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Coma E, Martinez-Marcos M, Hermosilla E, Mendioroz J, Reñé A, Fina F, Perramon-Malavez A, Prats C, Cereza G, Ciruela P, Pineda V, Antón A, Ricós-Furió G, Soriano-Arandes A, Cabezas C. Effectiveness of nirsevimab immunoprophylaxis against respiratory syncytial virus-related outcomes in hospital and primary care settings: a retrospective cohort study in infants in Catalonia (Spain). Arch Dis Child 2024:archdischild-2024-327153. [PMID: 38857952 DOI: 10.1136/archdischild-2024-327153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 05/16/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND In Catalonia, infants under 6 months old were eligible to receive nirsevimab, a novel monoclonal antibody against respiratory syncytial virus (RSV). We aimed to analyse nirsevimab's effectiveness across primary and hospital care outcomes. METHODS Retrospective cohort study from 1 October 2023 to 31 January 2024, including all infants born between April and September 2023. We established two cohorts based on nirsevimab administration (immunised and non-immunised). We followed individuals until the earliest moment of an outcome-RSV infection, primary care attended bronchiolitis and pneumonia, hospital emergency visits due to bronchiolitis, hospital admission or intensive care unit (ICU) admission due to RSV bronchiolitis-death or the end of the study. We used the Kaplan-Meier estimator and fitted Cox regression models using a calendar time scale to estimate HRs and their 95% CIs. RESULTS Among 26 525 infants, a dose of nirsevimab led to an adjusted HR for hospital admission due to RSV bronchiolitis of 0.124 (95% CI: 0.086 to 0.179) and an adjusted HR for ICU admission of 0.099 (95% CI: 0.041 to 0.237). Additionally, the adjusted HRs observed for emergency visits were 0.446 (95% CI: 0.385 to 0.516) and 0.393 (95% CI: 0.203 to 0.758) for viral pneumonia, 0.519 (95% CI: 0.467 to 0.576) for bronchiolitis attended in primary care and 0.311 (95% CI: 0.200 to 0.483) for RSV infection. CONCLUSION We demonstrated nirsevimab's effectiveness with reductions of 87.6% and 90.1% in hospital and ICU admissions, respectively. These findings offer crucial guidance for public health authorities in implementing RSV immunisation campaigns.
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Affiliation(s)
- Ermengol Coma
- Primary Care Services Information System (SISAP), Institut Catala de la Salut, Barcelona, Spain
| | | | - Eduardo Hermosilla
- Primary Care Services Information System (SISAP), Institut Catala de la Salut, Barcelona, Spain
- Idiap Jordi Gol, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jacobo Mendioroz
- Public Health Secretariat, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Anna Reñé
- Primary Care Services Information System (SISAP), Institut Catala de la Salut, Barcelona, Spain
| | - Francesc Fina
- Primary Care Services Information System (SISAP), Institut Catala de la Salut, Barcelona, Spain
| | - Aida Perramon-Malavez
- Computational Biology and Complex Systems (BIOCOM-SC) Group, Departament de Fisica, Universitat Politecnica de Catalunya, Barcelona, Spain
| | - Clara Prats
- Computational Biology and Complex Systems (BIOCOM-SC) Group, Departament de Fisica, Universitat Politecnica de Catalunya, Barcelona, Spain
| | - Gloria Cereza
- Catalan Centre of Pharmacovigilance. Directorate-General for Healthcare Planning and Regulation, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Ciruela
- Public Health Secretariat, Department of Health, Generalitat de Catalunya, Barcelona, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Carlos III Health Institute, Madrid, Spain
| | - Valentí Pineda
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitari Parc Taulí, Hospital de Sabadell, Sabadell, Spain
| | - Andrés Antón
- Respiratory Virus Unit, Microbiology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Gemma Ricós-Furió
- Pediatric's Coordinator of Primary and Community Care, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
- Pediatric's Coordinator of Primary and Community Care, Institut Català de la Salut, Barcelona, Spain
| | - Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Children's Hospital, Hospital Vall d'Hebron, Barcelona, Spain
| | - Carmen Cabezas
- Public Health Secretariat, Department of Health, Generalitat de Catalunya, Barcelona, Spain
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Ghosh A, Kanta P, Ramola M, Mohindra R, Goyal K, Kishore R, Suri V, Lakshmi PVM, Chauhan C, Sharma M, Rakshit P, Ponnusamy K, Dikid T, Singh MP. Rapid Decline of SARS-CoV-2 Viral Load in Single vs. Double-Dose (Short-Interval <6 Weeks) ChAdOx nCoV-19 Vaccinated Health-Care Workers. Curr Microbiol 2024; 81:95. [PMID: 38353761 DOI: 10.1007/s00284-023-03603-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/26/2023] [Indexed: 02/16/2024]
Abstract
The present work was carried out during the emergence of Delta Variant of Concern (VoC) and aimed to study the change in SARS CoV-2 viral load in Covishield vaccinated asymptomatic/mildly symptomatic health-care workers (HCWs) to find out the optimum isolation period. The SARS CoV-2 viral load was carried out in sequential samples of 55 eligible HCWs which included unvaccinated (UnV; n = 11), single-dose vaccinated (SDV, n = 20) and double-dose vaccinated [DDV, n = 24; short-interval (<6 weeks)] subjects. The mean load of envelope (E) gene on day 5 in SDV [0.42 × 105 copies/reaction] was significantly lower as compared to DDV [6.3 × 105 copies/reaction, P = 0.005] and UnV [6.6 × 105 copies/reaction, P = 0.001] groups. The rate of decline of SARS CoV-2 viral load in the initial 5 days of PCR positivity was significantly higher in SDV as compared to that in DDV (Mean log decline 0.39 vs. 0.19; P < 0.001). This was possibly due to interference of adenoviral immunity of first dose of adenovirus-vectored vaccine in double-dose vaccinated HCWs who had received vaccines within a shorter interval (<6 weeks).
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Affiliation(s)
- Arnab Ghosh
- Department of Virology, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Poonam Kanta
- Department of Virology, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Manisha Ramola
- Department of Virology, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ritin Mohindra
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Kapil Goyal
- Department of Virology, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Roop Kishore
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Vikas Suri
- Department of Internal Medicine, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Chanderkanta Chauhan
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Manisha Sharma
- Department of Community Medicine and School of Public Health, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Partha Rakshit
- National Centre for Disease Control (NCDC), New Delhi, India
| | | | - Tanzin Dikid
- National Centre for Disease Control (NCDC), New Delhi, India
| | - Mini P Singh
- Department of Virology, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
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Yang Q, Yang Z, Cai X, Zhao H, Jia J, Sun F. Advances in methodologies of negative controls: a scoping review. J Clin Epidemiol 2024; 166:111228. [PMID: 38040387 DOI: 10.1016/j.jclinepi.2023.111228] [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: 05/20/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVES Negative controls are considered an important tool to mitigate biases in observational studies. The aim of this scoping review was to summarize current methodologies of negative controls (both negative control exposure [NCE] and negative control outcome [NCO]). STUDY DESIGN AND SETTING We searched PubMed, Web of Science, Embase, and Cochrane Library (up to March 9, 2023) for articles on methodologies of negative controls. Two reviewers selected eligible studies and collected relevant data independently and in duplicate. We reported total numbers and percentages, and summarized methodologies narratively. RESULTS A total of 37 relevant methodological articles were included in our review. These publications covered NCE (n = 11, 29.8%), NCO (n = 13, 35.1%), or both (n = 13, 35.1%), with most focused on bias detection (n = 14, 37.8%), bias correction (n = 16, 43.3%), and P value or confidence interval (CI) calibration (n = 5, 13.5%). For the two remaining articles (5.4%), one discussed bias detection and P value or CI calibration and the other covered all the three functions. For bias detection, the existence of an association between the NCE (NCO) and outcome (exposure) variables of interest simply indicates that results may suffer from confounding bias, selection bias and/or information bias. For bias correction, however, the algorithms of negative control methods need more stringent assumptions such as rank preservation, monotonicity, and linearity. CONCLUSION Negative controls can be leveraged for bias detection, P value or CI calibration, and bias correction, among which bias correction has been the most studied methodologically. The current available methods need some stringent assumptions to detect or remove bias. More methodological research is needed to optimize the use of negative controls.
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Affiliation(s)
- Qingqing Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Zhirong Yang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China; Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Xianming Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Houyu Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jinzhu Jia
- Department of Biostatistics, School of Public Health, Peking University, Beijing, China; Center for Statistical Science, Peking University, Beijing, China.
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases, Peking University, Beijing, China.
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Hu Y, Wang Y, Shao T, Tang W, Hu K, Zhou Y, Miao L, Liu J, Wang B, Yu W. Safety and immunogenicity of heterologous ChAdOx1-nCoV19 and BNT162b2 vaccination: A meta-analysis of the heterologous COVID-19 vaccination outcomes. Vaccine 2023; 41:3003-3010. [PMID: 37037708 PMCID: PMC10060199 DOI: 10.1016/j.vaccine.2023.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/10/2023] [Accepted: 03/26/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION Here, we systematically assessed the safety and immunogenicity of the heterologous ChAd/BNT vaccination regimens. MATERIALS AND METHODS We evaluated the immunogenicity by the geometric mean titers ratio (GMTR) of the neutralizing antibody and anti-spike IgG. The safety of heterologous ChAd/BNT vaccination was evaluated using the pooled risk ratios (RRs) calculated by the random-effects model about the adverse events. Our study was registered with PROSPERO, CRD42021265165. RESULTS Eleven studies were included in the analyses. Compared to the homologous ChAd/ChAd vaccination, the heterologous ChAd/BNT vaccination showed significantly higher immunogenicity in terms of the neutralizing antibody and GMTR of anti-spike IgG, but at the same time displayed higher incidence of total adverse reactions, especially for the local adverse reactions. Moreover, heterologous ChAd/BNT vaccination showed similar immunogenicity to the homologous BNT/BNT vaccination (GMTR of neutralizing antibody and anti-spike IgG) and similar safety. DISCUSSION Heterologous ChAd/BNT vaccination showed robust immunogenicity and tolerable safety.
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Affiliation(s)
- Yuxuan Hu
- Institute of Pharmaceutical Sciences, China Pharmaceutical University, Nanjing 211198, PR China
| | - Yanning Wang
- Clinical Stem Cell Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, PR China
| | - Taihang Shao
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing 211198, PR China
| | - Wenxi Tang
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing 211198, PR China
| | - Kerong Hu
- Department of Infectious Diseases, Huangshi Love&Health Hospital, Huangshi 435000, PR China
| | - Yujie Zhou
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing 210008, PR China
| | - Liyun Miao
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing 210008, PR China
| | - Jing Liu
- Clinical Laboratory, Nanjing Yuhua Hospital (Yuhua Branch of Nanjing First Hospital), Nanjing 210039, PR China.
| | - Bin Wang
- Clinical Stem Cell Center, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, PR China.
| | - Wenying Yu
- Institute of Pharmaceutical Sciences, China Pharmaceutical University, Nanjing 211198, PR China.
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Andersson NW, Thiesson EM, Laursen MV, Mogensen SH, Kjær J, Hviid A. Safety of heterologous primary and booster schedules with ChAdOx1-S and BNT162b2 or mRNA-1273 vaccines: nationwide cohort study. BMJ 2022; 378:e070483. [PMID: 35831006 PMCID: PMC9277486 DOI: 10.1136/bmj-2022-070483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the risk of adverse events associated with heterologous primary (two dose) and booster (three dose) vaccine schedules for covid-19 with Oxford-AstraZeneca's ChAdOx1-S priming followed by mRNA vaccines (Pfizer-BioNTech's BNT162b2 or Moderna's mRNA-1273) as compared with homologous mRNA vaccine schedules for covid-19. DESIGN Nationwide cohort study. SETTING Denmark, 1 January 2021 to 26 March 2022. PARTICIPANTS Adults aged 18-65 years who received a heterologous vaccine schedule of priming with ChAdOx1-S and one or two mRNA booster doses (with either the BNT162b2 or mRNA-1273 vaccine) were compared with adults who received a homologous BNT162b2 or mRNA-1273 vaccine schedule (ie, two dose v two dose, and three dose v three dose schedule). MAIN OUTCOME MEASURES The incidence of hospital contacts for a range of adverse cardiovascular and haemostatic events within 28 days after the second or third vaccine dose, comparing heterologous versus homologous vaccine schedules. Secondary outcomes included additional prioritised adverse events of special interest. Poisson regression was used to estimate incidence rate ratios with adjustment for selected covariates. RESULTS Individuals who had had a heterologous primary vaccine (n=137 495) or a homologous vaccine (n=2 688 142) were identified, in addition to those who had had a heterologous booster (n=129 770) or a homologous booster (n=2 197 213). Adjusted incidence rate ratios of adverse cardiovascular and haemostatic events within 28 days for the heterologous primary and booster vaccine schedules in comparison with the homologous mRNA vaccine schedules were 1.22 (95% confidence interval 0.79 to 1.91) and 1.00 (0.58 to 1.72) for ischaemic cardiac events, 0.74 (0.40 to 1.34) and 0.72 (0.37 to 1.42) for cerebrovascular events, 1.12 (0.13 to 9.58) and 4.74 (0.94 to 24.01) for arterial thromboembolisms, 0.79 (0.45 to 1.38) and 1.09 (0.60 to 1.98) for venous thromboembolisms, 0.84 (0.18 to 3.96) and 1.04 (0.60 to 4.55) for myocarditis or pericarditis, 0.97 (0.45 to 2.10) and 0.89 (0.21 to 3.77) for thrombocytopenia and coagulative disorders, and 1.39 (1.01 to 1.91) and 1.02 (0.70 to 1.47) for other bleeding events, respectively. No associations with any of the outcomes were found when restricting to serious adverse events defined as stay in hospital for more than 24 h. CONCLUSION Heterologous primary and booster covid-19 vaccine schedules of ChAdOx1-S priming and mRNA booster doses as both second and third doses were not associated with increased risk of serious adverse events compared with homologous mRNA vaccine schedules. These results are reassuring but given the rarity of some of the adverse events, associations cannot be excluded.
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Affiliation(s)
| | | | | | | | - Jesper Kjær
- Data Analytics Centre, Danish Medicines Agency, Copenhagen, Denmark
| | - Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Pharmacovigilance Research Center, Department of Drug Development and Clinical Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Au WY, Cheung PPH. Effectiveness of heterologous and homologous covid-19 vaccine regimens: living systematic review with network meta-analysis. BMJ 2022; 377:e069989. [PMID: 35640925 PMCID: PMC9724446 DOI: 10.1136/bmj-2022-069989] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of heterologous and homologous covid-19 vaccine regimens with and without boosting in preventing covid-19 related infection, hospital admission, and death. DESIGN Living systematic review and network meta-analysis. DATA SOURCES World Health Organization covid-19 databases, including 38 sources of published studies and preprints. STUDY SELECTION Randomised controlled trials, cohort studies, and case-control studies. METHODS 38 WHO covid-19 databases were searched on a weekly basis from 8 March 2022 to 31 July 2022. Studies that assessed the effectiveness of heterologous and homologous covid-19 vaccine regimens with or without a booster were identified. Studies were eligible when they reported the number of documented, symptomatic, severe covid-19 infections, covid-19 related hospital admissions, or covid-19 related deaths among populations that were vaccinated and unvaccinated. The primary measure was vaccine effectiveness calculated as 1−odds ratio. Secondary measures were surface under the cumulative ranking curve (SUCRA) scores and the relative effects for pairwise comparisons. The risk of bias was evaluated by using the risk of bias in non-randomised studies of interventions (ROBINS-I) tool for all cohort and case-control studies. The Cochrane risk of bias tool (version 2; ROB-2) was used to assess randomised controlled trials. RESULTS The second iteration of the analysis comprised 63 studies. 25 combinations of covid-19 vaccine regimens were identified, of which three doses of mRNA vaccine were found to be 93% (95% credible interval 70% to 98%) effective against asymptomatic or symptomatic covid-19 infections for non-delta or non-omicron related infections. Heterologous boosting using two dose adenovirus vector vaccines with one dose mRNA vaccine showed a vaccine effectiveness of 94% (72% to 99%) against non-delta or non-omicron related asymptomatic or symptomatic infections. Three doses of mRNA vaccine were found to be the most effective in reducing non-delta or non-omicron related hospital admission (96%, 82% to 99%). The vaccine effectiveness against death in people who received three doses of mRNA vaccine remains uncertain owing to confounders. The estimate for a four dose mRNA vaccine regimen was of low certainty, as only one study on the effectiveness of four doses could be included in this update. More evidence on four dose regimens will be needed to accurately assess the effectiveness of a fourth vaccine dose. For people with delta or omicron related infection, a two dose regimen of an adenovirus vector vaccine with one dose of mRNA booster was 77% (42% to 91%) effective against asymptomatic or symptomatic covid-19 infections, and a three dose regimen of a mRNA vaccine was 93% (76% to 98%) effective against covid-19 related hospital admission. CONCLUSION An mRNA booster is recommended to supplement any primary vaccine course. Heterologous and homologous three dose regimens work comparably well in preventing covid-19 infections, even against different variants. The effectiveness of three dose vaccine regimens against covid-19 related death remains uncertain. SYSTEMATIC REVIEW REGISTRATION This review was not registered. The protocol is included in the supplementary document. READERS' NOTE This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This version is update 1 of the original article published on 31 May 2022 (BMJ 2022;377:e069989), and previous versions can be found as data supplements (https://www.bmj.com/content/377/bmj-2022-069989/related). When citing this paper please consider adding the version number and date of access for clarity.
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Affiliation(s)
- Wing Ying Au
- Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China
- Department of Chemical Pathology, Chinese University of Hong Kong, Hong Kong, China
| | - Peter Pak-Hang Cheung
- Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China
- Department of Chemical Pathology, Chinese University of Hong Kong, Hong Kong, China
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