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Akbari A, Torabi F, Bedston S, Lowthian E, Abbasizanjani H, Fry R, Lyons J, Owen RK, Khunti K, Lyons R. Exploring ethnicity dynamics in Wales: a longitudinal population-scale linked data study and development of a harmonised ethnicity spine. BMJ Open 2024; 14:e077675. [PMID: 39097317 DOI: 10.1136/bmjopen-2023-077675] [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] [Indexed: 08/05/2024] Open
Abstract
OBJECTIVE This study aims to create a national ethnicity spine based on all available ethnicity records in linkable anonymised electronic health record and administrative data sources. DESIGN A longitudinal study using anonymised individual-level population-scale ethnicity data from 26 data sources available within the Secure Anonymised Information Linkage Databank. SETTING The national ethnicity spine is created based on longitudinal national data for the population of Wales-UK over 22 years (between 2000 and 2021). PROCEDURE AND PARTICIPANTS A total of 46 million ethnicity records for 4 297 694 individuals have been extracted, harmonised, deduplicated and made available within a longitudinal research ready data asset. OUTCOME MEASURES (1) Comparing the distribution of ethnicity records over time for four different selection approaches (latest, mode, weighted mode and composite) across age bands, sex, deprivation quintiles, health board and residential location and (2) distribution and completeness of records against the ONS census 2011. RESULTS The distribution of the dominant group (white) is minimally affected based on the four different selection approaches. Across all other ethnic group categorisations, the mixed group was most susceptible to variation in distribution depending on the selection approach used and varied from a 0.6% prevalence across the latest and mode approach to a 1.1% prevalence for the weighted mode, compared with the 3.1% prevalence for the composite approach. Substantial alignment was observed with ONS 2011 census with the Latest group method (kappa=0.68, 95% CI (0.67 to 0.71)) across all subgroups. The record completeness rate was over 95% in 2021. CONCLUSION In conclusion, our development of the population-scale ethnicity spine provides robust ethnicity measures for healthcare research in Wales and a template which can easily be deployed in other trusted research environments in the UK and beyond.
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Affiliation(s)
- Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Emily Lowthian
- Population Data Science, Swansea University Medical School, Swansea, UK
| | | | - Richard Fry
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Rhiannon K Owen
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Ronan Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
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2
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Jiménez-Sepúlveda N, Gras-Valentí P, Chico-Sánchez P, Castro-García JM, Ronda-Pérez E, Vanaclocha H, Peiró S, Burgos JS, Ana Berenguer, Navarro D, Sánchez-Payá J. Effectiveness of mRNA booster doses in preventing infections and hospitalizations due to SARS-CoV-2 and its dominant variant over time in Valencian healthcare workers, Spain. Vaccine 2024; 42:4011-4021. [PMID: 38760269 DOI: 10.1016/j.vaccine.2024.05.011] [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: 02/15/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of SARS-CoV-2 mRNA vaccines in preventing infection and hospitalization among healthcare workers (HCWs) in the Valencian Community (Spain), considering vaccination timing, dose number, and predominant variant. METHODS A test-negative case-control design estimated vaccine effectiveness against symptomatic disease and hospitalization due to SARS-CoV-2. HCWs who underwent PCR or antigen testing for SARS-CoV-2 from January 2021 to March 2022 were included. Cases had a positive diagnostic test, while controls had negative tests. Adjusted vaccine effectiveness (aVE) was calculated using the formula: aVE = (1 - Odds ratio) × 100. RESULTS During the Delta variant's predominance, aVE against infection within 12-120 days post-second dose was 64.8 % (BNT162b2) and 59.4 % (mRNA-1273), declining to 21.2 % and 42.2 %, respectively, after 120 days. For the Omicron variant, aVE within 12-120 days post-second dose was 61.1 % (BNT162b2) and 85.1 % (mRNA-1273), decreasing to 36.7 % and 24.9 %, respectively, after 120 days. After a booster dose of mRNA-1273, aVE was 64.0 % (BNT162b2 recipients) and 65.9 % (initial mRNA-1273 recipients). Regardless of variant, aVE for hospitalization prevention after 2 doses was 87.0 % (BNT162b2) and 89.0 % (mRNA-1273). CONCLUSION The administration of two doses of Moderna-mRNA-1273 against SARS-CoV-2 in HCWs proved to be highly effective in preventing infections and hospitalizations in the first 120 days after the second dose during the predominance of the Omicron variant. The decline in VE after 120 days since the administration of the second dose was significantly restored by the booster dose administration. This increase in VE was greater for the Pfizer vaccine. COVID-19 hospitalization prevention remained stable with both mRNA vaccines throughout the study period.
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Affiliation(s)
- Natali Jiménez-Sepúlveda
- Epidemiology Unit, Preventive Medicine Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Paula Gras-Valentí
- Epidemiology Unit, Preventive Medicine Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain; Preventive Medicine and Public Health Area, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | - Pablo Chico-Sánchez
- Epidemiology Unit, Preventive Medicine Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain; Preventive Medicine and Public Health Area, Faculty of Health Sciences, University of Alicante, Alicante, Spain.
| | | | - Elena Ronda-Pérez
- Preventive Medicine and Public Health Area, Faculty of Health Sciences, University of Alicante, Alicante, Spain; Centre of Networked Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Hermelinda Vanaclocha
- General Directorate of Public Health, Department of Health, Valencia Government, Valencia, Spain
| | - Salvador Peiró
- Foundation for the Promotion of Health and Biomedical Research of the Valencian, Community (FISABIO), Valencia, Spain
| | - Javier S Burgos
- General Directorate of Research and Healthcare Supervision, Department of Health, Valencia Government, Valencia, Spain
| | - Ana Berenguer
- General Directorate of Analysis and Public Policy, Valencia Government, Valencia, Spain
| | - David Navarro
- Microbiology Service, Clinic University Hospital, INCLIVA Health Research Institute, Valencia, Spain; Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain
| | - José Sánchez-Payá
- Epidemiology Unit, Preventive Medicine Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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Liu CW, Jeyakumar N, McArthur E, Sontrop JM, Myran DT, Schwartz KL, Sood MM, Tanuseputro P, Garg AX. COVID-19 vaccine uptake among Ontario physicians: a descriptive population-based retrospective cohort study. BMJ Open 2024; 14:e080461. [PMID: 38858148 PMCID: PMC11168153 DOI: 10.1136/bmjopen-2023-080461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVES To determine COVID-19 vaccine uptake among physicians in Ontario, Canada from 14 December 2020 to 13 February 2022. DESIGN Population-based retrospective cohort study. SETTING All registered physicians in Ontario, Canada using data from linked provincial administrative healthcare databases. PARTICIPANTS 41 267 physicians (including postgraduate trainees) who were Ontario residents and registered with the College of Physicians and Surgeons of Ontario were included. Physicians who were out of province, had not accessed Ontario Health Insurance Plan-insured services for their own care for ≥5 years and those with missing identifiers were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were the proportions of physicians who were recorded to have received at least one, at least two and three doses of a Health Canada-approved COVID-19 vaccine by study end date. Secondary outcomes were how uptake varied by physician characteristics (including age, sex, specialty and residential location) and time elapsed between doses. RESULTS Of 41 267 physicians, (56% male, mean age 47 years), 39 359 (95.4%) received at least one dose, 39 148 (94.9%) received at least two doses and 35 834 (86.8%) received three doses of a COVID-19 vaccine. Of those who received three doses, the proportions were 90.4% among those aged ≥60 years and 81.2-89.5% among other age groups; 88.7% among family physicians and 89% among specialists. 1908 physicians (4.6%) had no record of vaccination, and this included 3.4% of family physicians and 4.1% of specialists; however, 28% of this group had missing specialty information. CONCLUSIONS In Ontario, within 14 months of COVID-19 vaccine availability, 86.8% of physicians had three doses of a COVID-19 vaccine, compared with 45.6% of the general population. Findings may signify physicians' confidence in the safety and effectiveness of COVID-19 vaccines.
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Affiliation(s)
- Cheng-Wei Liu
- Department of Medicine, Western University, London, Ontario, Canada
| | - Nivethika Jeyakumar
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Jessica M Sontrop
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Daniel T Myran
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kevin L Schwartz
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Manish M Sood
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amit X Garg
- Department of Medicine, Western University, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
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4
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Copland E, Hirst J, Mi E, Patone M, Chen D, Coupland C, Hippisley-Cox J. Effectiveness and safety of COVID-19 vaccination in people with blood cancer. Eur J Cancer 2024; 201:113603. [PMID: 38359496 DOI: 10.1016/j.ejca.2024.113603] [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: 09/12/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND People with blood cancer have increased risk of severe COVID-19 outcomes and poor response to vaccination. We assessed the safety and effectiveness of COVID-19 vaccines in this vulnerable group compared to the general population. METHODS Individuals aged ≥12 years as of 1st December 2020 in the QResearch primary care database were included. We assessed adjusted COVID-19 vaccine effectiveness (aVE) against COVID-19-related hospitalisation and death in people with blood cancer using a nested matched case-control study. Using the self-controlled case series methodology, we compared the risk of 56 pre-specified adverse events within 1-28 days of a first, second or third COVID-19 vaccine dose in people with and without blood cancer. FINDINGS The cohort comprised 12,274,948 individuals, of whom 81,793 had blood cancer. COVID-19 vaccines were protective against COVID-19-related hospitalisation and death in people with blood cancer, although they were less effective, particularly against COVID-19-related hospitalisation, compared to the general population. In the blood cancer population, aVE against COVID-19-related hospitalisation was 64% (95% confidence interval [CI] 48%-75%) 14-41 days after a third dose, compared to 80% (95% CI 78%-81%) in the general population. Against COVID-19-related mortality, aVE was >80% in people with blood cancer 14-41 days after a second or third dose. We found no significant difference in risk of adverse events 1-28 days after any vaccine dose between people with and without blood cancer. INTERPRETATION Our study provides robust evidence which supports the use of COVID-19 vaccinations for people with blood cancer.
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Affiliation(s)
- Emma Copland
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Jennifer Hirst
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Emma Mi
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Martina Patone
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Daniel Chen
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Carol Coupland
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; Lifespan and Population Health Unit, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Science, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK.
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5
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Tsang RSM, Agrawal U, Joy M, Byford R, Robertson C, Anand SN, Hinton W, Mayor N, Kar D, Williams J, Victor W, Akbari A, Bradley DT, Murphy S, O’Reilly D, Owen RK, Chuter A, Beggs J, Howsam G, Sheikh A, Richard Hobbs FD, de Lusignan S. Adverse events after first and second doses of COVID-19 vaccination in England: a national vaccine surveillance platform self-controlled case series study. J R Soc Med 2024; 117:134-148. [PMID: 37921538 PMCID: PMC11100448 DOI: 10.1177/01410768231205430] [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: 11/15/2022] [Accepted: 09/17/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVES To estimate the incidence of adverse events of interest (AEIs) after receiving their first and second doses of coronavirus disease 2019 (COVID-19) vaccinations, and to report the safety profile differences between the different COVID-19 vaccines. DESIGN We used a self-controlled case series design to estimate the relative incidence (RI) of AEIs reported to the Oxford-Royal College of General Practitioners national sentinel network. We compared the AEIs that occurred seven days before and after receiving the COVID-19 vaccinations to background levels between 1 October 2020 and 12 September 2021. SETTING England, UK. PARTICIPANTS Individuals experiencing AEIs after receiving first and second doses of COVID-19 vaccines. MAIN OUTCOME MEASURES AEIs determined based on events reported in clinical trials and in primary care during post-license surveillance. RESULTS A total of 7,952,861 individuals were vaccinated with COVID-19 vaccines within the study period. Among them, 781,200 individuals (9.82%) presented to general practice with 1,482,273 AEIs. Within the first seven days post-vaccination, 4.85% of all the AEIs were reported. There was a 3-7% decrease in the overall RI of AEIs in the seven days after receiving both doses of Pfizer-BioNTech BNT162b2 (RI = 0.93; 95% CI: 0.91-0.94) and 0.96; 95% CI: 0.94-0.98), respectively) and Oxford-AstraZeneca ChAdOx1 (RI = 0.97; 95% CI: 0.95-0.98) for both doses), but a 20% increase after receiving the first dose of Moderna mRNA-1273 (RI = 1.20; 95% CI: 1.00-1.44)). CONCLUSIONS COVID-19 vaccines are associated with a small decrease in the incidence of medically attended AEIs. Sentinel networks could routinely report common AEI rates, which could contribute to reporting vaccine safety.
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Affiliation(s)
- Ruby SM Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Utkarsh Agrawal
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, G1 1XH, UK
- Public Health Scotland, Glasgow, G2 6QE, UK
| | - Sneha N Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - William Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Nikhil Mayor
- Royal Surrey NHS Foundation Trust, Guildford, GU2 7XX, UK
| | - Debasish Kar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - William Victor
- Royal College of General Practitioners, London, NW1 2FB, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, SA2 8QA, UK
| | - Declan T Bradley
- Centre for Public Health, Queen’s University Belfast, Belfast, BT12 6BA, UK
- Public Health Agency, Belfast, BT2 8BS, UK
| | - Siobhan Murphy
- Centre for Public Health, Queen’s University Belfast, Belfast, BT12 6BA, UK
| | - Dermot O’Reilly
- Centre for Public Health, Queen’s University Belfast, Belfast, BT12 6BA, UK
| | - Rhiannon K Owen
- Population Data Science, Swansea University Medical School, Swansea University, Swansea, SA2 8QA, UK
| | - Antony Chuter
- BREATHE – The Health Data Research Hub for Respiratory Health, Edinburgh, EH16 4SS, UK
| | - Jillian Beggs
- BREATHE – The Health Data Research Hub for Respiratory Health, Edinburgh, EH16 4SS, UK
| | - Gary Howsam
- Royal College of General Practitioners, London, NW1 2FB, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, EH16 4SS, UK
| | - FD Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, G1 1XH, UK
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6
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Aldridge SJ, Agrawal U, Murphy S, Millington T, Akbari A, Almaghrabi F, Anand SN, Bedston S, Goudie R, Griffiths R, Joy M, Lowthian E, de Lusignan S, Patterson L, Robertson C, Rudan I, Bradley DT, Lyons RA, Sheikh A, Owen RK. Uptake of COVID-19 vaccinations amongst 3,433,483 children and young people: meta-analysis of UK prospective cohorts. Nat Commun 2024; 15:2363. [PMID: 38491011 PMCID: PMC10943015 DOI: 10.1038/s41467-024-46451-0] [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: 05/24/2023] [Accepted: 02/27/2024] [Indexed: 03/18/2024] Open
Abstract
SARS-CoV-2 infection in children and young people (CYP) can lead to life-threatening COVID-19, transmission within households and schools, and the development of long COVID. Using linked health and administrative data, we investigated vaccine uptake among 3,433,483 CYP aged 5-17 years across all UK nations between 4th August 2021 and 31st May 2022. We constructed national cohorts and undertook multi-state modelling and meta-analysis to identify associations between demographic variables and vaccine uptake. We found that uptake of the first COVID-19 vaccine among CYP was low across all four nations compared to other age groups and diminished with subsequent doses. Age and vaccination status of adults living in the same household were identified as important risk factors associated with vaccine uptake in CYP. For example, 5-11 year-olds were less likely to receive their first vaccine compared to 16-17 year-olds (adjusted Hazard Ratio [aHR]: 0.10 (95%CI: 0.06-0.19)), and CYP in unvaccinated households were less likely to receive their first vaccine compared to CYP in partially vaccinated households (aHR: 0.19, 95%CI 0.13-0.29).
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Affiliation(s)
- Sarah J Aldridge
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK.
| | - Utkarsh Agrawal
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Siobhán Murphy
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | | | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | | | - Sneha N Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | - Rosalind Goudie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rowena Griffiths
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emily Lowthian
- Department of Education and Childhood Studies, School of Social Sciences, Swansea University, Swansea, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lynsey Patterson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
- Public Health Agency, Belfast, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, Strathclyde University, Glasgow, UK and Public Health Scotland, Glasgow, UK
| | - Igor Rudan
- Centre for Global Health, Usher Institute, the University of Edinburgh, Edinburgh, UK
| | - Declan T Bradley
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
- Public Health Agency, Belfast, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | - Aziz Sheikh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rhiannon K Owen
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK.
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7
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Gehring S, Kowalzik F, Okasha O, Engelmann T, Schreiner D, Jensen C, Mähringer-Kunz A, Hartig-Merkel W, Mai Phuong Tran T, Oostvogels C, Verstraeten T. A prospective cohort study of SARS-CoV-2 infection-induced seroconversion and disease incidence in German healthcare workers before and during the rollout of COVID-19 vaccines. PLoS One 2024; 19:e0294025. [PMID: 38289913 PMCID: PMC10826949 DOI: 10.1371/journal.pone.0294025] [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: 11/23/2022] [Accepted: 07/22/2023] [Indexed: 02/01/2024] Open
Abstract
We assessed the seroepidemiology of SARS-CoV-2 infection and the incidence of coronavirus disease 2019 (COVID-19) before and during the rollout of COVID-19 vaccines, in a prospective observational cohort study on healthcare workers (HCWs) in a large tertiary hospital in Mainz, Germany. Antibody status was assessed during six visits between September 2020 and February 2022. Self-reported symptoms were collected using a smartphone application; symptomatic HCWs were tested using real-time polymerase chain reaction (RT-PCR) assays for SARS-CoV-2. Rates of virologically confirmed and severe COVID-19 were estimated using the U.S. Food and Drug Administration (FDA) and Coalition for Epidemic Preparedness Innovations (CEPI) case definitions, respectively, and were contrasted to background community transmission and circulating SARS-CoV-2 variants. A total of 3665 HCWs were enrolled (mean follow-up time: 18 months); 97 met the FDA definition of virologically confirmed COVID-19 (incidence rate (IR) 2.3/1000 person-months (PMs), one severe case). Most cases reported ≥2 symptoms, commonly, cough and anosmia or ageusia. Overall, 263 individuals seroconverted (IR 6.6/1000 PMs-2.9 times the estimated IR of COVID-19), indicating many cases were missed, either due to asymptomatic infections or to an atypical presentation of symptoms. A triphasic trend in anti-SARS-CoV-2 seroprevalence and seroconversion was observed, with an initial increase following the rollout of COVID-19 vaccines, a two-fold decline six months later, and finally a six-fold increase by the end of the study when Omicron was the dominant circulating variant. Despite the increase in infection rates at the end of the study due to the circulation of the Omicron variant, the infection and disease rates observed were lower than the published estimates in HCWs and rates in the general local population. Preferential vaccination of HCWs and the strict monitoring program for SARS-CoV-2 infection are the most likely reasons for the successful control of COVID-19 in this high-risk population.
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Affiliation(s)
- Stephan Gehring
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | - Frank Kowalzik
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | - Omar Okasha
- P95 Pharmacovigilance and Epidemiology, Leuven, Belgium
| | - Tobias Engelmann
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | - Daniel Schreiner
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | - Christian Jensen
- Zentrum für Kinder- und Jugendmedizin, Universitätsmedizin Mainz, Mainz, Germany
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8
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Reynolds L, Dewey C, Asfour G, Little M. Vaccine efficacy against SARS-CoV-2 for Pfizer BioNTech, Moderna, and AstraZeneca vaccines: a systematic review. Front Public Health 2023; 11:1229716. [PMID: 37942238 PMCID: PMC10628441 DOI: 10.3389/fpubh.2023.1229716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023] Open
Abstract
The purpose of this systematic review was to report on the vaccine efficacy (VE) of three SARS-CoV-2 vaccines approved by Health Canada: Pfizer BioNTech, Moderna, and AstraZeneca. Four databases were searched for primary publications on population-level VE. Ninety-two publications matched the inclusion criteria, and the extracted data were separated by vaccine type: mRNA vaccines (Pfizer and Moderna) and the AstraZeneca vaccine. The median VE for PCR-positive patients and various levels of clinical disease was determined for the first and second doses of both vaccine types against multiple SARS-CoV-2 variants. The median VE for PCR-positive infections against unidentified variants from an mRNA vaccine was 64.5 and 89%, respectively, after one or two doses. The median VE for PCR-positive infections against unidentified variants from the AstraZeneca vaccine was 53.4 and 69.6%, respectively, after one or two doses. The median VE for two doses of mRNA for asymptomatic, symptomatic, and severe infection against unidentified variants was 85.5, 93.2, and 92.2%, respectively. The median VE for two doses of AstraZeneca for asymptomatic, symptomatic, and severe infection against unidentified variants was 69.7, 71, and 90.2%, respectively. Vaccine efficacy numerically increased from the first to the second dose, increased from the first 2 weeks to the second 2 weeks post-vaccination for both doses, but decreased after 4 months from the second dose. Vaccine efficacy did not differ by person's age.
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Affiliation(s)
- Lia Reynolds
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Cate Dewey
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Ghaid Asfour
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Matthew Little
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
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9
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Patterson L, Berry E, Parsons C, Clarke B, Little A, Beggs J, Chuter A, Jackson T, Hsia Y, McGrath H, Millman C, Murphy S, Bradley DT, Milligan S. Using the COM-B framework to elucidate facilitators and barriers to COVID-19 vaccine uptake in pregnant women: a qualitative study. BMC Pregnancy Childbirth 2023; 23:640. [PMID: 37674175 PMCID: PMC10481472 DOI: 10.1186/s12884-023-05958-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023] Open
Abstract
Since April 2021, COVID-19 vaccines have been recommended for pregnant women. Despite this, COVID-19 vaccine uptake in this group is low compared to the non-pregnant population of childbearing age. Our aim was to understand barriers and facilitators to COVID-19 vaccine uptake among pregnant women in Northern Ireland using the COM-B framework, and so to make recommendations for public health interventions. The COM-B proposes that human behaviour is influenced by the extent to which a person has the capability, opportunity, and motivation to enact that behaviour. Understanding the factors underpinning behaviour through this lens helps discern what needs to change to change behaviour, therefore supporting the development of targeted interventions.This study consisted of eight semi-structured interviews with new/expectant mothers who did not receive a COVID-19 vaccine dose while pregnant since April 2021, and a focus group with five participants who received at least one COVID-19 vaccine dose while pregnant. Interview and focus group data were analysed using semi-deductive reflexive thematic analysis framed by a subtle realist approach. The COM-B was used to categorise codes and subthemes were developed within each COM-B construct.Within Psychological Capability, subthemes captured the need for consistent and reliable COVID-19 vaccine information and access to balanced and jargon-free, risk-benefit information that is tailored to the pregnant individual. The behaviour/opinions of family, friends, and local healthcare providers had a powerful influence on COVID-19 vaccine decisions (Social Opportunity). Integrating the COVID-19 vaccine as part of routine antenatal pathways was believed to support access and sense of familiarity (Physical Opportunity). Participants valued health autonomy, however experienced internal conflict driven by concerns about long-term side effects for their baby (Reflective Motivation). Feelings of fear, lack of empathy from healthcare providers, and anticipated guilt commonly underpinned indecision as to whether to get the vaccine (Automatic Motivation).Our study highlighted that the choice to accept a vaccine during pregnancy generates internal conflict and worry. Several participants cited their concern was primarily around the safety for their baby. Healthcare professionals (HCPs) play a significant part when it comes to decision making about COVID-19 vaccines among pregnant women. HCPs and pregnant women should be involved in the development of interventions to improve the delivery and communication of information.
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Affiliation(s)
- Lynsey Patterson
- Public Health Agency, Belfast, UK.
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
| | - Emma Berry
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Carole Parsons
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | | | | | - Jillian Beggs
- PPI, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Antony Chuter
- PPI, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Tracy Jackson
- PPI, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Yingfen Hsia
- School of Pharmacy, Queen's University Belfast, Belfast, UK
- Centre for Neonatal and Paediatric Infection, St George's University of London, London, UK
| | | | | | - Siobhan Murphy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Declan T Bradley
- Public Health Agency, Belfast, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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10
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Hu S, Xiong C, Zhao Y, Yuan X, Wang X. Vaccination, human mobility, and COVID-19 health outcomes: Empirical comparison before and during the outbreak of SARS-Cov-2 B.1.1.529 (Omicron) variant. Vaccine 2023; 41:5097-5112. [PMID: 37270367 PMCID: PMC10234469 DOI: 10.1016/j.vaccine.2023.05.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/27/2023] [Accepted: 05/22/2023] [Indexed: 06/05/2023]
Abstract
The B.1.1.529 (Omicron) variant surge has raised concerns about the effectiveness of vaccines and the impact of imprudent reopening. Leveraging over two years of county-level COVID-19 data in the US, this study aims to investigate relationships among vaccination, human mobility, and COVID-19 health outcomes (assessed via case rate and case-fatality rate), controlling for socioeconomic, demographic, racial/ethnic, and partisan factors. A set of cross-sectional models was first fitted to empirically compare disparities in COVID-19 health outcomes before and during the Omicron surge. Then, time-varying mediation analyses were employed to delineate how the effects of vaccine and mobility on COVID-19 health outcomes vary over time. Results showed that vaccine effectiveness against case rate lost significance during the Omicron surge, while its effectiveness against case-fatality rate remained significant throughout the pandemic. We also documented salient structural inequalities in COVID-19-related outcomes, with disadvantaged populations consistently bearing a larger brunt of case and death tolls, regardless of high vaccination rates. Last, findings revealed that mobility presented a significantly positive relationship with case rates during each wave of variant outbreak. Mobility substantially mediated the direct effect from vaccination to case rate, leading to a 10.276 % (95 % CI: 6.257, 14.294) decrease in vaccine effectiveness on average. Altogether, our study implies that sole reliance on vaccination to halt COVID-19 needs to be re-examined. Well-resourced and coordinated efforts to enhance vaccine effectiveness, mitigate health disparity and selectively loosen non-pharmaceutical interventions are essential to bringing the pandemic to an end.
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Affiliation(s)
- Songhua Hu
- Department of Civil and Environmental Engineering, University of Maryland, College Park, MD 20742, United States.
| | - Chenfeng Xiong
- Department of Civil and Environmental Engineering, Villanova University, PA 19085, United States.
| | - Yingrui Zhao
- Department of Geographical Sciences, University of Maryland, College Park, MD 20742, United States
| | - Xin Yuan
- Department of Civil and Environmental Engineering, Villanova University, PA 19085, United States
| | - Xuqiu Wang
- Department of Civil and Environmental Engineering, Villanova University, PA 19085, United States
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Thomas I, Mackie P. Assessing the coverage and timeliness of coronavirus vaccination among people experiencing homelessness in Wales, UK: a population-level data-linkage study. BMC Public Health 2023; 23:1494. [PMID: 37543593 PMCID: PMC10403942 DOI: 10.1186/s12889-023-16432-x] [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: 10/07/2022] [Accepted: 08/01/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND People experiencing homelessness have elevated morbidity, increasing their risk of COVID-19 related complications and mortality. Achieving high vaccination coverage in a timely manner among homeless populations was therefore important during the mass vaccination programme in Wales to limit adverse outcomes. However, no systematic monitoring of vaccinations among people experiencing homelessness in Wales has been undertaken. METHODS Retrospective cohort analysis was conducted using de-identified administrative data. Study cohort members were adults (≥ 18 years old) living in Wales on the 2 December 2020 and who had recently experienced homelessness, defined as experiencing homelessness between 1 July 2020 and 2 December 2020. The outcome of interest was first coronavirus vaccine dose. Follow-up started on 2 December 2020, and ended if the participant died, had a break in address history > 30 days, reached the end of follow up (30 November 2021), or had the outcome of interest. Median-time-to-vaccination was used as a crude measure of 'timeliness' of vaccine uptake. To account for competing risk of death prior to vaccination, vaccine coverage was described using cumulative incidence at 350-days, and at 50-day increments over follow-up (2 December 2020 to 17 November 2021). As a benchmark, all time-to-event measures were generated for the adult population in Wales with similar baseline individual and residential characteristics as the study cohort. RESULTS 1,595 people with recent experiences of homelessness were identified and included in analysis. The study cohort were disproportionately male (68.8%) and concentrated in the most deprived areas in Wales. Median time-to-vaccination for the study cohort was 196 days (95% CI.: 184-209 days), compared to 141 days (95% CI.: 141-141 days) among the matched adult population in Wales. Cumulative incidence of vaccination after 350-days of follow-up was 60.4% (95% CI.: 57.8-62.8%) among the study cohort, compared to 81.4% (95% CI.: 81.3-81.5%) among the matched adult population. Visual analysis of cumulative incidence over time suggests that vaccine inequality, i.e., difference between study cohort and matched adult population, peaked after 200-days of follow-up, and declined slightly until last follow-up at 350-days. CONCLUSIONS Despite being prioritised for vaccination, people experiencing homelessness in Wales appear to have been under-engaged, leading to lower vaccination coverage and greater time unvaccinated, potentially increasing their risk of COVID-19 complications and mortality.
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Affiliation(s)
- Ian Thomas
- Administrative Data Research Wales/Cardiff University, School of Social Sciences, SPARK, Maindy Road, CF24 4HQ, Cardiff, UK.
| | - Peter Mackie
- Cardiff University, School of Geography and Planning, Glamorgan Building, King Edward VII Avenue, CF10 3WA, Cardiff, UK
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Lyons J, Nafilyan V, Akbari A, Bedston S, Harrison E, Hayward A, Hippisley-Cox J, Kee F, Khunti K, Rahman S, Sheikh A, Torabi F, Lyons RA. An external validation of the QCOVID3 risk prediction algorithm for risk of hospitalisation and death from COVID-19: An observational, prospective cohort study of 1.66m vaccinated adults in Wales, UK. PLoS One 2023; 18:e0285979. [PMID: 37200350 PMCID: PMC10194890 DOI: 10.1371/journal.pone.0285979] [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: 01/16/2023] [Accepted: 05/07/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION At the start of the COVID-19 pandemic there was an urgent need to identify individuals at highest risk of severe outcomes, such as hospitalisation and death following infection. The QCOVID risk prediction algorithms emerged as key tools in facilitating this which were further developed during the second wave of the COVID-19 pandemic to identify groups of people at highest risk of severe COVID-19 related outcomes following one or two doses of vaccine. OBJECTIVES To externally validate the QCOVID3 algorithm based on primary and secondary care records for Wales, UK. METHODS We conducted an observational, prospective cohort based on electronic health care records for 1.66m vaccinated adults living in Wales on 8th December 2020, with follow-up until 15th June 2021. Follow-up started from day 14 post vaccination to allow the full effect of the vaccine. RESULTS The scores produced by the QCOVID3 risk algorithm showed high levels of discrimination for both COVID-19 related deaths and hospital admissions and good calibration (Harrell C statistic: ≥ 0.828). CONCLUSION This validation of the updated QCOVID3 risk algorithms in the adult vaccinated Welsh population has shown that the algorithms are valid for use in the Welsh population, and applicable on a population independent of the original study, which has not been previously reported. This study provides further evidence that the QCOVID algorithms can help inform public health risk management on the ongoing surveillance and intervention to manage COVID-19 related risks.
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Affiliation(s)
- Jane Lyons
- Faculty of Medicine, Health & Life Science, Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Vahé Nafilyan
- Office of National Statistics, Newport, United Kingdom
| | - Ashley Akbari
- Faculty of Medicine, Health & Life Science, Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Stuart Bedston
- Faculty of Medicine, Health & Life Science, Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Ewen Harrison
- Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew Hayward
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Julia Hippisley-Cox
- Nuffield Department, Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Frank Kee
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Shamim Rahman
- Department of Health and Social Care, Mental Health and Disabilities Analysis, London, United Kingdom
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Fatemeh Torabi
- Faculty of Medicine, Health & Life Science, Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Ronan A. Lyons
- Faculty of Medicine, Health & Life Science, Population Data Science, Swansea University Medical School, Swansea University, Swansea, United Kingdom
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Langlete P, Tesli M, Veneti L, Starrfelt J, Elstrøm P, Meijerink H. Estimated vaccine effectiveness against SARS-CoV-2 Delta and Omicron infections among health care workers and the general adult population in Norway, August 2021 - January 2022. Vaccine 2023:S0264-410X(23)00549-2. [PMID: 37211454 DOI: 10.1016/j.vaccine.2023.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/22/2023] [Accepted: 05/05/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Health care workers (HCW) have a higher exposure to SARS-CoV-2 virus than other professionals and to protect both HCW and patients, HCW have been prioritized for vaccination against SARS-CoV-2 in many countries. Estimating the COVID-19 vaccine effectiveness among HCW is important to provide recommendations to protect risk groups. METHODS We estimated vaccine effectiveness against SARS-CoV-2 infections using Cox proportional hazard models among HCW with comparisons in the general population, from 1 August 2021 to 28 January 2022. Vaccine status is specified as a time-varying covariate and all models incorporated explicit time and were adjusted for age, sex, comorbidities, county of residence, country of birth, and living conditions. Data from the adult Norwegian population (aged 18-67 years) and HCW workplace data (as registered 1 January 2021) were collated from the National Preparedness Register for COVID-19 (Beredt C19). RESULTS Vaccine effectiveness was higher for Delta than for the Omicron variant in HCW (71 % compared to 19 %) as well as in non-HCW (69 % compared to -32 %). For the Omicron variant a 3rd dose provides significantly better protection against infection than 2 doses in both HCW (33 %) and non-HCW (10 %). Further, HCW seem to have better vaccine effectiveness than non-HCW for the Omicron, but not for the Delta variant. CONCLUSIONS Vaccine effectiveness were comparable between HCW and non-HCW for the delta variant, but significantly higher in HCW than non-HCW for the omicron variant. Both HCW and non-HCW got increased protection from a third dose.
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Affiliation(s)
- Petter Langlete
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway.
| | - Martin Tesli
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; Oslo University Hospital, Oslo, Norway
| | - Lamprini Veneti
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Jostein Starrfelt
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Petter Elstrøm
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway; Centre for Epidemic Intervention Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Hinta Meijerink
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
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14
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Wu N, Joyal-Desmarais K, Ribeiro PAB, Vieira AM, Stojanovic J, Sanuade C, Yip D, Bacon SL. Long-term effectiveness of COVID-19 vaccines against infections, hospitalisations, and mortality in adults: findings from a rapid living systematic evidence synthesis and meta-analysis up to December, 2022. THE LANCET. RESPIRATORY MEDICINE 2023; 11:439-452. [PMID: 36780914 PMCID: PMC9917454 DOI: 10.1016/s2213-2600(23)00015-2] [Citation(s) in RCA: 90] [Impact Index Per Article: 90.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Synthesising evidence on the long-term vaccine effectiveness of COVID-19 vaccines (BNT162b2 [Pfizer-BioNTech], mRNA-1273 [Moderna], ChAdOx1 nCoV-19 [AZD1222; Oxford-AstraZeneca], and Ad26.COV2.S [Janssen]) against infections, hospitalisations, and mortality is crucial to making evidence-based pandemic policy decisions. METHODS In this rapid living systematic evidence synthesis and meta-analysis, we searched EMBASE and the US National Institutes of Health's iSearch COVID-19 Portfolio, supplemented by manual searches of COVID-19-specific sources, until Dec 1, 2022, for studies that reported vaccine effectiveness immediately and at least 112 days after a primary vaccine series or at least 84 days after a booster dose. Single reviewers assessed titles, abstracts, and full-text articles, and extracted data, with a second reviewer verifying included studies. The primary outcomes were vaccine effectiveness against SARS-CoV-2 infections, hospitalisations, and mortality, which were assessed using three-level meta-analytic models. This study is registered with the National Collaborating Centre for Methods and Tools, review 473. FINDINGS We screened 16 696 records at the title and abstract level, appraised 832 (5·0%) full texts, and initially included 73 (0·4%) studies. Of these, we excluded five (7%) studies because of critical risk of bias, leaving 68 (93%) studies that were extracted for analysis. For infections caused by any SARS-CoV-2 strain, vaccine effectiveness for the primary series reduced from 83% (95% CI 80-86) at baseline (14-42 days) to 62% (53-69) by 112-139 days. Vaccine effectiveness at baseline was 92% (88-94) for hospitalisations and 91% (85-95) for mortality, and reduced to 79% (65-87) at 224-251 days for hospitalisations and 86% (73-93) at 168-195 days for mortality. Estimated vaccine effectiveness was lower for the omicron variant for infections, hospitalisations, and mortality at baseline compared with that of other variants, but subsequent reductions occurred at a similar rate across variants. For booster doses, which covered mostly omicron studies, vaccine effectiveness at baseline was 70% (56-80) against infections and 89% (82-93) against hospitalisations, and reduced to 43% (14-62) against infections and 71% (51-83) against hospitalisations at 112 days or later. Not enough studies were available to report on booster vaccine effectiveness against mortality. INTERPRETATION Our analyses indicate that vaccine effectiveness generally decreases over time against SARS-CoV-2 infections, hospitalisations, and mortality. The baseline vaccine effectiveness levels for the omicron variant were notably lower than for other variants. Therefore, other preventive measures (eg, face-mask wearing and physical distancing) might be necessary to manage the pandemic in the long term. FUNDING Canadian Institutes of Health Research and the Public Health Agency of Canada.
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Affiliation(s)
- Nana Wu
- META Group, Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada; Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Keven Joyal-Desmarais
- META Group, Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada; Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Paula A B Ribeiro
- META Group, Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Ariany Marques Vieira
- META Group, Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada; Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Jovana Stojanovic
- META Group, Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada; Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada
| | - Comfort Sanuade
- META Group, Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada; Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Doro Yip
- META Group, Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Simon L Bacon
- META Group, Montreal Behavioural Medicine Centre, CIUSSS du Nord-de-l'Île-de-Montréal, Montreal, QC, Canada; Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada.
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15
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González-Parra G, Arenas AJ. Mathematical Modeling of SARS-CoV-2 Omicron Wave under Vaccination Effects. COMPUTATION (BASEL, SWITZERLAND) 2023; 11:36. [PMID: 38957648 PMCID: PMC11218807 DOI: 10.3390/computation11020036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Over the course of the COVID-19 pandemic millions of deaths and hospitalizations have been reported. Different SARS-CoV-2 variants of concern have been recognized during this pandemic and some of these variants of concern have caused uncertainty and changes in the dynamics. The Omicron variant has caused a large amount of infected cases in the US and worldwide. The average number of deaths during the Omicron wave toll increased in comparison with previous SARS-CoV-2 waves. We studied the Omicron wave by using a highly nonlinear mathematical model for the COVID-19 pandemic. The novel model includes individuals who are vaccinated and asymptomatic, which influences the dynamics of SARS-CoV-2. Moreover, the model considers the waning of the immunity and efficacy of the vaccine against the Omicron strain. This study uses the facts that the Omicron strain has a higher transmissibility than the previous circulating SARS-CoV-2 strain but is less deadly. Preliminary studies have found that Omicron has a lower case fatality rate compared to previous circulating SARS-CoV-2 strains. The simulation results show that even if the Omicron strain is less deadly it might cause more deaths, hospitalizations and infections. We provide a variety of scenarios that help to obtain insight about the Omicron wave and its consequences. The proposed mathematical model, in conjunction with the simulations, provides an explanation for a large Omicron wave under various conditions related to vaccines and transmissibility. These results provide an awareness that new SARS-CoV-2 variants can cause more deaths even if their fatality rate is lower.
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Affiliation(s)
- Gilberto González-Parra
- Department of Mathematics, New Mexico Tech, New Mexico Institute of Mining and Technology, Socorro, NM 87801, USA
| | - Abraham J. Arenas
- Departamento de Matematicas y Estadistica, Universidad de Cordoba, Monteria 230002, Colombia
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16
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Pienthong T, Chancharoenrat W, Sajak S, Phetsaen S, Hanchai P, Thongphubeth K, Khawcharoenporn T. Risk categorization and outcomes among healthcare workers exposed to COVID-19: A cohort study from a Thai tertiary-care center. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023:S1684-1182(23)00011-7. [PMID: 36725439 PMCID: PMC9852258 DOI: 10.1016/j.jmii.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/29/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND A risk categorization tool for healthcare workers (HCWs) exposed to COVID-19 is crucial for preventing COVID-19 transmission and requires validation and modification according to local context. METHODS From January to December 2021, a prospective cohort study was conducted among Thai HCWs to evaluate the performance of the specifically-created risk categorization tool, which classified HCWs into low-risk (LR), intermediate-risk (IR), and high-risk (HR) groups based on types of activities, duration of exposure, and protective methods used during exposure. Subsequent measures were determined for the HCWs based on the risk categories. RESULTS 1891 HCWs were included; 52%, 25% and 23% were LR, IR, and HR, respectively. COVID-19 was diagnosed in 1.3%, 5.1% and 27.3% of LR, IR and HR HCWs, respectively (P <0.001). Independent factors associated with COVID-19 were household or community exposure [adjusted odds ratio (aOR), 1588.68; P <0.001), being HR (aOR, 11.94; P <0.001), working at outpatient departments (aOR, 2.54; P <0.001), and no history of COVID-19 vaccination (aOR, 2.05; P = 0.01). The monthly rates of COVID-19 among LR, IR, and HR HCWs significantly decreased after the incremental rate of full vaccination. In-hospital transmission between HCWs occurred in 8% and was mainly due to eating at the same table. CONCLUSION The study risk categorization tool can differentiate risks of COVID-19 among the HCWs. Prevention of COVID-19 should be focused on HCWs with the identified risk factors and behaviors associated with COVID-19 development and encouraging receipt of full vaccination.
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Affiliation(s)
- Thanus Pienthong
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | | | - Sirinporn Sajak
- Infection Control Department, Thammasat University Hospital, Pathumthani, Thailand
| | - Suphannee Phetsaen
- Infection Control Department, Thammasat University Hospital, Pathumthani, Thailand
| | - Padcharadda Hanchai
- Infection Control Department, Thammasat University Hospital, Pathumthani, Thailand
| | | | - Thana Khawcharoenporn
- Division of Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand,Corresponding author. Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
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17
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Tsang RSM, Joy M, Byford R, Robertson C, Anand SN, Hinton W, Mayor N, Kar D, Williams J, Victor W, Akbari A, Bradley DT, Murphy S, O’Reilly D, Owen RK, Chuter A, Beggs J, Howsam G, Sheikh A, Hobbs FDR, de Lusignan S. Adverse events following first and second dose COVID-19 vaccination in England, October 2020 to September 2021: a national vaccine surveillance platform self-controlled case series study. Euro Surveill 2023; 28:2200195. [PMID: 36695484 PMCID: PMC9853944 DOI: 10.2807/1560-7917.es.2023.28.3.2200195] [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] [Indexed: 01/21/2023] Open
Abstract
BackgroundPost-authorisation vaccine safety surveillance is well established for reporting common adverse events of interest (AEIs) following influenza vaccines, but not for COVID-19 vaccines.AimTo estimate the incidence of AEIs presenting to primary care following COVID-19 vaccination in England, and report safety profile differences between vaccine brands.MethodsWe used a self-controlled case series design to estimate relative incidence (RI) of AEIs reported to the national sentinel network, the Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub. We compared AEIs (overall and by clinical category) 7 days pre- and post-vaccination to background levels between 1 October 2020 and 12 September 2021.ResultsWithin 7,952,861 records, 781,200 individuals (9.82%) presented to general practice with 1,482,273 AEIs, 4.85% within 7 days post-vaccination. Overall, medically attended AEIs decreased post-vaccination against background levels. There was a 3-7% decrease in incidence within 7 days after both doses of Comirnaty (RI: 0.93; 95% CI: 0.91-0.94 and RI: 0.96; 95% CI: 0.94-0.98, respectively) and Vaxzevria (RI: 0.97; 95% CI: 0.95-0.98). A 20% increase was observed after one dose of Spikevax (RI: 1.20; 95% CI: 1.00-1.44). Fewer AEIs were reported as age increased. Types of AEIs, e.g. increased neurological and psychiatric conditions, varied between brands following two doses of Comirnaty (RI: 1.41; 95% CI: 1.28-1.56) and Vaxzevria (RI: 1.07; 95% CI: 0.97-1.78).ConclusionCOVID-19 vaccines are associated with a small decrease in medically attended AEI incidence. Sentinel networks could routinely report common AEI rates, contributing to reporting vaccine safety.
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Affiliation(s)
- Ruby SM Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, United Kingdom,Public Health Scotland, Glasgow, United Kingdom
| | - Sneha N Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - William Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Nikhil Mayor
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Debasish Kar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - William Victor
- Royal College of General Practitioners, London, United Kingdom
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea University, United Kingdom
| | - Declan T Bradley
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom,Public Health Agency, Belfast, United Kingdom
| | - Siobhan Murphy
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Dermot O’Reilly
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Rhiannon K Owen
- Population Data Science, Swansea University Medical School, Swansea University, United Kingdom
| | - Antony Chuter
- BREATHE – The Health Data Research Hub for Respiratory Health, Edinburgh, United Kingdom
| | - Jillian Beggs
- BREATHE – The Health Data Research Hub for Respiratory Health, Edinburgh, United Kingdom
| | - Gary Howsam
- Royal College of General Practitioners, London, United Kingdom
| | - Aziz Sheikh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - FD Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom,Royal College of General Practitioners, London, United Kingdom
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18
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Emmerson C, Hollinghurst J, North L, Fry R, Akbari A, Humphreys C, Gravenor MB, Lyons RA. The impact of dementia, frailty and care home characteristics on SARS-CoV-2 incidence in a national cohort of Welsh care home residents during a period of high community prevalence. Age Ageing 2022; 51:afac250. [PMID: 36469089 PMCID: PMC9721242 DOI: 10.1093/ageing/afac250] [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: 02/18/2022] [Revised: 06/14/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND dementia may increase care home residents' risk of COVID-19, but there is a lack of evidence on this effect and on interactions with individual and care home-level factors. METHODS we created a national cross-sectional retrospective cohort of care home residents in Wales for 1 September to 31 December 2020. Risk factors were analysed using multi-level logistic regression to model the likelihood of SARS-CoV-2 infection and mortality. RESULTS the cohort included 9,571 individuals in 673 homes. Dementia was diagnosed in 5,647 individuals (59%); 1,488 (15.5%) individuals tested positive for SARS-CoV-2. We estimated the effects of age, dementia, frailty, care home size, proportion of residents with dementia, nursing and dementia services, communal space and region. The final model included the proportion of residents with dementia (OR for positive test 4.54 (95% CIs 1.55-13.27) where 75% of residents had dementia compared to no residents with dementia) and frailty (OR 1.29 (95% CIs 1.05-1.59) for severe frailty compared with no frailty). Analysis suggested 76% of the variation was due to setting rather than individual factors. Additional analysis suggested severe frailty and proportion of residents with dementia was associated with all-cause mortality, as was dementia diagnosis. Mortality analyses were challenging to interpret. DISCUSSION whilst individual frailty increased the risk of COVID-19 infection, dementia was a risk factor at care home but not individual level. These findings suggest whole-setting interventions, particularly in homes with high proportions of residents with dementia and including those with low/no individual risk factors may reduce the impact of COVID-19.
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Affiliation(s)
| | - Joseph Hollinghurst
- Population Data Science and Health Data Research UK, Swansea University, Swansea, UK
| | - Laura North
- Population Data Science and Health Data Research UK, Swansea University, Swansea, UK
| | - Richard Fry
- Population Data Science and Health Data Research UK, Swansea University, Swansea, UK
| | - Ashley Akbari
- Population Data Science and Health Data Research UK, Swansea University, Swansea, UK
| | | | - Mike B Gravenor
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Ronan A Lyons
- Population Data Science and Health Data Research UK, Swansea University, Swansea, UK
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19
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Jiménez-Sepúlveda N, Chico-Sánchez P, Castro-García JM, Escribano-Cañadas I, Merino-Lucas E, Ronda-Pérez E, Sánchez-Payá J, Gras-Valentí P. The Waning of BNT162b2 Vaccine Effectiveness for SARS-CoV-2 Infection Prevention over Time: A Test-Negative Study in Health Care Professionals of a Health Department from January 2021 to December 2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113884. [PMID: 36360764 PMCID: PMC9653695 DOI: 10.3390/ijerph192113884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 06/01/2023]
Abstract
The duration of protection of vaccines against SARS-CoV-2 infection has been evaluated in previous studies, but uncertainty remains about the persistence of effectiveness over time and the ideal timing for booster doses. Therefore, the aim of this study was to evaluate BNT162b2 vaccine effectiveness against SARS-CoV-2 infection in health care workers (HCWs) at a tertiary hospital depending on time elapsed since the completion of a two-dose vaccination regimen. We conducted a case-control with negative test study between 25 January and 12 December 2021 that included 1404 HCWs who underwent an active infection diagnostic test (AIDT) to rule out SARS-CoV-2 infection due to COVID-19 suspicion or prior close contact with patients diagnosed with COVID-19. The adjusted vaccine effectiveness (aVE) for the prevention of SARS-CoV-2 infection 12 to 120 days after completing the full two-dose vaccination regimen was 91.9%. Then, aVE decreased to 63.7% between 121 to 240 days after completing the full two-dose regimen and to 37.2% after 241 days since the second dose. Vaccination against SARS-CoV-2 infection in HCWs remains highly effective after 12 to 120 days have elapsed since the administration of two doses of the BNT162b2 vaccine; however, effectiveness decreases as time elapses since its administration.
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Affiliation(s)
- Natali Jiménez-Sepúlveda
- Epidemiology Unit, Department of Preventive Medicine, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital Dr. Balmis, 03010 Alicante, Spain
| | - Pablo Chico-Sánchez
- Epidemiology Unit, Department of Preventive Medicine, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital Dr. Balmis, 03010 Alicante, Spain
| | | | - Isabel Escribano-Cañadas
- Department of Microbiology, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital Dr. Balmis, 03010 Alicante, Spain
| | - Esperanza Merino-Lucas
- Unit of Infectious Diseases, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital Dr. Balmis, 03010 Alicante, Spain
| | - Elena Ronda-Pérez
- Preventive Medicine and Public Health Area, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain
- Centre of Networked Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - José Sánchez-Payá
- Epidemiology Unit, Department of Preventive Medicine, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital Dr. Balmis, 03010 Alicante, Spain
| | - Paula Gras-Valentí
- Epidemiology Unit, Department of Preventive Medicine, Alicante Institute for Health and Biomedical Research (ISABIAL), General University Hospital Dr. Balmis, 03010 Alicante, Spain
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20
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Hernandez-Suarez C, Murillo-Zamora E. Waning immunity to SARS-CoV-2 following vaccination or infection. Front Med (Lausanne) 2022; 9:972083. [PMID: 36313998 PMCID: PMC9606629 DOI: 10.3389/fmed.2022.972083] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
We use survival analysis to analyze the decay in the protection induced by eight SARS-CoV-2 vaccines using data from 33,418 fully anonymized patients from the IMSS public health system in Mexico, including only previously vaccinated, confirmed SARS-CoV-2 positive with a PCR test. We analyze the waning effect in those with complete vs. incomplete dose fitting a Weibull distribution. We compare these results with an estimate of the waning effect due to active infection. In two-dose vaccines, we found that the average protection time of a complete dose increases 2.6 times compared to that of an incomplete dose. All analyzed vaccines provided a protection that lasted longer than the protection due to active infection, except in those patients that did not fulfilled the complete dose. The average protection of a full dose is 2.2 times larger than that provided by active infection. The average protection of active infection is about the same as the average protection of an incomplete dose. All evaluated vaccines had lost most of their protective effect between 8 and 11 months of application of first shot. Our results highly correlate with NT50 and other estimates of vaccine efficacy. We found that on average, vaccination increases Age50, the age at which there is a 50% probability of severe disease if infected, in 15 years. We also found that Age50 increases with mean protection time.
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Affiliation(s)
- Carlos Hernandez-Suarez
- Instituto de Ciencias Tecnología e Innovación, Universidad Francisco Gavidia, San Salvador, El Salvador
| | - Efrèn Murillo-Zamora
- Unidad de Medicina Familiar No. 19, Departamento de Epidemiología, Instituto Mexicano del Seguro Social, Colima, Mexico
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21
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Galanis P, Vraka I, Katsiroumpa A, Siskou O, Konstantakopoulou O, Katsoulas T, Mariolis-Sapsakos T, Kaitelidou D. COVID-19 Vaccine Uptake among Healthcare Workers: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 10:1637. [PMID: 36298502 PMCID: PMC9610263 DOI: 10.3390/vaccines10101637] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
The vaccine-induced immunity of healthcare workers (HCWs) is crucial to controlling the COVID-19 pandemic. Therefore, we conducted a systematic review and meta-analysis to assess the COVID-19 vaccine uptake among HCWs worldwide and to identify predictors of vaccination. We searched Scopus, Web of Science, Medline, PubMed, ProQuest, CINAHL, and medRxiv up to 25 August 2022. We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We found 25 studies including 491,624 vaccinated HCWs, while the full sample included 555,561 HCWs. The overall proportion of vaccinated HCWs was 77.3%. Vaccine uptake for studies that were conducted in North America (85.6%) was higher than the proportion for studies that were conducted in Asia (79.5%), Europe (72.8%), and Africa (65.6%). The overall prevalence of COVID-19 vaccine uptake was 83.6% and 77.4% for physicians and nurses, respectively. Older age, white race, physicians' profession, seasonal influenza vaccine, direct COVID-19 patient care, and confidence in COVID-19 vaccine safety and effectiveness were positive predictors of vaccine uptake, while history of SARS-CoV-2 infection was a negative predictor. Deep understanding of the factors that influence HCWs' decisions to receive a COVID-19 vaccine is critical to implementing tailored communication strategies for HCWs who are at risk for not getting vaccinated.
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Affiliation(s)
- Petros Galanis
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Irene Vraka
- Department of Radiology, P. & A. Kyriakou Children’s Hospital, 11527 Athens, Greece
| | - Aglaia Katsiroumpa
- Clinical Epidemiology Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Olga Siskou
- Department of Tourism Studies, University of Piraeus, 18534 Piraeus, Greece
| | - Olympia Konstantakopoulou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Theodoros Katsoulas
- Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Daphne Kaitelidou
- Center for Health Services Management and Evaluation, Faculty of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece
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22
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Ostropolets A, Hripcsak G. COVID-19 vaccination effectiveness rates by week and sources of bias: a retrospective cohort study. BMJ Open 2022; 12:e061126. [PMID: 35998962 PMCID: PMC9402447 DOI: 10.1136/bmjopen-2022-061126] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/23/2022] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To examine COVID-19 vaccine effectiveness over six 7-day intervals after the first dose and assess underlying bias in observational data. DESIGN AND SETTING Retrospective cohort study using Columbia University Irving Medical Center data linked to state and city immunisation registries. OUTCOMES AND MEASURES We used large-scale propensity score matching with up to 54 987 covariates, fitted Cox proportional hazards models and constructed Kaplan-Meier plots for two main outcomes (COVID-19 infection and COVID-19-associated hospitalisation). We conducted manual chart review of cases in week 1 in both groups along with a set of secondary analyses for other index date, outcome and population choices. RESULTS The study included 179 666 patients. We observed increasing effectiveness after the first dose of mRNA vaccines with week 6 effectiveness approximating 84% (95% CI 72% to 91%) for COVID-19 infection and 86% (95% CI 69% to 95%) for COVID-19-associated hospitalisation. When analysing unexpectedly high effectiveness in week 1, chart review revealed that vaccinated patients are less likely to seek care after vaccination and are more likely to be diagnosed with COVID-19 during the encounters for other conditions. Secondary analyses highlighted potential outcome misclassification for International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis, the influence of excluding patients with prior COVID-19 infection and anchoring in the unexposed group. Long-term vaccine effectiveness in fully vaccinated patients matched the results of the randomised trials. CONCLUSIONS For vaccine effectiveness studies, observational data need to be scrutinised to ensure compared groups exhibit similar health-seeking behaviour and are equally likely to be captured in the data. While we found that studies may be capable of accurately estimating long-term effectiveness despite bias in early weeks, the early week results should be reported in every study so that we may gain a better understanding of the biases. Given the difference in temporal trends of vaccine exposure and patients' baseline characteristics, indirect comparison of vaccines may produce biased results.
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Affiliation(s)
- Anna Ostropolets
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
- Medical Informatics Services, New York-Presbyterian Hospital, New York, New York, USA
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23
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Higdon MM, Wahl B, Jones CB, Rosen JG, Truelove SA, Baidya A, Nande AA, ShamaeiZadeh PA, Walter KK, Feikin DR, Patel MK, Deloria Knoll M, Hill AL. A Systematic Review of Coronavirus Disease 2019 Vaccine Efficacy and Effectiveness Against Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Disease. Open Forum Infect Dis 2022; 9:ofac138. [PMID: 35611346 PMCID: PMC9047227 DOI: 10.1093/ofid/ofac138] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/17/2022] [Indexed: 01/13/2023] Open
Abstract
Billions of doses of coronavirus disease 2019 (COVID-19) vaccines have been administered globally, dramatically reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) incidence and severity in some settings. Many studies suggest vaccines provide a high degree of protection against infection and disease, but precise estimates vary and studies differ in design, outcomes measured, dosing regime, location, and circulating virus strains. In this study, we conduct a systematic review of COVID-19 vaccines through February 2022. We included efficacy data from Phase 3 clinical trials for 15 vaccines undergoing World Health Organization Emergency Use Listing evaluation and real-world effectiveness for 8 vaccines with observational studies meeting inclusion criteria. Vaccine metrics collected include protection against asymptomatic infection, any infection, symptomatic COVID-19, and severe outcomes including hospitalization and death, for partial or complete vaccination, and against variants of concern Alpha, Beta, Gamma, Delta, and Omicron. We additionally review the epidemiological principles behind the design and interpretation of vaccine efficacy and effectiveness studies, including important sources of heterogeneity.
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Affiliation(s)
- Melissa M Higdon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brian Wahl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carli B Jones
- Department of Pathology Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shaun A Truelove
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anurima Baidya
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anjalika A Nande
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Parisa A ShamaeiZadeh
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Karoline K Walter
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel R Feikin
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Minal K Patel
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Maria Deloria Knoll
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alison L Hill
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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