; (E.M.); (T.J.)
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Panero MS, Khuri-Bulos N, Biscayart C, Bonvehí P, Hayajneh W, Madhi SA. The role of National Immunization Technical Advisory Groups (NITAG) in strengthening health system governance: Lessons from three middle-income countries-Argentina, Jordan, and South Africa (2017-2018). Vaccine 2020; 38:7118-7128. [PMID: 32950303 PMCID: PMC10783979 DOI: 10.1016/j.vaccine.2020.08.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Toward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance. METHODS In 2017-2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC). RESULTS Document review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation. CONCLUSIONS Systematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making.
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Affiliation(s)
- Maria S Panero
- US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Cristián Biscayart
- Dirección de Control de Enfermedades Inmunoprevenibles, Ministerio de Salud de la Nación, Argentina
| | - Pablo Bonvehí
- Sociedad Argentina de Infectología, Buenos Aires, Argentina
| | | | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Impact of HIV status and vaccination schedule on bacterial nasopharyngeal carriage following infant immunisation with the pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine in South Africa. Vaccine 2020; 38:2350-2360. [PMID: 32035706 DOI: 10.1016/j.vaccine.2020.01.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Nasopharyngeal carriage (NPC) of Streptococcus pneumoniae is a precondition for pneumococcal disease and a source of transmission. This trial evaluated NPC of S. pneumoniae and other pathogens post-vaccination with the pneumococcal non-typeable Haemophilus influenzae (NTHi) protein D conjugate vaccine (PHiD-CV) in human immunodeficiency virus (HIV)-infected (HIV+), HIV-exposed-uninfected (HEU), and HIV-unexposed-uninfected (HUU) South African children. METHODS In this phase III, open, single-centre, controlled study (ClinicalTrials.gov: NCT00829010), 484 children were stratified by HIV status: 83 HIV+, 101 HEU, and 300 HUU. HIV+ and HEU children received a 3 + 1 PHiD-CV vaccination schedule: primary vaccination, age 6/10/14 weeks, and booster dose, age 9-10 months. HUU infants were randomised (1:1:1) to 3-dose priming and booster (HUU/3+1); 3-dose priming without booster (HUU/3+0); or 2-dose priming and booster (HUU/2+1). Bacterial NPC was assessed 8 times up to 24-27 months of age. RESULTS Overall pneumococcal carriage rates were similar across 3+1 groups irrespective of HIV status; trends towards higher carriage rates in the HIV+ than HEU and HUU/3+1 groups were observed at 24-27 months of age. In HUU children, carriage of any pneumococcal serotype was similar for the three different dosing schedules at all timepoints; carriage of vaccine-type pneumococci tended to be lower at 16-19 months and 24-27 months of age in children who had received a booster dose (HUU/2+1 and HUU/3+1 groups) than in the HUU/3+0 group. Carriage rates of NTHi, Staphylococcus aureus and Moraxella catarrhalis were comparable between all groups. CONCLUSIONS HIV infection or exposure did not seem to alter the effect of PHiD-CV on pneumococcal NPC in children during their first 2 years of life. NPC prevalence of vaccine-type pneumococci following vaccination series tended to be lower in children who had received a booster dose in comparison to those who had not.
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Madhi SA, Koen A, Jose L, Moreira M, van Niekerk N, Cutland C, François N, Ruiz-Guiñazú J, Yarzabal JP, Borys D, Schuerman L. Immunization with 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) according to different schedules in infants in South Africa: a phase III trial. Expert Rev Vaccines 2018; 16:641-656. [PMID: 28425818 DOI: 10.1080/14760584.2017.1321990] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Limited clinical data exists to assess differences between various infant pneumococcal conjugate vaccine schedules. In this trial, we evaluated immunogenicity of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) administered using 3 different immunization schedules in HIV unexposed-uninfected infants in South Africa. METHODS In this phase III, open, single-center, controlled study (clinicaltrials.gov: NCT00829010), 300 infants were randomized (1:1:1) to 1 of 3 PHiD-CV schedules: 3-dose priming and booster (3 + 1); 3-dose priming without booster (3 + 0); or 2-dose priming and booster (2 + 1). The booster was administered at 9-10 months of age. immune responses were assessed up to 21 months after primary vaccination. RESULTS Post-priming antibody levels tended to be lower in the 2 + 1 group. At 6 months post-priming, antibody concentrations and opsonophagocytic activity titers were within similar ranges after 2- or 3-dose priming. Robust increases were observed pre- to post-booster in the 3 + 1 and 2 + 1 groups. CONCLUSIONS PHiD-CV was immunogenic when administered in different schedules. Post-booster responses suggest effective immunological priming with both 2- and 3-dose primary series and support administration of the booster dose at 9-10 months of age.
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Affiliation(s)
- Shabir A Madhi
- a Medical Research Council: Respiratory and Meningeal Pathogens Research Unit , University of the Witwatersrand , Johannesburg , South Africa.,b Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases , University of the Witwatersrand , Johannesburg , South Africa.,c National Institute for Communicable Diseases: a division of National Health Laboratory Service , Johannesburg , South Africa
| | - Anthonet Koen
- a Medical Research Council: Respiratory and Meningeal Pathogens Research Unit , University of the Witwatersrand , Johannesburg , South Africa.,b Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases , University of the Witwatersrand , Johannesburg , South Africa
| | - Lisa Jose
- a Medical Research Council: Respiratory and Meningeal Pathogens Research Unit , University of the Witwatersrand , Johannesburg , South Africa.,b Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases , University of the Witwatersrand , Johannesburg , South Africa
| | | | - Nadia van Niekerk
- a Medical Research Council: Respiratory and Meningeal Pathogens Research Unit , University of the Witwatersrand , Johannesburg , South Africa.,b Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases , University of the Witwatersrand , Johannesburg , South Africa
| | - Clare Cutland
- a Medical Research Council: Respiratory and Meningeal Pathogens Research Unit , University of the Witwatersrand , Johannesburg , South Africa.,b Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases , University of the Witwatersrand , Johannesburg , South Africa
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Blau J, Sadr-Azodi N, Clementz M, Abeysinghe N, Cakmak N, Duclos P, Janusz C, Jauregui B, Mihigo R, Mosina L, Takashima Y, Senouci K. Indicators to assess National Immunization Technical Advisory Groups (NITAGs). Vaccine 2013; 31:2653-7. [PMID: 23398930 DOI: 10.1016/j.vaccine.2013.01.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 01/09/2013] [Accepted: 01/25/2013] [Indexed: 11/25/2022]
Abstract
A National Immunization Technical Advisory Group (NITAG) is an expert advisory committee that provides evidence-based recommendations to the Ministry of Health (MoH) to guide immunization programs and policies. The World Health Organization (WHO), the Initiative for Supporting National Independent Immunization and Vaccine Advisory Committees (SIVAC) at Agence de Médecine Préventive (AMP) and the US Centers for Disease Control and Prevention (US CDC) engaged NITAG stakeholders and technical partners in the development of indicators to assess the effectiveness of NITAGs. A list of 17 process, output and outcome indicators was developed and tested in 14 countries to determine whether they were understandable, feasible to collect, and useful for the countries. Based on the findings, a revised version of the indicators is proposed for self-assessment in the countries, as well as for global monitoring of the NITAGs.
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Affiliation(s)
- Julia Blau
- Agence de Médecine Préventive (AMP), 164 rue de Vaugirard, Paris 75015, France.
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