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Ghafari M, Hosseinpour S, Rezaee-Zavareh MS, Dascalu S, Rostamian S, Aramesh K, Madani K, Kordasti S. A quantitative evaluation of the impact of vaccine roll-out rate and coverage on reducing deaths: insights from the first 2 years of COVID-19 epidemic in Iran. BMC Med 2023; 21:429. [PMID: 37953291 PMCID: PMC10642021 DOI: 10.1186/s12916-023-03127-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Vaccination has played a pivotal role in reducing the burden of COVID-19. Despite numerous studies highlighting its benefits in reducing the risk of severe disease and death, we still lack a quantitative understanding of how varying vaccination roll-out rates influence COVID-19 mortality. METHODS We developed a framework for estimating the number of avertable COVID-19 deaths (ACDs) by vaccination in Iran. To achieve this, we compared Iran's vaccination roll-out rates with those of eight model countries that predominantly used inactivated virus vaccines. We calculated net differences in the number of fully vaccinated individuals under counterfactual scenarios where Iran's per-capita roll-out rate was replaced with that of the model countries. This, in turn, enabled us to determine age specific ACDs for the Iranian population under counterfactual scenarios where number of COVID-19 deaths are estimated using all-cause mortality data. These estimates covered the period from the start of 2020 to 20 April 2022. RESULTS We found that while Iran would have had an approximately similar number of fully vaccinated individuals under counterfactual roll-out rates based on Bangladesh, Nepal, Sri Lanka, and Turkey (~ 65-70%), adopting Turkey's roll-out rates could have averted 50,000 (95% confidence interval: 38,100-53,500) additional deaths, while following Bangladesh's rates may have resulted in 52,800 (17,400-189,500) more fatalities in Iran. Surprisingly, mimicking Argentina's slower roll-out led to only 12,600 (10,400-13,300) fewer deaths, despite a higher counterfactual percentage of fully vaccinated individuals (~ 79%). Emulating Montenegro or Bolivia, with faster per capita roll-out rates and approximately 50% counterfactual full vaccination, could have prevented more deaths in older age groups, especially during the early waves. Finally, replicating Bahrain's model as an upper-bound benchmark, Iran could have averted 75,300 (56,000-83,000) deaths, primarily in the > 50 age groups. CONCLUSIONS Our analysis revealed that faster roll-outs were consistently associated with higher numbers of averted deaths, even in scenarios with lower overall coverage. This study offers valuable insights into future decision-making regarding infectious disease epidemic management through vaccination strategies. It accomplishes this by comparing various countries' relative performance in terms of timing, pace, and vaccination coverage, ultimately contributing to the prevention of COVID-19-related deaths.
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Affiliation(s)
- Mahan Ghafari
- Big Data Institute and Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Department of Biology, University of Oxford, Oxford, UK.
| | - Sepanta Hosseinpour
- School of Dentistry, The University of Queensland, Herston, QLD 4006, Australia
| | | | | | - Somayeh Rostamian
- Department of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Kiarash Aramesh
- The James F. Drane Bioethics Institute, PennWest University, Edinboro, PA, USA
| | - Kaveh Madani
- United Nations University Institute for Water, Environment and Health (UNU-INWEH), Hamilton, ON, Canada
| | - Shahram Kordasti
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
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Ghafari M, Watson OJ, Karlinsky A, Ferretti L, Katzourakis A. A framework for reconstructing SARS-CoV-2 transmission dynamics using excess mortality data. Nat Commun 2022; 13:3015. [PMID: 35641529 PMCID: PMC9156676 DOI: 10.1038/s41467-022-30711-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/13/2022] [Indexed: 11/09/2022] Open
Abstract
The transmission dynamics and burden of SARS-CoV-2 in many regions of the world is still largely unknown due to the scarcity of epidemiological analyses and lack of testing to assess the prevalence of disease. In this work, we develop a quantitative framework based on excess mortality data to reconstruct SARS-CoV-2 transmission dynamics and assess the level of underreporting in infections and deaths. Using weekly all-cause mortality data from Iran, we are able to show a strong agreement between our attack rate estimates and seroprevalence measurements in each province and find significant heterogeneity in the level of exposure across the country with 11 provinces reaching near 100% attack rates. Despite having a young population, our analysis reveals that incorporating limited access to medical services in our model, coupled with undercounting of COVID-19-related deaths, leads to estimates of infection fatality rate in most provinces of Iran that are comparable to high-income countries.
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Affiliation(s)
- Mahan Ghafari
- Department of Zoology, University of Oxford, Oxford, UK.
| | - Oliver J Watson
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Ariel Karlinsky
- Department of Economics, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Luca Ferretti
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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McAlister FA, Nabipoor M, Chu A, Lee DS, Saxinger L, Bakal JA. The impact of shifting demographics, variants of concern and vaccination on outcomes during the first 3 COVID-19 waves in Alberta and Ontario: a retrospective cohort study. CMAJ Open 2022; 10:E400-E408. [PMID: 35473827 PMCID: PMC9121845 DOI: 10.9778/cmajo.20210323] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In Canada, published outcome data for COVID-19 come largely from the first 2 waves of the pandemic. We examined changes in demographics and 30-day outcomes after SARS-CoV-2 infection during the first 3 pandemic waves in Alberta and Ontario; for wave 3, we compared outcomes between those infected with a variant of concern and those infected with the original "wild-type" SARS-CoV-2. METHODS We conducted a population-based retrospective cohort study using linked health care data sets in Alberta and Ontario. We identified all-cause hospitalizations or deaths within 30 days after a positive result on a reverse transcription polymerase chain reaction test for SARS-CoV-2 in individuals of any age between Mar. 1, 2020, and June 30, 2021, with genomic confirmation of variants of concern. We compared outcomes in wave 3 (February 2021 to June 2021) with outcomes in waves 1 and 2 combined (March 2020 to January 2021) after adjusting for age, sex and Charlson Comorbidity Index score. Using wave 3 data only, we compared outcomes by vaccination status and whether or not the individual was infected with a variant of concern. RESULTS Compared to those infected with SARS-CoV-2 during waves 1 and 2 (n = 372 070), we found a shift toward a younger and healthier demographic in those infected during wave 3 (n = 359 079). In wave 3, patients were more likely to be hospitalized (adjusted odds ratio [aOR] 1.57, 95% confidence interval [CI] 1.46-1.70) but had a shorter length of hospital stay (median 6 days v. 7 days, p < 0.001) and lower 30-day mortality (aOR 0.73, 95% CI 0.65-0.81). The 217 892 patients in wave 3 who were infected with a variant of concern (83.5% confirmed to have the Alpha variant, 1.7% confirmed to have the Delta variant) had a higher risk of death (Alpha: aOR 1.29, 95% CI 1.16-1.44; Delta: aOR 2.05, 95% CI 1.49-2.82) and hospitalization (Alpha: aOR 1.59, 95% CI 1.53-1.66; Delta: aOR 1.88, 95% CI 1.64-2.15) than those infected with wild-type SARS-CoV-2. INTERPRETATION We observed a shift among those infected with SARS-CoV-2 toward younger patients with fewer comorbidities, a shorter length of hospital stay and lower mortality risk as the pandemic evolved in Alberta and Ontario; however, infection with a variant of concern was associated with a substantially higher risk of hospitalization or death. As variants of concern emerge, ongoing monitoring of disease expression and outcomes among vaccinated and unvaccinated individuals is important to understand the phenotypes of COVID-19 and the anticipated burdens for the health care system.
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Affiliation(s)
- Finlay A McAlister
- The Department of Medicine, Faculty of Medicine and Dentistry (McAlister, Saxinger, Bakal), University of Alberta, Edmonton, Alta.; The Alberta Strategy for Patient Oriented Research Support Unit (McAlister, Nabipoor, Bakal); The Canadian VIGOUR Centre (McAlister), University of Alberta, Edmonton, Alta.; ICES (Chu, Lee); University of Toronto (Chu, Lee); University Health Network (Lee), Toronto, Ont.
| | - Majid Nabipoor
- The Department of Medicine, Faculty of Medicine and Dentistry (McAlister, Saxinger, Bakal), University of Alberta, Edmonton, Alta.; The Alberta Strategy for Patient Oriented Research Support Unit (McAlister, Nabipoor, Bakal); The Canadian VIGOUR Centre (McAlister), University of Alberta, Edmonton, Alta.; ICES (Chu, Lee); University of Toronto (Chu, Lee); University Health Network (Lee), Toronto, Ont
| | - Anna Chu
- The Department of Medicine, Faculty of Medicine and Dentistry (McAlister, Saxinger, Bakal), University of Alberta, Edmonton, Alta.; The Alberta Strategy for Patient Oriented Research Support Unit (McAlister, Nabipoor, Bakal); The Canadian VIGOUR Centre (McAlister), University of Alberta, Edmonton, Alta.; ICES (Chu, Lee); University of Toronto (Chu, Lee); University Health Network (Lee), Toronto, Ont
| | - Douglas S Lee
- The Department of Medicine, Faculty of Medicine and Dentistry (McAlister, Saxinger, Bakal), University of Alberta, Edmonton, Alta.; The Alberta Strategy for Patient Oriented Research Support Unit (McAlister, Nabipoor, Bakal); The Canadian VIGOUR Centre (McAlister), University of Alberta, Edmonton, Alta.; ICES (Chu, Lee); University of Toronto (Chu, Lee); University Health Network (Lee), Toronto, Ont
| | - Lynora Saxinger
- The Department of Medicine, Faculty of Medicine and Dentistry (McAlister, Saxinger, Bakal), University of Alberta, Edmonton, Alta.; The Alberta Strategy for Patient Oriented Research Support Unit (McAlister, Nabipoor, Bakal); The Canadian VIGOUR Centre (McAlister), University of Alberta, Edmonton, Alta.; ICES (Chu, Lee); University of Toronto (Chu, Lee); University Health Network (Lee), Toronto, Ont
| | - Jeffrey A Bakal
- The Department of Medicine, Faculty of Medicine and Dentistry (McAlister, Saxinger, Bakal), University of Alberta, Edmonton, Alta.; The Alberta Strategy for Patient Oriented Research Support Unit (McAlister, Nabipoor, Bakal); The Canadian VIGOUR Centre (McAlister), University of Alberta, Edmonton, Alta.; ICES (Chu, Lee); University of Toronto (Chu, Lee); University Health Network (Lee), Toronto, Ont
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Khalagi K, Gharibzadeh S, Khalili D, Mansournia MA, Mirab Samiee S, Aghamohamadi S, Mir-Mohammad-Ali Roodaki M, Hashemi SM, Tayeri K, Namdari Tabar H, Azadmanesh K, Tabrizi JS, Mohammad K, Hajipour F, Namaki S, Raeisi A, Ostovar A. Prevalence of COVID-19 in Iran: results of the first survey of the Iranian COVID-19 Serological Surveillance programme. Clin Microbiol Infect 2021; 27:1666-1671. [PMID: 34111585 PMCID: PMC8226066 DOI: 10.1016/j.cmi.2021.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This study aims to estimate the prevalence of coronavirus disease 2019 (COVID-19) in the general population of Iran. METHODS The target population was all Iranian people aged 6 years and older in the country. A stratified random sampling design was used to select 28 314 people from among the individuals registered in the electronic health record systems used in primary health care in Iran. Venous blood was taken from each participant and tested for the IgG antibody against COVID-19. The prevalence of COVID-19 was estimated at provincial and national levels after adjusting for the measurement error of the laboratory test, non-response bias and sampling design. RESULTS Of the 28 314 Iranians selected, 11 256 (39.75%) participated in the study. Of these, 5406 (48.0%) were male and 6851 (60.9%) lived in urban areas. The mean (standard deviation) participant age was 35.89 (18.61) years. The adjusted prevalence of COVID-19 until 20 August 2020 was estimated as 14.2% (95% uncertainty interval 13.3%-15.2%), which was equal to 11 958 346 (95% CI 11 211 011-12 746 776) individuals. The adjusted prevalences of infection were 14.6%, 13.8%, 16.6%, 11.7% and 19.4% among men, women, urban population, rural population and individuals aged 60 years or more, respectively. Ardabil, Golestan and Khuzestan provinces had the highest prevalence and Alborz, Hormozgan and Kerman provinces had the lowest. CONCLUSIONS Based on the study results, a large proportion of the Iranian population had not yet been infected by COVID-19. The observance of hygienic principles and social restrictions should therefore continue until the majority of the population has been vaccinated.
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Affiliation(s)
- Kazem Khalagi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Safoora Gharibzadeh
- Department of Epidemiology and Biostatistics, Research Center for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Mirab Samiee
- Reference Health Laboratory, Ministry of Health and Medical Education, Tehran, Iran
| | - Saeide Aghamohamadi
- Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Seyed Mahmoud Hashemi
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Katayoun Tayeri
- Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran
| | - Hengameh Namdari Tabar
- HIV/STI Control Department, Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Jafar Sadegh Tabrizi
- Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kazem Mohammad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Firoozeh Hajipour
- Endocrinology Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeid Namaki
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Raeisi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Whittaker C, Walker PGT, Alhaffar M, Hamlet A, Djaafara BA, Ghani A, Ferguson N, Dahab M, Checchi F, Watson OJ. Under-reporting of deaths limits our understanding of true burden of covid-19. BMJ 2021; 375:n2239. [PMID: 34642172 DOI: 10.1136/bmj.n2239] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Charles Whittaker
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
| | | | - Mervat Alhaffar
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Syria Research Group (SyRG), co-hosted by the London School of Hygiene and Tropical Medicine, London, UK; and Saw Swee Hock School of Public Health, Singapore
| | - Arran Hamlet
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
| | - Bimandra A Djaafara
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Azra Ghani
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
| | - Neil Ferguson
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
| | - Maysoon Dahab
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Oliver J Watson
- MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA), Imperial College London, London, UK
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