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Mizuno T, Kondo Y, Sakai M, Saneyasu K, Kojima R, Miyake Y. Cost-effectiveness of nirmatrelvir/ritonavir for high-risk adult outpatients with COVID-19 in Japan. J Infect Chemother 2024; 30:716-724. [PMID: 38325626 DOI: 10.1016/j.jiac.2024.02.001] [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: 09/30/2023] [Revised: 01/12/2024] [Accepted: 02/02/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION This study aimed to evaluate the cost-effectiveness of nirmatrelvir/ritonavir (Nir/Rit) for adult outpatients with COVID-19 from the perspective of a Japanese public healthcare payer. METHODS A cost-effectiveness simulation was conducted comparing Nir/Rit for the outpatient treatment of high-risk COVID-19 patients to best supportive care (BSC) without antiviral or antibody drugs. The analytical model was divided into two phases: the treatment phase, lasting 35 days from the start of COVID-19 treatment, and the post-treatment phase. Patients who survived the treatment phase were assumed to follow a general population survival curve. Expected costs and expected quality-adjusted life years (QALYs) for both BSC and Nir/Rit were calculated for ages 40 to 80 to obtain the incremental cost-effectiveness ratio (ICER). The robustness of the results was evaluated through deterministic and probabilistic sensitivity analysis (PSA). RESULTS The ICERs for patients aged 40, 50, 60, 70, and 80 were 18,854,276 Japanese Yen (JPY)/QALY, 8,482,034 JPY/QALY, 4,976,612 JPY/QALY, 2,636,096 JPY/QALY, and 1,597,783 JPY/QALY, respectively. In the deterministic sensitivity analysis, both the mortality risk during the treatment phase and the relative mortality risk with Nir/Rit had a high impact on ICER across all ages. In the PSA, when the willingness-to-pay (WTP) threshold was set at 5 million JPY/QALY, the probability of the ICER being below the WTP threshold was 0%, 0.2%, 45.4%, 99.9%, and 100% at ages 40, 50, 60, 70, and 80, respectively. CONCLUSION Nir/Rit is cost-effective for older individuals aged 60 and over but not for younger age groups.
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Affiliation(s)
- Takahito Mizuno
- Department of Pharmacy, Toyota Kosei Hospital: 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Yu Kondo
- Department of Pharmacy, Toyota Kosei Hospital: 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan.
| | - Mikiyasu Sakai
- Department of Pharmacy, Toyota Kosei Hospital: 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Kenichi Saneyasu
- Department of Pharmacy, Toyota Kosei Hospital: 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Ryota Kojima
- Department of Pharmacy, Toyota Kosei Hospital: 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Yoshio Miyake
- Department of Pharmacy, Toyota Kosei Hospital: 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
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Murthy SC, Gordon SM, Lowry AM, Blackstone EH. Evolution of serious and life-threatening COVID-19 pneumonia as the SARS-CoV-2 pandemic progressed: an observational study of mortality to 60 days after admission to a 15-hospital US health system. BMJ Open 2024; 14:e075028. [PMID: 38977360 PMCID: PMC11256047 DOI: 10.1136/bmjopen-2023-075028] [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: 06/29/2023] [Accepted: 05/13/2024] [Indexed: 07/10/2024] Open
Abstract
OBJECTIVE In order to predict at hospital admission the prognosis of patients with serious and life-threatening COVID-19 pneumonia, we sought to understand the clinical characteristics of hospitalised patients at admission as the SARS-CoV-2 pandemic progressed, document their changing response to the virus and its variants over time, and identify factors most importantly associated with mortality after hospital admission. DESIGN Observational study using a prospective hospital systemwide COVID-19 database. SETTING 15-hospital US health system. PARTICIPANTS 26 872 patients admitted with COVID-19 to our Northeast Ohio and Florida hospitals from 1 March 2020 to 1 June 2022. MAIN OUTCOME MEASURES 60-day mortality (highest risk period) after hospital admission analysed by random survival forests machine learning using demographics, medical history, and COVID-19 vaccination status, and viral variant, symptoms, and routine laboratory test results obtained at hospital admission. RESULTS Hospital mortality fell from 11% in March 2020 to 3.7% in March 2022, a 66% decrease (p<0.0001); 60-day mortality fell from 17% in May 2020 to 4.7% in May 2022, a 72% decrease (p<0.0001). Advanced age was the strongest predictor of 60-day mortality, followed by admission laboratory test results. Risk-adjusted 60-day mortality had all patients been admitted in March 2020 was 15% (CI 3.0% to 28%), and had they all been admitted in May 2022, 12% (CI 2.2% to 23%), a 20% decrease (p<0.0001). Dissociation between observed and predicted decrease in mortality was related to temporal change in admission patient profile, particularly in laboratory test results, but not vaccination status or viral variant. CONCLUSIONS Hospital mortality from COVID-19 decreased substantially as the pandemic evolved but persisted after hospital discharge, eclipsing hospital mortality by 50% or more. However, after accounting for the many, even subtle, changes across the pandemic in patients' demographics, medical history and particularly admission laboratory results, a patient admitted early in the pandemic and predicted to be at high risk would remain at high risk of mortality if admitted tomorrow.
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Affiliation(s)
- Sudish C Murthy
- Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Ashley M Lowry
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
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McGovern I, Chastek B, Bancroft T, Webb N, Imran M, Pelton SI, Haag MDM. Relative vaccine effectiveness of MF59-adjuvanted vs high-dose trivalent inactivated influenza vaccines for prevention of test-confirmed influenza hospitalizations during the 2017-2020 influenza seasons. Int J Infect Dis 2024; 146:107160. [PMID: 38969330 DOI: 10.1016/j.ijid.2024.107160] [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: 03/19/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVES This study evaluated relative vaccine effectiveness (rVE) of MF59-adjuvanted trivalent inactivated influenza vaccine (aTIV) vs high-dose trivalent inactivated influenza vaccine (HD-TIV) for prevention of test-confirmed influenza emergency department visits and/or inpatient admissions ("ED/IP") and for IP admissions alone pooled across the 2017-2020 influenza seasons. Exploratory individual season analyses were also performed. METHODS This retrospective test-negative design study included United States (US) adults age ≥65 years vaccinated with aTIV or HD-TIV who presented to an ED or IP setting with acute respiratory or febrile illness during the 2017-2020 influenza seasons. Test-positive cases and test-negative controls were grouped by vaccine received. The rVE of aTIV vs HD-TIV was evaluated using a combination of inverse probability of treatment weighting and logistic regression to adjust for potential confounders. RESULTS Pooled analyses over the three seasons found no significant differences in the rVE of aTIV vs HD-TIV for prevention of test-confirmed influenza ED/IP (-2.5% [-19.6, 12.2]) visits and admissions or IP admissions alone (-1.6% [-22.5, 15.7]). The exploratory individual season analyses also showed no significant differences. CONCLUSIONS Evidence from the 2017-2020 influenza seasons indicates aTIV and HD-TIV are comparable for prevention of test-confirmed influenza ED/IP visits in US adults age ≥65 years.
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Kim T, Lee H, Jeong CY, Yeom SW, Kim BG, Park TS, Park DW, Moon JY, Kim TH, Sohn JW, Yoon HJ, Kim SH, Kim JS. Does COVID-19 vaccination increase the risk of interstitial lung disease at a population level? ERJ Open Res 2024; 10:00690-2023. [PMID: 38957166 PMCID: PMC11215762 DOI: 10.1183/23120541.00690-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/05/2024] [Indexed: 07/04/2024] Open
Abstract
This study showed a significantly lower incidence of ILD among COVID-19 vaccinated individuals compared to unvaccinated, suggesting that the risk of COVID-19 vaccine-related ILD is not as high as previously reported https://bit.ly/3TWzzxP.
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Affiliation(s)
- Taehee Kim
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
- T.H. Kim, H. Lee and C.Y. Jeong contributed equally to this work
| | - Hyun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
- T.H. Kim, H. Lee and C.Y. Jeong contributed equally to this work
| | - Cho Yun Jeong
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- T.H. Kim, H. Lee and C.Y. Jeong contributed equally to this work
| | - Sang Woo Yeom
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Bo-Guen Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tai Sun Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Dong Won Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hyung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jang Won Sohn
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
- J.S. Kim and S-H. Kim contributed equally to this work
| | - Jong Seung Kim
- Research Institute of Clinical Medicine of Jeonbuk National University – Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- J.S. Kim and S-H. Kim contributed equally to this work
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Farmer G, Sikdar KC, Lo T, Conly J, Slobodan J, Ross J, James S, Usman H, Kemp K, Baker K, Doucette K, Nijssen-Jordan C, Saxinger LM, Joffe AM. Real-world evidence of sotrovimab effectiveness for preventing severe outcomes in patients with COVID-19: A quality improvement propensity-matched retrospective cohort study of a pan-provincial program in Alberta, Canada. Int J Infect Dis 2024; 146:107136. [PMID: 38880123 DOI: 10.1016/j.ijid.2024.107136] [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: 01/11/2024] [Revised: 05/21/2024] [Accepted: 06/11/2024] [Indexed: 06/18/2024] Open
Abstract
OBJECTIVES Post-marketing surveillance of sotrovimab's effect during implementation in the Canadian population is limited. METHODS The study used a propensity score-matched retrospective cohort design. Follow-up began between the periods of December 15, 2021 and April 30 2022. The study assessed any severe outcome defined as all-cause hospital admission or mortality within 30 days of a confirmed COVID-19-positive test. Covariate-adjusted odds ratios between sotrovimab treatment and the severe outcome was conducted using logistic regression. RESULTS There were 22,289 individuals meeting the treatment criteria for sotrovimab. There were 1603 treated and 6299 untreated individuals included in the analysis. The outcome occurrence in the study was 5.49% (treated) and 4.21% (untreated), with a median time from diagnosis to treatment of 1.00 days (interquartile range 2.00 days). In the propensity-matched cohort, sotrovimab was not associated with lower odds of a severe outcome (odds ratio 1.20, 95% confidence interval 0.91-1.58), adjusting for confounding variables. CONCLUSIONS After adjusting for confounding variables, sotrovimab treatment was not associated with lower odds of a severe outcome within 30-days of COVID-19-positive date.
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Affiliation(s)
- Gregory Farmer
- Department of Provincial Population and Public Health (PPPH), Alberta Health Services, Edmonton, Canada.
| | - Khokan C Sikdar
- Department of Provincial Population and Public Health (PPPH), Alberta Health Services, Edmonton, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Tkt Lo
- Department of Provincial Population and Public Health (PPPH), Alberta Health Services, Edmonton, Canada
| | - John Conly
- Department of Medicine, Division of Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Canada; Alberta Health Services, Alberta, Canada
| | - Jeremy Slobodan
- Department of Drug Utilization, Information and Stewardship, Alberta Health Services, Edmonton, Canada
| | - Jordan Ross
- Department of Provincial Population and Public Health (PPPH), Alberta Health Services, Edmonton, Canada
| | - Samantha James
- Department of Provincial Population and Public Health (PPPH), Alberta Health Services, Edmonton, Canada
| | - Hussain Usman
- Department of Provincial Population and Public Health (PPPH), Alberta Health Services, Edmonton, Canada
| | - Kyle Kemp
- Department of Provincial Population and Public Health (PPPH), Alberta Health Services, Edmonton, Canada
| | - Kristi Baker
- Department of Oncology, Division of Experimental Oncology, University of Alberta, Edmonton, Canada
| | - Karen Doucette
- Alberta Health Services, Alberta, Canada; Department of Medicine, Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | | | - Lynora M Saxinger
- Alberta Health Services, Alberta, Canada; Department of Medicine, Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - A Mark Joffe
- Alberta Health Services, Alberta, Canada; Department of Medicine, Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Zhang Y, Fu Z, Zhang H, Lin K, Song J, Guo J, Zhang Q, Yuan G, Wang H, Fan M, Zhao Y, Sun R, Guo T, Jiang N, Qiu C, Zhang W, Ai J. Proteomic and Cellular Characterization of Omicron Breakthrough Infections and a Third Homologous or Heterologous Boosting Vaccination in a Longitudinal Cohort. Mol Cell Proteomics 2024; 23:100769. [PMID: 38641227 PMCID: PMC11154224 DOI: 10.1016/j.mcpro.2024.100769] [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: 07/18/2023] [Revised: 01/18/2024] [Accepted: 03/23/2024] [Indexed: 04/21/2024] Open
Abstract
The understanding of dynamic plasma proteome features in hybrid immunity and breakthrough infection is limited. A deeper understanding of the immune differences between heterologous and homologous immunization could assist in the future establishment of vaccination strategies. In this study, 40 participants who received a third dose of either a homologous BBIBP-CorV or a heterologous ZF2001 protein subunit vaccine following two doses of inactivated coronavirus disease 2019 vaccines and 12 patients with BA2.2 breakthrough infections were enrolled. Serum samples were collected at days 0, 28, and 180 following the boosting vaccination and breakthrough and then analyzed using neutralizing antibody tests and mass spectrometer-based proteomics. Mass cytometry of peripheral blood mononuclear cell samples was also performed in this cohort. The chemokine signaling pathway and humoral response markers (IgG2 and IgG3) associated with infection were found to be upregulated in breakthrough infections compared to vaccination-induced immunity. Elevated expression of IGKV, IGHV, IL-17 signaling, and the phagocytosis pathway, along with lower expression of FGL2, were correlated with higher antibody levels in the boosting vaccination groups. The MAPK signaling pathway and Fc gamma R-mediated phagocytosis were more enriched in the heterologous immunization groups than in the homologous immunization groups. Breakthrough infections can trigger more intensive inflammatory chemokine responses than vaccination. T-cell and innate immune activation have been shown to be closely related to enhanced antibody levels after vaccination and therefore might be potential targets for vaccine adjuvant design.
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Affiliation(s)
- Yi Zhang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhangfan Fu
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haocheng Zhang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ke Lin
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jieyu Song
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jingxin Guo
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiran Zhang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Guanmin Yuan
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongyu Wang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Mingxiang Fan
- Tongji Medical School, Tongji University, Shanghai, China
| | - Yuanhan Zhao
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Rui Sun
- iMarker lab, Westlake Laboratory of Life Sciences and Biomedicine, Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang Province, China
| | - Tiannan Guo
- iMarker lab, Westlake Laboratory of Life Sciences and Biomedicine, Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang Province, China
| | - Ning Jiang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chao Qiu
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenhong Zhang
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; Shanghai huashen institute of microbes and infections, Shanghai, China.
| | - Jingwen Ai
- Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
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Leung WC, Ho RWH, Leung AKL, Chu FHN, Lo CNR, Chan AA, Chan CYC, Chan DYH, Chui JHY, Li WTV, Yeung EHL, Teo KC, Lau GKK, Chang RSK. Risk of Seizure Aggravation after COVID-19 Vaccinations in Patients with Epilepsy. Vaccines (Basel) 2024; 12:593. [PMID: 38932322 PMCID: PMC11209536 DOI: 10.3390/vaccines12060593] [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: 04/28/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Although Coronavirus disease 2019 (COVID-19) vaccinations are generally recommended for persons with epilepsy (PwE), a significant vaccination gap remains due to patient concerns over the risk of post-vaccination seizure aggravation (PVSA). In this single-centre, retrospective cohort study, we aimed to determine the early (7-day) and delayed (30-day) risk of PVSA, and to identify clinical predictors of PVSA among PwE. Adult epilepsy patients aged ≥18 years without a history of COVID-19 infection were recruited from a specialty epilepsy clinic in early 2022. Demographic, epilepsy characteristics, and vaccination data were extracted from a centralized electronic patient record. Seizure frequency before and after vaccination, vaccination-related adverse effects, and reasons for or against vaccination were obtained by a structured questionnaire. A total of 786 PwEs were included, of which 27.0% were drug-resistant. At the time of recruitment, 74.6% had at least 1 dose of the COVID-19 vaccine. Subjects with higher seizure frequency (p < 0.0005), on more anti-seizure medications (p = 0.004), or had drug-resistant epilepsy (p = 0.001) were less likely to be vaccinated. No significant increase in seizure frequency was observed in the early (7 days) and delayed phases (30 days) after vaccination in our cohort. On the contrary, there was an overall significant reduction in seizure frequency 30 days after vaccination (1.31 vs. 1.89, t = 3.436; p = 0.001). This difference was seen in both types of vaccine (BNT162b2 and CoronaVac) and drug-resistant epilepsy, but just missed significance for the second dose (1.13 vs. 1.87, t = 1.921; p = 0.055). Only 5.3% had PVSA after either dose of vaccine. Higher pre-vaccination seizure frequency of ≥1 per week (OR 3.01, 95% CI 1.05-8.62; p = 0.04) and drug-resistant status (OR 3.32, 95% CI 1.45-249 7.61; p = 0.005) were predictive of PVSA. Meanwhile, seizure freedom for 3 months before vaccination was independently associated with a lower risk of PVSA (OR 0.11, 95% CI 0.04-0.28; p < 0.0005). This may guide epilepsy treatment strategies to achieve better seizure control for at least 3 months prior to vaccination. As COVID-19 shifts to an endemic phase, this study provides important data demonstrating the overall safety of COVID-19 vaccinations among PwE. Identification of high-risk patients with subsequent individualized approaches in treatment and monitoring strategies may alleviate vaccination hesitancy among PwE.
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Affiliation(s)
- William C.Y. Leung
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
| | - Ryan Wui-Hang Ho
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
| | - Anthony Ka-Long Leung
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
| | - Florinda Hui-Ning Chu
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
| | - Cheuk Nam Rachel Lo
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
| | - Andrian A. Chan
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Cheuk Yan Claudia Chan
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Desmond Yin Hei Chan
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Jacklyn Hoi Ying Chui
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Wai Tak Victor Li
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Elton Hau Lam Yeung
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Kay Cheong Teo
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Gary Kui-Kai Lau
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China; (A.A.C.); (C.Y.C.C.); (D.Y.H.C.); (J.H.Y.C.); (W.T.V.L.); (E.H.L.Y.)
| | - Richard Shek-Kwan Chang
- Division of Neurology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China; (R.W.-H.H.); (A.K.-L.L.); (F.H.-N.C.); (C.N.R.L.); (K.C.T.); (G.K.-K.L.)
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Lee HE, Jeong NY, Park M, Lim E, Kim JA, Won H, Kim CJ, Park SM, Choi NK. Effectiveness of COVID-19 vaccines against severe outcomes in cancer patients: Real-world evidence from self-controlled risk interval and retrospective cohort studies. J Infect Public Health 2024; 17:854-861. [PMID: 38554591 DOI: 10.1016/j.jiph.2024.03.015] [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: 12/11/2023] [Revised: 02/18/2024] [Accepted: 03/12/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND The effectiveness of COVID-19 vaccines is generally reduced in cancer patients compared to the general population. However, there are only a few studies that compare the relative risk of breakthrough infections and severe COVID-19 outcomes in fully vaccinated cancer patients versus their unvaccinated counterparts. METHODS To assess the effectiveness of COVID-19 vaccines in cancer patients, we employed (1) a self-controlled risk interval (SCRI) design, and (2) a retrospective matched cohort design. A SCRI design was used to compare the risk of breakthrough infection in vaccinated cancer patients during the period immediately following vaccination ("control window") and the period in which immunity is achieved ("exposure windows"). The retrospective matched cohort design was used to compare the risk of severe COVID-19 outcomes between vaccinated and unvaccinated cancer patients. For both studies, data were extracted from the Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service cohort, including demographics, medical history, and vaccination records of all individuals confirmed with COVID-19. We used conditional Poisson regression to calculate the incidence rate ratio (IRR) for breakthrough infection and Cox regression to estimate the hazard ratio (HR) for severe outcomes. RESULTS Of 14,448 cancer patients diagnosed with COVID-19 between October 2020 and December 2021, a total of 217 and 3996 cancer patients were included in the SCRI and cohort study respectively. While the risk of breakthrough infections, measured by the incidence rate in the control and exposure windows, did not show statistically significant difference in vaccinated cancer patients (IRR=0.88, 95% CI: 0.64-1.22), the risk of severe COVID-19 outcomes was significantly lower in vaccinated cancer patients compared to those unvaccinated (HR=0.27, 95% CI: 0.22-0.34). CONCLUSION COVID-19 vaccines significantly reduce the risk of severe outcomes in cancer patients, though their efficacy against breakthrough infections is less evident.
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Affiliation(s)
- Hui-Eon Lee
- Graduate School of Industrial Pharmaceutical Science, College of Pharmacy, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760 Republic of Korea
| | - Na-Young Jeong
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Republic of Korea
| | - Minah Park
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Republic of Korea
| | - Eunsun Lim
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Republic of Korea
| | - Jeong Ah Kim
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Republic of Korea
| | - Heehyun Won
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Republic of Korea
| | - Chung-Jong Kim
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, 260, Gonghang-daero, Gangseo-gu, Seoul, Republic of Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea; Department of Biomedical Sciences, Seoul National University Graduate School, Seoul National University College of Medicine, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Nam-Kyong Choi
- Graduate School of Industrial Pharmaceutical Science, College of Pharmacy, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760 Republic of Korea; Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Republic of Korea.
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9
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Stein AN, Mills CW, McGovern I, McDermott KW, Dean A, Bogdanov AN, Sullivan SG, Haag MDM. Relative Vaccine Effectiveness of Cell- vs Egg-Based Quadrivalent Influenza Vaccine Against Test-Confirmed Influenza Over 3 Seasons Between 2017 and 2020 in the United States. Open Forum Infect Dis 2024; 11:ofae175. [PMID: 38698895 PMCID: PMC11064727 DOI: 10.1093/ofid/ofae175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/20/2024] [Indexed: 05/05/2024] Open
Abstract
Background Influenza vaccine viruses grown in eggs may acquire egg-adaptive mutations that may reduce antigenic similarity between vaccine and circulating influenza viruses and decrease vaccine effectiveness. We compared cell- and egg-based quadrivalent influenza vaccines (QIVc and QIVe, respectively) for preventing test-confirmed influenza over 3 US influenza seasons (2017-2020). Methods Using a retrospective test-negative design, we estimated the relative vaccine effectiveness (rVE) of QIVc vs QIVe among individuals aged 4 to 64 years who had an acute respiratory or febrile illness and were tested for influenza in routine outpatient care. Exposure, outcome, and covariate data were obtained from electronic health records linked to pharmacy and medical claims. Season-specific rVE was estimated by comparing the odds of testing positive for influenza among QIVc vs QIVe recipients. Models were adjusted for age, sex, geographic region, influenza test date, and additional unbalanced covariates. A doubly robust approach was used combining inverse probability of treatment weights with multivariable regression. Results The study included 31 824, 33 388, and 34 398 patients in the 2017-2018, 2018-2019, and 2019-2020 seasons, respectively; ∼10% received QIVc and ∼90% received QIVe. QIVc demonstrated superior effectiveness vs QIVe in prevention of test-confirmed influenza: rVEs were 14.8% (95% CI, 7.0%-22.0%) in 2017-2018, 12.5% (95% CI, 4.7%-19.6%) in 2018-2019, and 10.0% (95% CI, 2.7%-16.7%) in 2019-2020. Conclusions This study demonstrated consistently superior effectiveness of QIVc vs QIVe in preventing test-confirmed influenza over 3 seasons characterized by different circulating viruses and degrees of egg adaptation.
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Affiliation(s)
- Alicia N Stein
- Centre for Outcomes Research and Epidemiology, CSL Seqirus, Melbourne, Australia
| | | | - Ian McGovern
- Centre for Outcomes Research and Epidemiology, CSL Seqirus, Waltham, Massachusetts, USA
| | | | - Alex Dean
- Real World Evidence, Veradigm, Chicago, Illinois, USA
| | | | - Sheena G Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, and Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute of Infection and Immunity, Melbourne, Australia
- Department of Epidemiology, University of California, Los Angeles, California, USA
| | - Mendel D M Haag
- Centre for Outcomes Research and Epidemiology, CSL Seqirus, Amsterdam, Netherlands
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10
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de Rioja VL, Basile L, Perramon-Malavez A, Martínez-Solanas É, López D, Medina Maestro S, Coma E, Fina F, Prats C, Mendioroz Peña J, Alvarez-Lacalle E. Severity of Omicron Subvariants and Vaccine Impact in Catalonia, Spain. Vaccines (Basel) 2024; 12:466. [PMID: 38793717 PMCID: PMC11125683 DOI: 10.3390/vaccines12050466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
In the current COVID-19 landscape dominated by Omicron subvariants, understanding the timing and efficacy of vaccination against emergent lineages is crucial for planning future vaccination campaigns, yet detailed studies stratified by subvariant, vaccination timing, and age groups are scarce. This retrospective study analyzed COVID-19 cases from December 2021 to January 2023 in Catalonia, Spain, focusing on vulnerable populations affected by variants BA.1, BA.2, BA.5, and BQ.1 and including two national booster campaigns. Our database includes detailed information such as dates of diagnosis, hospitalization and death, last vaccination, and cause of death, among others. We evaluated the impact of vaccination on disease severity by age, variant, and vaccination status, finding that recent vaccination significantly mitigated severity across all Omicron subvariants, although efficacy waned six months post-vaccination, except for BQ.1, which showed more stable levels. Unvaccinated individuals had higher hospitalization and mortality rates. Our results highlight the importance of periodic vaccination to reduce severe outcomes, which are influenced by variant and vaccination timing. Although the seasonality of COVID-19 is uncertain, our analysis suggests the potential benefit of annual vaccination in populations >60 years old, probably in early fall, if COVID-19 eventually exhibits a major peak similar to other respiratory viruses.
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Affiliation(s)
- Víctor López de Rioja
- Department of Physics, Universitat Politècnica de Catalunya, Castelldefels, 08860 Barcelona, Spain; (A.P.-M.); (C.P.); (E.A.-L.)
| | - Luca Basile
- Public Health Agency of Catalonia, Department of Health, 08005 Barcelona, Spain; (L.B.); (S.M.M.); (J.M.P.)
| | - Aida Perramon-Malavez
- Department of Physics, Universitat Politècnica de Catalunya, Castelldefels, 08860 Barcelona, Spain; (A.P.-M.); (C.P.); (E.A.-L.)
| | | | - Daniel López
- Department of Physics, Universitat Politècnica de Catalunya, Castelldefels, 08860 Barcelona, Spain; (A.P.-M.); (C.P.); (E.A.-L.)
| | - Sergio Medina Maestro
- Public Health Agency of Catalonia, Department of Health, 08005 Barcelona, Spain; (L.B.); (S.M.M.); (J.M.P.)
| | - Ermengol Coma
- Primary Care Services Information System (SISAP), Institut Català de la Salut, 08007 Barcelona, Spain; (E.C.)
| | - Francesc Fina
- Primary Care Services Information System (SISAP), Institut Català de la Salut, 08007 Barcelona, Spain; (E.C.)
| | - Clara Prats
- Department of Physics, Universitat Politècnica de Catalunya, Castelldefels, 08860 Barcelona, Spain; (A.P.-M.); (C.P.); (E.A.-L.)
| | - Jacobo Mendioroz Peña
- Public Health Agency of Catalonia, Department of Health, 08005 Barcelona, Spain; (L.B.); (S.M.M.); (J.M.P.)
- University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Enric Alvarez-Lacalle
- Department of Physics, Universitat Politècnica de Catalunya, Castelldefels, 08860 Barcelona, Spain; (A.P.-M.); (C.P.); (E.A.-L.)
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11
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Ogilvie RP, Layton JB, Lloyd PC, Jiao Y, Djibo DA, Wong HL, Gruber JF, Parambi R, Deng J, Miller M, Song J, Weatherby LB, Peetluk L, Lo AC, Matuska K, Wernecke M, Bui CL, Clarke TC, Cho S, Bell EJ, Yang G, Amend KL, Forshee RA, Anderson SA, McMahill-Walraven CN, Chillarige Y, Anthony MS, Seeger JD, Shoaibi A. Effectiveness of BNT162b2 COVID-19 primary series vaccination in children aged 5-17 years in the United States: a cohort study. BMC Pediatr 2024; 24:276. [PMID: 38671379 PMCID: PMC11047006 DOI: 10.1186/s12887-024-04756-5] [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: 09/19/2023] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND COVID-19 vaccines are authorized for use in children in the United States; real-world assessment of vaccine effectiveness in children is needed. This study's objective was to estimate the effectiveness of receiving a complete primary series of monovalent BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine in US children. METHODS This cohort study identified children aged 5-17 years vaccinated with BNT162b2 matched with unvaccinated children. Participants and BNT162b2 vaccinations were identified in Optum and CVS Health insurance administrative claims databases linked with Immunization Information System (IIS) COVID-19 vaccination records from 16 US jurisdictions between December 11, 2020, and May 31, 2022 (end date varied by database and IIS). Vaccinated children were followed from their first BNT162b2 dose and matched to unvaccinated children on calendar date, US county of residence, and demographic and clinical factors. Censoring occurred if vaccinated children failed to receive a timely dose 2 or if unvaccinated children received any dose. Two COVID-19 outcome definitions were evaluated: COVID-19 diagnosis in any medical setting and COVID-19 diagnosis in hospitals/emergency departments (EDs). Propensity score-weighted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with Cox proportional hazards models, and vaccine effectiveness (VE) was estimated as 1 minus HR. VE was estimated overall, within age subgroups, and within variant-specific eras. Sensitivity, negative control, and quantitative bias analyses evaluated various potential biases. RESULTS There were 453,655 eligible vaccinated children one-to-one matched to unvaccinated comparators (mean age 12 years; 50% female). COVID-19 hospitalizations/ED visits were rare in children, regardless of vaccination status (Optum, 41.2 per 10,000 person-years; CVS Health, 44.1 per 10,000 person-years). Overall, vaccination was associated with reduced incidence of any medically diagnosed COVID-19 (meta-analyzed VE = 38% [95% CI, 36-40%]) and hospital/ED-diagnosed COVID-19 (meta-analyzed VE = 61% [95% CI, 56-65%]). VE estimates were lowest among children 5-11 years and during the Omicron-variant era. CONCLUSIONS Receipt of a complete BNT162b2 vaccine primary series was associated with overall reduced medically diagnosed COVID-19 and hospital/ED-diagnosed COVID-19 in children; observed VE estimates differed by age group and variant era. REGISTRATION The study protocol was publicly posted on the BEST Initiative website ( https://bestinitiative.org/wp-content/uploads/2022/03/C19-VX-Effectiveness-Protocol_2022_508.pdf ).
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Affiliation(s)
| | - J Bradley Layton
- RTI Health Solutions, 3040 East Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709, USA.
| | | | | | | | - Hui Lee Wong
- US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | - Jie Deng
- Optum Epidemiology, Boston, MA, USA
| | | | | | | | | | | | | | | | - Christine L Bui
- RTI Health Solutions, 3040 East Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709, USA
| | | | - Sylvia Cho
- US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | | | | | | | | | - Mary S Anthony
- RTI Health Solutions, 3040 East Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709, USA
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12
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Yang Y, He Y, Huang J, Yan H, Zhang X, Xiao Z, Lu X. Characteristics and spectrum changes of PICU cases during the COVID-19 pandemic: a retrospective analysis. Front Pediatr 2024; 12:1325471. [PMID: 38725989 PMCID: PMC11079195 DOI: 10.3389/fped.2024.1325471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
Objective This study aims to compare the changes in the disease spectrum of children admitted to the Pediatric Intensive Care Units (PICU) during the COVID-19 pandemic with the three years prior to the pandemic, exploring the impact of the COVID-19 pandemic on the disease spectrum of PICU patients. Methods A retrospective analysis was conducted on critically ill children admitted to the PICU of Hunan Children's Hospital from January 2020 to December 2022, and the results were compared with cases from the same period between January 2017 and December 2019. The cases were divided into pre-pandemic period (January 2017-December 2019) with 8,218 cases, and pandemic period (January 2020-December 2022) with 5,619 cases. General characteristics, age, and gender were compared between the two groups. Results Compared to the pre-pandemic period, there was a 31.62% decrease in the number of admitted children during the pandemic period, and a 52.78% reduction in the proportion of respiratory system diseases. The overall mortality rate decreased by 87.81%. There were differences in age and gender distribution between the two periods. The length of hospital stay during the pandemic showed no statistical significance, whereas hospitalization costs exhibited statistical significance. Conclusion The COVID-19 pandemic has exerted a certain influence on the disease spectrum of PICU admissions. Implementing relevant measures during the pandemic can help reduce the occurrence of respiratory system diseases in children. Considering the changes in the disease spectrum of critically ill PICU children, future clinical prevention and treatment in PICUs should continue to prioritize the respiratory, neurological, and hematological oncology systems.
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Affiliation(s)
| | | | | | | | | | | | - Xiulan Lu
- Department of Intensive Care Unit, Affiliated School of Medicine of Central South University (Hunan Children's Hospital), Changsha, Hunan, China
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13
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Fang F, Clemens JD, Zhang ZF, Brewer TF. Impact of SARS-CoV-2 vaccines on Covid-19 incidence and mortality in the United States. PLoS One 2024; 19:e0301830. [PMID: 38656933 PMCID: PMC11042718 DOI: 10.1371/journal.pone.0301830] [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: 08/08/2022] [Accepted: 03/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Given the waning of vaccine effectiveness and the shifting of the most dominant strains in the U.S., it is imperative to understand the association between vaccination coverage and Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) disease and mortality at the community levels and whether that association might vary according to the dominant SARS-CoV-2 strains in the U.S. METHODS Generalized estimating equations were used to estimate associations between U.S. county-level cumulative vaccination rates and booster distribution and the daily change in county-wide Coronavirus 2019 disease (COVID-19) risks and mortality during Alpha, Delta and Omicron predominance. Models were adjusted for potential confounders at both county and state level. A 2-week lag and a 4-week lag were introduced to assess vaccination rate impact on incidence and mortality, respectively. RESULTS Among 3,073 counties in 48 states, the average county population complete vaccination rate of all age groups was 50.79% as of March 11th, 2022. Each percentage increase in vaccination rates was associated with reduction of 4% (relative risk (RR) 0.9607 (95% confidence interval (CI): 0.9553, 0.9661)) and 3% (RR 0.9694 (95% CI: 0.9653, 0.9736)) in county-wide COVID-19 cases and mortality, respectively, when Alpha was the dominant variant. The associations between county-level vaccine rates and COVID-19 incidence diminished during the Delta and Omicron predominance. However, each percent increase in people receiving a booster shot was associated with reduction of 6% (RR 0.9356 (95% CI: 0.9235, 0.9479)) and 4% (RR 0.9595 (95% CI: 0.9431, 0.9761)) in COVID-19 incidence and mortality in the community, respectively, during the Omicron predominance. CONCLUSIONS Associations between complete vaccination rates and COVID-19 incidence and mortality appeared to vary with shifts in the dominant variant, perhaps due to variations in vaccine efficacy by variant or to waning vaccine immunity over time. Vaccine boosters were associated with notable protection against Omicron disease and mortality.
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Affiliation(s)
- Fang Fang
- Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - John David Clemens
- Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles (UCLA), Los Angeles, CA, United States of America
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- International Vaccination Institute (IVI), Seoul, the Republic of Korea
| | - Zuo-Feng Zhang
- Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles (UCLA), Los Angeles, CA, United States of America
- Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, United States of America
- Department of Medicine, Center for Human Nutrition, UCLA David Geffen School of Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA, United States of America
| | - Timothy F. Brewer
- Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles (UCLA), Los Angeles, CA, United States of America
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA, United States of America
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14
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Tippett A, Ess G, Hussaini L, Reese O, Salazar L, Kelly M, Taylor M, Ciric C, Keane A, Cheng A, Gibson T, Li W, Hsiao HM, Bristow L, Hellmeister K, Al-Husein Z, Hubler R, Begier E, Liu Q, Gessner B, Swerdlow DL, Kamidani S, Kao C, Yildirim I, Rouphael N, Rostad CA, Anderson EJ. Influenza Vaccine Effectiveness Pre-pandemic Among Adults Hospitalized With Congestive Heart Failure or Chronic Obstructive Pulmonary Disease and Older Adults. Clin Infect Dis 2024; 78:1065-1072. [PMID: 37946601 DOI: 10.1093/cid/ciad679] [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: 08/18/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Data are limited on influenza vaccine effectiveness (VE) in the prevention of influenza-related hospitalizations in older adults and those with underlying high-risk comorbidities. METHODS We conducted a prospective, test-negative, case-control study at 2 US hospitals from October 2018-March 2020 among adults aged ≥50 years hospitalized with acute respiratory illnesses (ARIs) and adults ≥18 years admitted with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) exacerbations. Adults were eligible if they resided in 1 of 8 counties in metropolitan Atlanta, Georgia. Nasopharyngeal and oropharyngeal swabs were tested using BioFire FilmArray (bioMérieux, Inc.) respiratory panel, and standard-of-care molecular results were included when available. Influenza vaccination history was determined from the Georgia vaccine registry and medical records. We used multivariable logistic regression to control for potential confounders and to determine 95% confidence intervals (CIs). RESULTS Among 3090 eligible adults, 1562 (50.6%) were enrolled. Of the 1515 with influenza vaccination history available, 701 (46.2%) had received vaccination during that season. Influenza was identified in 37 (5.3%) vaccinated versus 78 (9.6%) unvaccinated participants. After adjustment for age, race/ethnicity, immunosuppression, month, and season, pooled VE for any influenza-related hospitalization in the eligible study population was 63.1% (95% CI, 43.8-75.8%). Adjusted VE against influenza-related hospitalization for ARI in adults ≥50 years was 55.9% (29.9-72.3%) and adjusted VE against influenza-related CHF/COPD exacerbation in adults ≥18 years was 80.3% (36.3-93.9%). CONCLUSIONS Influenza vaccination was effective in preventing influenza-related hospitalizations in adults aged ≥50 years and those with CHF/COPD exacerbations during the 2018-2020 seasons.
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Affiliation(s)
- Ashley Tippett
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gabby Ess
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laila Hussaini
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Olivia Reese
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Luis Salazar
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mary Kelly
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Meg Taylor
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Caroline Ciric
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amy Keane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew Cheng
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Theda Gibson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wensheng Li
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hui-Mien Hsiao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laurel Bristow
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kieffer Hellmeister
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zayna Al-Husein
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | - Qing Liu
- Pfizer, Inc,New York, New York, USA
| | | | | | - Satoshi Kamidani
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Carol Kao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Inci Yildirim
- Department of Pediatrics (Infectious Diseases), Yale-New Haven Hospital, New Haven, Connecticut, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
- Yale School of Public Health, Yale Institute for Global Health, New Haven, Connecticut, USA
- Center for Infection and Immunity, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nadine Rouphael
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Medicine, Hope Clinic, Emory University School of Medicine, Atlanta, Georgia, USA
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Kavikondala S, Haeussler K, Wang X, Bausch-Jurken MT, Nassim M, Mishra NK, Malmenäs M, Sharma P, Van de Velde N, Green N, Beck E. Comparative Effectiveness of mRNA-1273 and BNT162b2 COVID-19 Vaccines Among Older Adults: Systematic Literature Review and Meta-Analysis Using the GRADE Framework. Infect Dis Ther 2024; 13:779-811. [PMID: 38498109 PMCID: PMC11058186 DOI: 10.1007/s40121-024-00936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/30/2024] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION The mRNA vaccines mRNA-1273 and BNT162b2 demonstrated high efficacy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in phase 3 clinical trials, including among older adults. To inform coronavirus disease 2019 (COVID-19) vaccine selection, this systematic literature review (SLR) and meta-analysis assessed the comparative effectiveness of mRNA-1273 versus BNT162b2 in older adults. METHODS We systematically searched for relevant studies reporting COVID-19 outcomes with mRNA vaccines in older adults aged ≥ 50 years by first cross-checking relevant published SLRs. Based on the cutoff date from a previous similar SLR, we then searched the WHO COVID-19 Research Database for relevant articles published between April 9, 2022, and June 2, 2023. Outcomes of interest were SARS-CoV-2 infection, symptomatic SARS-CoV-2 infection, severe SARS-CoV-2 infection, COVID-19-related hospitalization, and COVID-19-related death following ≥ 2 vaccine doses. Random effects meta-analysis models were used to pool risk ratios (RRs) across studies. Heterogeneity was evaluated using chi-square testing. Evidence certainty was assessed per GRADE framework. RESULTS Twenty-four non-randomized real-world studies reporting clinical outcomes with mRNA vaccines in individuals aged ≥ 50 years were included in the meta-analysis. Vaccination with mRNA-1273 was associated with significantly lower risk of SARS-CoV-2 infection (RR 0.72 [95% confidence interval (CI) 0.64‒0.80]), symptomatic SARS-CoV-2 infection (RR 0.72 [95% CI 0.62‒0.83]), severe SARS-CoV-2 infection (RR 0.67 [95% CI 0.57‒0.78]), and COVID-19-related hospitalization (RR 0.65 [95% CI 0.53‒0.79]) but not COVID-19-related death (RR 0.80 [95% CI 0.64‒1.00]) compared with BNT162b2. There was considerable heterogeneity between studies for all outcomes (I2 > 75%) except death (I2 = 0%). Multiple subgroup and sensitivity analyses excluding specific studies generally demonstrated consistent results. Certainty of evidence across outcomes was rated as low (type 3) or very low (type 4), reflecting the lack of randomized controlled trial data. CONCLUSION Meta-analysis of 24 observational studies demonstrated significantly lower risk of asymptomatic, symptomatic, and severe infections and hospitalizations with the mRNA-1273 versus BNT162b2 vaccine in older adults aged ≥ 50 years.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Ekkehard Beck
- Moderna, Inc., 200 Technology Square, Cambridge, MA, 02139, USA.
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16
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Álvarez Aldeán J, José Álvarez García F, de la Calle Fernández-Miranda M, Figueras Falcón T, Iofrío de Arce A, López Rojano M, Rivero Calle I, Suy Franch A. Vaccination in pregnancy. Consensus document of the CAV-AEP and the SEGO. An Pediatr (Barc) 2024; 100:268-274. [PMID: 38565447 DOI: 10.1016/j.anpede.2024.02.014] [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: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
During pregnancy, physiological changes in the immune response make pregnant women more susceptible to serious infection, increasing the risk for the mother as well as the foetus, newborn and infant. All women should be correctly and fully vaccinated as they enter their reproductive years, especially against diseases such as tetanus, hepatitis B, measles, rubella and varicella. In addition to the recommended vaccines, in risk situations, inactivated vaccines could be administered to women who were not correctly vaccinated before, while attenuated vaccines are contraindicated. Despite the fact that vaccination during pregnancy is a very important preventive measure and the existing recommendations from public health authorities, scientific societies and health professionals, the vaccination coverage could clearly be improved, especially against influenza and SARS-CoV-2, so any health professional involved in the care of pregnant women should proactively recommend these vaccines. The Spanish Association of Pediatrics (AEP), through its Advisory Committee on Vaccines, and the Spanish Society of Gynaecology and Obstetrics (SEGO) recommend vaccination against the following diseases during pregnancy: against influenza and COVID-19, in any trimester of pregnancy and during the postpartum period (up to 6 months post birth) in women not vaccinated during pregnancy; against pertussis, with the Tdap vaccine, between weeks 27 and 36 of gestation (in the CAV-AEP recommendations, preferably between weeks 27 and 28); and against RSV, with RSVPreF, between weeks 24 and 36 of gestation, preferably between weeks 32 and 36.
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Affiliation(s)
- Javier Álvarez Aldeán
- Servicio de Pediatría, Hospital Costa del Sol, Asociación Española de Pediatría (CAV-AEP), Marbella, Málaga, Spain
| | - Francisco José Álvarez García
- Centro de Salud de Llanera, Asturias Departamento de Medicina. Universidad de Oviedo. Asociación Española de Pediatría (CAV-AEP), Oviedo, Spain.
| | - Maria de la Calle Fernández-Miranda
- Sección de Obstetricia, Hospital Universitario la Paz, Facultad de Medicina, Universidad Autónoma de Madrid, Sociedad Española de Ginecología y Obstetricia, Madrid, Spain
| | - Tatiana Figueras Falcón
- Unidad Medicina Materno Fetal, Servicio de Obstetricia y Ginecologia, Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas, Sociedad Española de Ginecología y Obstetricia, Las Palmas de Gran Canaria, Spain
| | - Antonio Iofrío de Arce
- Centro de Salud El Ranero, Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP), Murcia, Spain
| | - Marta López Rojano
- Servicio de Medicina Maternofetal, BCNatal-Centro de Medicina Maternofetal y Neonatal de Barcelona (Hospital Clínic de Barcelona y Hospital Sant Joan de Déu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Sociedad Española de Ginecología y Obstetricia, Barcelona, Spain
| | - Irene Rivero Calle
- Sección de Pediatría Clínica, Infectológica y Traslacional, Hospital Clínico Universitario de Santiago de Compostela, Sociedad Española de Infectología Pediátrica (SEIP), Grupo Genética, Vacunas, Infecciones y Pediatría (GENVIP). Asociación Española de Pediatría (CAV-AEP), Santiago de Compostela, A Coruña, Spain
| | - Anna Suy Franch
- Sección de Obstetricia, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Sociedad Española de Ginecología y Obstetricia, Barcelona, Spain
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17
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Zhang G, Zhang J, Gao Q, Zhao Y, Lai Y. Clinical and immunologic features of co-infection in COVID-19 patients, along with potential traditional Chinese medicine treatments. Front Immunol 2024; 15:1357638. [PMID: 38576608 PMCID: PMC10991704 DOI: 10.3389/fimmu.2024.1357638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
Objectives With the increasing number of people worldwide infected with SARS-CoV-2, the likelihood of co-infection and/or comorbidities is rising. The impact of these co-infections on the patient's immune system remains unclear. This study aims to investigate the immunological characteristics of secondary infections in hospitalized COVID-19 patients, and preliminarily predict potential therapeutic effects of traditional Chinese medicine and their derivatives for the treatment of co-infections. Methods In this retrospective cohort study, we included 131 hospitalized patients with laboratory-confirmed COVID-19, of whom there were 64 mild and 67 severe cases. We analyzed clinical characteristics and immunologic data, including circulating immune cell numbers, levels of inflammatory factors and viral load, comparing COVID-19 patients with and without co-infection. Results Among 131 hospitalized COVID-19 patients, 41 (31.3%) were co-infection positive, with 33 (80.5%) having severe disease and 14 (34.1%) of them resulting in fatalities. Co-infected patients exhibited significantly higher severity and mortality rates compared to non-co-infected counterparts. Co-infected patients had significantly lower absolute counts of lymphocytes, total T lymphocytes, CD4+ T cells, CD8+ T cells and B lymphocytes, while levels of hs-CRP, PCT and IL-6 were significantly elevated compared to non-co-infected patients. Additionally, the viral load of co-infected patients was significantly higher than non-co-infected patients. Conclusion Co-infection emerges as a dangerous factor for COVID-19 patients, elevating the risk of severe pneumonia and mortality. Co-infection suppresses the host's immune response by reducing the number of lymphocytes and increasing inflammation, thereby diminishing the antiviral and anti-infective effects of the immune system, which promotes the severity of the disease. Therefore, it is crucial to implement infection prevention measures to minimize the spread of co-infections among COVID-19 hospitalized patients. Additionally, changes in these biomarkers provide a theoretical basis for the effective treatment of co-infections with traditional Chinese medicine.
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Affiliation(s)
- Guochao Zhang
- Department of Clinical Laboratory, Ninth Hospital of Xi’an, Xi’an, Shannxi, China
| | - Junjun Zhang
- Xianyang Center for Disease Control and Prevention, Xianyang, Shannxi, China, China
| | - Qi Gao
- Department of Clinical Laboratory, Ninth Hospital of Xi’an, Xi’an, Shannxi, China
| | - Yingying Zhao
- Department of Pathology, Fenyang College of Shanxi Medical University, Fenyang, Shanxi, China
| | - Yanjun Lai
- Department of Clinical Laboratory, Ninth Hospital of Xi’an, Xi’an, Shannxi, China
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18
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Adams K, Weber ZA, Yang DH, Klein NP, DeSilva MB, Dascomb K, Irving SA, Naleway AL, Rao S, Gaglani M, Flannery B, Garg S, Kharbanda AB, Grannis SJ, Ong TC, Embi PJ, Natarajan K, Fireman B, Zerbo O, Goddard K, Timbol J, Hansen JR, Grisel N, Arndorfer J, Ball SW, Dunne MM, Kirshner L, Chung JR, Tenforde MW. Vaccine Effectiveness Against Pediatric Influenza-A-Associated Urgent Care, Emergency Department, and Hospital Encounters During the 2022-2023 Season: VISION Network. Clin Infect Dis 2024; 78:746-755. [PMID: 37972288 PMCID: PMC10954409 DOI: 10.1093/cid/ciad704] [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: 09/12/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND During the 2022-2023 influenza season, the United States experienced the highest influenza-associated pediatric hospitalization rate since 2010-2011. Influenza A/H3N2 infections were predominant. METHODS We analyzed acute respiratory illness (ARI)-associated emergency department or urgent care (ED/UC) encounters or hospitalizations at 3 health systems among children and adolescents aged 6 months-17 years who had influenza molecular testing during October 2022-March 2023. We estimated influenza A vaccine effectiveness (VE) using a test-negative approach. The odds of vaccination among influenza-A-positive cases and influenza-negative controls were compared after adjusting for confounders and applying inverse-propensity-to-be-vaccinated weights. We developed overall and age-stratified VE models. RESULTS Overall, 13 547 of 44 787 (30.2%) eligible ED/UC encounters and 263 of 1862 (14.1%) hospitalizations were influenza-A-positive cases. Among ED/UC patients, 15.2% of influenza-positive versus 27.1% of influenza-negative patients were vaccinated; VE was 48% (95% confidence interval [CI], 44-52%) overall, 53% (95% CI, 47-58%) among children aged 6 months-4 years, and 38% (95% CI, 30-45%) among those aged 9-17 years. Among hospitalizations, 17.5% of influenza-positive versus 33.4% of influenza-negative patients were vaccinated; VE was 40% (95% CI, 6-61%) overall, 56% (95% CI, 23-75%) among children ages 6 months-4 years, and 46% (95% CI, 2-70%) among those 5-17 years. CONCLUSIONS During the 2022-2023 influenza season, vaccination reduced the risk of influenza-associated ED/UC encounters and hospitalizations by almost half (overall VE, 40-48%). Influenza vaccination is a critical tool to prevent moderate-to-severe influenza illness in children and adolescents.
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Affiliation(s)
- Katherine Adams
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zachary A Weber
- Department of Clinical Research, Westat, Rockville, Maryland, USA
| | - Duck-Hye Yang
- Department of Clinical Research, Westat, Rockville, Maryland, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Malini B DeSilva
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Stephanie A Irving
- Department of Science Programs, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Allison L Naleway
- Department of Science Programs, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Suchitra Rao
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Manjusha Gaglani
- Department of Pediatrics, Section of Pediatric Infectious Diseases, Baylor Scott & White Health and Baylor College of Medicine, Temple, Texas, USA
- Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Brendan Flannery
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anupam B Kharbanda
- Department of Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Toan C Ong
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Peter J Embi
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Karthik Natarajan
- 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
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Julius Timbol
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - John R Hansen
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Sarah W Ball
- Department of Clinical Research, Westat, Rockville, Maryland, USA
| | - Margaret M Dunne
- Department of Clinical Research, Westat, Rockville, Maryland, USA
| | - Lindsey Kirshner
- Department of Clinical Research, Westat, Rockville, Maryland, USA
| | - Jessie R Chung
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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19
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Giannouchos TV, Hair NL, Olatosi B, Li X. Waning effectiveness of mRNA COVID-19 vaccines against inpatient and emergency department encounters. PLoS One 2024; 19:e0300198. [PMID: 38452010 PMCID: PMC10919609 DOI: 10.1371/journal.pone.0300198] [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: 10/26/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
In the United States, most real-world estimates of COVID-19 vaccine effectiveness are based on data drawn from large health systems or sentinel populations. More data is needed to understand how the benefits of vaccination may vary across US populations with disparate risk profiles and policy contexts. We aimed to provide estimates of mRNA COVID-19 vaccine effectiveness against moderate and severe outcomes of COVID-19 based on state population-level data sources. Using statewide integrated administrative and clinical data and a test-negative case-control study design, we assessed mRNA COVID-19 vaccine effectiveness against SARS-CoV-2-related hospitalizations and emergency department visits among adults in South Carolina. We presented estimates of vaccine effectiveness at discrete time intervals for adults who received one, two or three doses of mRNA COVID-19 vaccine compared to adults who were unvaccinated. We also evaluated changes in vaccine effectiveness over time (waning) for the overall sample and in subgroups defined by age. We showed that while two doses of mRNA COVID-19 vaccine were initially highly effective, vaccine effectiveness waned as time elapsed since the second dose. Compared to protection against hospitalizations, protection against emergency department visits was found to wane more sharply. In all cases, a third dose of mRNA COVID-19 vaccine conferred significant gains in protection relative to waning protection after two doses. Further, over more than 120 days of follow-up, the data revealed relatively limited waning of vaccine effectiveness after a third dose of mRNA COVID-19 vaccine.
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Affiliation(s)
- Theodoros V. Giannouchos
- Department of Health Policy and Organization, The University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States of America
| | - Nicole L. Hair
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
- Big Data Health Science Research Center, University of South Carolina, Columbia, South Carolina, United States of America
| | - Xiaoming Li
- Big Data Health Science Research Center, University of South Carolina, Columbia, South Carolina, United States of America
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
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20
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Ihongbe TO, Kim JEC, Dahlen H, Kranzler EC, Seserman K, Moffett K, Hoffman L. Trends in primary, booster, and updated COVID-19 vaccine readiness in the United States, January 2021-April 2023: Implications for 2023-2024 updated COVID-19 vaccines. Prev Med 2024; 180:107887. [PMID: 38325608 DOI: 10.1016/j.ypmed.2024.107887] [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: 11/12/2023] [Revised: 02/03/2024] [Accepted: 02/04/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE COVID-19 vaccines have mitigated the severity of COVID-19 and its sequelae. The emergence of new SARS-CoV-2 variants and waning immunity conferred by COVID-19 vaccination have necessitated booster and updated COVID-19 vaccines. This study examined trends in vaccine readiness-a composite measure of intention and uptake-for the primary, booster, and 2022-2023 updated (bivalent) COVID-19 vaccines among U.S. adults. METHODS Data from the nationally-representative U.S. Department of Health and Human Services' COVID-19 Monthly Outcome Survey from January 2021 to April 2023 were analyzed (N = 140,180). We conducted pairwise comparisons (weighted t-tests) to assess for significant between-month differences in the proportion of participants in each vaccine-readiness category (vaccine ready, wait and see, and no vaccine intention) for the following outcomes: (1) primary; (2) booster; and (3) updated COVID-19 vaccine readiness. RESULTS From January 2021 to April 2023, significant increases in the primary vaccine ready group were accompanied by decreases in the wait and see and no vaccine intention groups (p < 0.001). From January to September 2022, the no booster intention group notably increased (p < 0.001), whereas the booster ready group decreased (p < 0.001), and the wait and see group remained stable (p = 0.116). From October 2022 to April 2023, the no updated vaccine intention group increased (p < 0.001), the wait and see group decreased (p < 0.01), and the updated vaccine ready group remained unchanged (p = 0.357). CONCLUSIONS Findings show decreased vaccine readiness for the booster and 2022-2023 updated (bivalent) COVID-19 vaccines relative to the primary COVID-19 vaccines. Implications for the 2023-2024 updated COVID-19 vaccines are discussed.
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Affiliation(s)
| | | | | | | | | | | | - Leah Hoffman
- Fors Marsh, Arlington, VA, United States of America
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21
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Levy ME, Yang D, Dunne MM, Miley K, Irving SA, Grannis SJ, Weber ZA, Griggs EP, Spark TL, Bassett E, Embi PJ, Gaglani M, Natarajan K, Valvi NR, Ong TC, Naleway AL, Stenehjem E, Klein NP, Link‐Gelles R, DeSilva MB, Kharbanda AB, Raiyani C, Beaton MA, Dixon BE, Rao S, Dascomb K, Patel P, Mamawala M, Han J, Fadel WF, Barron MA, Grisel N, Dickerson M, Liao I, Arndorfer J, Najdowski M, Murthy K, Ray C, Tenforde MW, Ball SW. Risk of COVID-19 Hospitalization and Protection Associated With mRNA Vaccination Among US Adults With Psychiatric Disorders. Influenza Other Respir Viruses 2024; 18:e13269. [PMID: 38494192 PMCID: PMC10944689 DOI: 10.1111/irv.13269] [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: 08/15/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Although psychiatric disorders have been associated with reduced immune responses to other vaccines, it remains unknown whether they influence COVID-19 vaccine effectiveness (VE). This study evaluated risk of COVID-19 hospitalization and estimated mRNA VE stratified by psychiatric disorder status. METHODS In a retrospective cohort analysis of the VISION Network in four US states, the rate of laboratory-confirmed COVID-19-associated hospitalization between December 2021 and August 2022 was compared across psychiatric diagnoses and by monovalent mRNA COVID-19 vaccination status using Cox proportional hazards regression. RESULTS Among 2,436,999 adults, 22.1% had ≥1 psychiatric disorder. The incidence of COVID-19-associated hospitalization was higher among patients with any versus no psychiatric disorder (394 vs. 156 per 100,000 person-years, p < 0.001). Any psychiatric disorder (adjusted hazard ratio [aHR], 1.27; 95% CI, 1.18-1.37) and mood (aHR, 1.25; 95% CI, 1.15-1.36), anxiety (aHR, 1.33, 95% CI, 1.22-1.45), and psychotic (aHR, 1.41; 95% CI, 1.14-1.74) disorders were each significant independent predictors of hospitalization. Among patients with any psychiatric disorder, aHRs for the association between vaccination and hospitalization were 0.35 (95% CI, 0.25-0.49) after a recent second dose, 0.08 (95% CI, 0.06-0.11) after a recent third dose, and 0.33 (95% CI, 0.17-0.66) after a recent fourth dose, compared to unvaccinated patients. Corresponding VE estimates were 65%, 92%, and 67%, respectively, and were similar among patients with no psychiatric disorder (68%, 92%, and 79%). CONCLUSION Psychiatric disorders were associated with increased risk of COVID-19-associated hospitalization. However, mRNA vaccination provided similar protection regardless of psychiatric disorder status, highlighting its benefit for individuals with psychiatric disorders.
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Affiliation(s)
| | | | | | | | | | - Shaun J. Grannis
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
- School of MedicineIndiana UniversityIndianapolisIndianaUSA
| | | | - Eric P. Griggs
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | - Peter J. Embi
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
- Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Manjusha Gaglani
- Baylor Scott & White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Karthik Natarajan
- Department of Biomedical InformaticsColumbia University Irving Medical CenterNew YorkNew YorkUSA
- New York Presbyterian HospitalNew YorkNew YorkUSA
| | - Nimish R. Valvi
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
| | - Toan C. Ong
- School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | | | - Edward Stenehjem
- Division of Infectious Diseases and Clinical EpidemiologyIntermountain HealthcareSalt Lake CityUtahUSA
| | - Nicola P. Klein
- Kaiser Permanente Vaccine Study CenterKaiser Permanente Northern California Division of ResearchOaklandCaliforniaUSA
| | - Ruth Link‐Gelles
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | | | | | - Maura A. Beaton
- Department of Biomedical InformaticsColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Brian E. Dixon
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
- Fairbanks School of Public HealthIndiana UniversityIndianapolisIndianaUSA
| | - Suchitra Rao
- School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical EpidemiologyIntermountain HealthcareSalt Lake CityUtahUSA
| | - Palak Patel
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Jungmi Han
- Department of Biomedical InformaticsColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - William F. Fadel
- Center for Biomedical InformaticsRegenstrief InstituteIndianapolisIndianaUSA
- Fairbanks School of Public HealthIndiana UniversityIndianapolisIndianaUSA
| | - Michelle A. Barron
- School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical EpidemiologyIntermountain HealthcareSalt Lake CityUtahUSA
| | - Monica Dickerson
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Julie Arndorfer
- Division of Infectious Diseases and Clinical EpidemiologyIntermountain HealthcareSalt Lake CityUtahUSA
| | - Morgan Najdowski
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Caitlin Ray
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Mark W. Tenforde
- Influenza Division, National Center for Immunization and Respiratory DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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22
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Tzivian L, Benis A, Rusakova A, Syundyukov E, Seidmann A, Ophir Y. International scientific communication on COVID-19 data: management pitfalls understanding. J Public Health (Oxf) 2024; 46:87-96. [PMID: 38141038 DOI: 10.1093/pubmed/fdad277] [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: 04/24/2023] [Revised: 11/23/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND During the pandemic, countries utilized various forms of statistical estimations of coronavirus disease-2019 (COVID-19) impact. Differences between databases make direct comparisons and interpretations of data in different countries a challenge. We evaluated country-specific approaches to COVID-19 data and recommended changes that would improve future international collaborations. METHODS We compared the COVID-19 reports presented on official UK (National Health System), Israeli (Department of Health), Latvian (Center for Disease Prevention and Control) and USA (Centers for Disease Control and Prevention) health authorities' websites. RESULTS Our analysis demonstrated critical differences in the ways COVID-19 statistics were made available to the general and scientific communities. Specifically, the differences in approaches were found in the presentation of the number of infected cases and tests, and percentage of positive cases, the number of severe cases, the number of vaccinated, and the number and percent of deaths. CONCLUSION Findability, Accessibility, Interoperability and Reusability principles could guide the development of essential global standards that provide a basis for communication within and outside of the scientific community.
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Affiliation(s)
- Lilian Tzivian
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga LV-1586, Latvia
| | - Arriel Benis
- Digital Medical Technologies Department, Holon Institute of Technology, Holon 5810201, Israel
| | - Agnese Rusakova
- Faculty of Education, Psychology and Arts, University of Latvia, Riga LV-1586, Latvia
| | - Emil Syundyukov
- Longenesis Ltd, Riga LV-1010, Latvia
- Faculty of Computing, University of Latvia LV-1586, Riga, Latvia
| | - Abraham Seidmann
- Questrom Business School, Boston University, Boston, MA 02215, USA
- Health Analytics and Digital Health, Digital Business Institute, Boston University, Boston, MA 02215, USA
| | - Yotam Ophir
- Department of Communication, University at Buffalo, State University of New York, Buffalo, NY 14260, USA
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23
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Mésidor M, Liu Y, Talbot D, Skowronski DM, De Serres G, Merckx J, Koushik A, Tadrous M, Carazo S, Jiang C, Schnitzer ME. Test negative design for vaccine effectiveness estimation in the context of the COVID-19 pandemic: A systematic methodology review. Vaccine 2024; 42:995-1003. [PMID: 38072756 DOI: 10.1016/j.vaccine.2023.12.013] [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: 06/27/2023] [Revised: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND During the height of the global COVID-19 pandemic, the test-negative design (TND) was extensively used in many countries to evaluate COVID-19 vaccine effectiveness (VE). Typically, the TND involves the recruitment of care-seeking individuals who meet a common clinical case definition. All participants are then tested for an infection of interest. OBJECTIVES To review and describe the variation in TND methodology, and disclosure of potential biases, as applied to the evaluation of COVID-19 VE during the early vaccination phase of the pandemic. METHODS We conducted a systematic review by searching four biomedical databases using defined keywords to identify peer-reviewed articles published between January 1, 2020, and January 25, 2022. We included only original articles that employed a TND to estimate VE of COVID-19 vaccines in which cases and controls were evaluated based on SARS-CoV-2 laboratory test results. RESULTS We identified 96 studies, 35 of which met the defined criteria. Most studies were from North America (16 studies) and targeted the general population (28 studies). Outcome case definitions were based primarily on COVID-19-like symptoms; however, several papers did not consider or specify symptoms. Cases and controls had the same inclusion criteria in only half of the studies. Most studies relied upon administrative or hospital databases assembled for a different (non-evaluation) clinical purpose. Potential unmeasured confounding (20 studies), misclassification of current SARS-CoV-2 infection (16 studies) and selection bias (10 studies) were disclosed as limitations by some studies. CONCLUSION We observed potentially meaningful deviations from the validated design in the application of the TND during the COVID-19 pandemic.
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Affiliation(s)
- Miceline Mésidor
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec - Université Laval, Québec, Canada
| | - Yan Liu
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
| | - Denis Talbot
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Centre de recherche du CHU de Québec - Université Laval, Québec, Canada.
| | - Danuta M Skowronski
- British Columbia Centre for Disease Control, Vancouver, Canada; University of British Columbia, Vancouver, Canada
| | - Gaston De Serres
- Département de médecine sociale et préventive, Université Laval, Québec, Canada; Institut national de santé publique du Québec, Québec, Canada
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Anita Koushik
- Département de médecine sociale et préventive, Université de Montréal, Québec, Canada
| | | | - Sara Carazo
- Institut national de santé publique du Québec, Québec, Canada
| | - Cong Jiang
- Faculty of Pharmacy, Université de Montréal, Québec, Canada
| | - Mireille E Schnitzer
- Faculty of Pharmacy, Université de Montréal, Québec, Canada; Département de médecine sociale et préventive, Université de Montréal, Québec, Canada.
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24
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Ma M, Zhang X, Zhou L, Han Z, Shi Y, Li J, Wu L, Xu Z, Zhu W. D3Rings: A Fast and Accurate Method for Ring System Identification and Deep Generation of Drug-Like Cyclic Compounds. J Chem Inf Model 2024; 64:724-736. [PMID: 38206320 DOI: 10.1021/acs.jcim.3c01657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Continuous exploration of the chemical space of molecules to find ligands with high affinity and specificity for specific targets is an important topic in drug discovery. A focus on cyclic compounds, particularly natural compounds with diverse scaffolds, provides important insights into novel molecular structures for drug design. However, the complexity of their ring structures has hindered the applicability of widely accepted methods and software for the systematic identification and classification of cyclic compounds. Herein, we successfully developed a new method, D3Rings, to identify acyclic, monocyclic, spiro ring, fused and bridged ring, and cage ring compounds, as well as macrocyclic compounds. By using D3Rings, we completed the statistics of cyclic compounds in three different databases, e.g., ChEMBL, DrugBank, and COCONUT. The results demonstrated the richness of ring structures in natural products, especially spiro, macrocycles, and fused and bridged rings. Based on this, three deep generative models, namely, VAE, AAE, and CharRNN, were trained and used to construct two data sets similar to DrugBank and COCONUT but 10 times larger than them. The enlarged data sets were then used to explore the molecular chemical space, focusing on complex ring structures, for novel drug discovery and development. Docking experiments with the newly generated COCONUT-like data set against three SARS-CoV-2 target proteins revealed that an expanded compound database improves molecular docking results. Cyclic structures exhibited the best docking scores among the top-ranked docking molecules. These results suggest the importance of exploring the chemical space of structurally novel cyclic compounds and continuous expansion of the library of drug-like compounds to facilitate the discovery of potent ligands with high binding affinity to specific targets. D3Rings is now freely available at http://www.d3pharma.com/D3Rings/.
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Affiliation(s)
- Minfei Ma
- Stake Key Laboratory of Drug Research; Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- School of Pharmacy, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xinben Zhang
- Stake Key Laboratory of Drug Research; Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Liping Zhou
- Stake Key Laboratory of Drug Research; Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- School of Pharmacy, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zijian Han
- Stake Key Laboratory of Drug Research; Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- School of Pharmacy, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yulong Shi
- Stake Key Laboratory of Drug Research; Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- School of Pharmacy, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jintian Li
- Stake Key Laboratory of Drug Research; Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- School of Pharmacy, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Leyun Wu
- Stake Key Laboratory of Drug Research; Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- School of Pharmacy, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhijian Xu
- Stake Key Laboratory of Drug Research; Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- School of Pharmacy, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Weiliang Zhu
- Stake Key Laboratory of Drug Research; Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
- School of Pharmacy, University of Chinese Academy of Sciences, Beijing 100049, China
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25
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Seidman G, AlKasir A, Ricker K, Lane JT, Zink AB, Williams MA. Regulations and Funding to Create Enterprise Architecture for a Nationwide Health Data Ecosystem. Am J Public Health 2024; 114:209-217. [PMID: 38207252 PMCID: PMC10862221 DOI: 10.2105/ajph.2023.307477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 01/13/2024]
Abstract
The COVID-19 pandemic highlighted the United States' lack of a nationwide infrastructure for collecting, sharing, and using health data, especially for secondary uses (e.g., population health management and public health). The federal government is taking several important steps to upgrade the nation's health data ecosystem-notably, the Centers for Disease Control and Prevention's Data Modernization Initiative and the Office of the National Coordinator for Health Information Technology's Trusted Exchange Framework and Common Agreement. However, substantial barriers remain. Inconsistent regulations, infrastructure, and governance across federal and state levels and between states significantly impede the exchange and analysis of health data. Siloed systems and insufficient funding block effective integration of clinical, public health, and social determinants data within and between states. In this analytic essay, we propose strategies to develop a nationwide health data ecosystem. We focus on providing federal guidance and incentives to develop state-designated entities responsible for the collection, integration, and analysis of clinical, public health, social determinants of health, claims, administrative, and other relevant data. These recommendations include a regulatory clearinghouse, federal guidance, model legislation and templated regulation, funding to incentive enterprise architecture, regulatory sandboxes, and a 3-pronged research agenda. (Am J Public Health. 2024;114(2):209-217. https://doi.org/10.2105/AJPH.2023.307477).
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Affiliation(s)
- Gabriel Seidman
- Gabriel Seidman and Ahmad AlKasir are with the Ellison Institute of Technology, Los Angeles, CA. Kate Ricker is with Amelia Mayme Consulting, Denver, CO. J. T. Lane is with the Association of State and Territorial Health Officials (ASTHO), Arlington, VA. Anne Zink is with the Alaska Department of Health, Anchorage, and ASTHO. Michelle Williams is with Harvard T. H. Chan School of Public Health, Boston, MA
| | - Ahmad AlKasir
- Gabriel Seidman and Ahmad AlKasir are with the Ellison Institute of Technology, Los Angeles, CA. Kate Ricker is with Amelia Mayme Consulting, Denver, CO. J. T. Lane is with the Association of State and Territorial Health Officials (ASTHO), Arlington, VA. Anne Zink is with the Alaska Department of Health, Anchorage, and ASTHO. Michelle Williams is with Harvard T. H. Chan School of Public Health, Boston, MA
| | - Kate Ricker
- Gabriel Seidman and Ahmad AlKasir are with the Ellison Institute of Technology, Los Angeles, CA. Kate Ricker is with Amelia Mayme Consulting, Denver, CO. J. T. Lane is with the Association of State and Territorial Health Officials (ASTHO), Arlington, VA. Anne Zink is with the Alaska Department of Health, Anchorage, and ASTHO. Michelle Williams is with Harvard T. H. Chan School of Public Health, Boston, MA
| | - J T Lane
- Gabriel Seidman and Ahmad AlKasir are with the Ellison Institute of Technology, Los Angeles, CA. Kate Ricker is with Amelia Mayme Consulting, Denver, CO. J. T. Lane is with the Association of State and Territorial Health Officials (ASTHO), Arlington, VA. Anne Zink is with the Alaska Department of Health, Anchorage, and ASTHO. Michelle Williams is with Harvard T. H. Chan School of Public Health, Boston, MA
| | - Anne B Zink
- Gabriel Seidman and Ahmad AlKasir are with the Ellison Institute of Technology, Los Angeles, CA. Kate Ricker is with Amelia Mayme Consulting, Denver, CO. J. T. Lane is with the Association of State and Territorial Health Officials (ASTHO), Arlington, VA. Anne Zink is with the Alaska Department of Health, Anchorage, and ASTHO. Michelle Williams is with Harvard T. H. Chan School of Public Health, Boston, MA
| | - Michelle A Williams
- Gabriel Seidman and Ahmad AlKasir are with the Ellison Institute of Technology, Los Angeles, CA. Kate Ricker is with Amelia Mayme Consulting, Denver, CO. J. T. Lane is with the Association of State and Territorial Health Officials (ASTHO), Arlington, VA. Anne Zink is with the Alaska Department of Health, Anchorage, and ASTHO. Michelle Williams is with Harvard T. H. Chan School of Public Health, Boston, MA
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26
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Martínez-Baz I, Trobajo-Sanmartín C, Miqueleiz A, Egüés N, García Cenoz M, Casado I, Navascués A, Fernández-Huerta M, Echeverría A, Guevara M, Ezpeleta C, Castilla J. Hospitalisations and Deaths Averted by COVID-19 Vaccination in Navarre, Spain, 2021-2022. Vaccines (Basel) 2024; 12:58. [PMID: 38250871 PMCID: PMC10818920 DOI: 10.3390/vaccines12010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
In 2021-2022, most of the Spanish population received COVID-19 vaccines and a high proportion of them had SARS-CoV-2 infection. We estimated the rate of hospitalisations and deaths that were averted by risk reduction among vaccinated COVID-19 cases. Hospitalisations and deaths were analysed among COVID-19 cases confirmed in 2021 and 2022 in Navarre, Spain. To calculate the number of prevented outcomes by sex, age, comorbidities, and semester, the difference in the risk of each outcome between unvaccinated and vaccinated cases was multiplied by the number of vaccinated cases. COVID-19 vaccination coverage with any dose reached 88%, 86% with full vaccination, and 56% with a booster dose. The cumulative rates per 1000 inhabitants were 382 COVID-19 confirmed cases, 6.70 hospitalisations, and 1.15 deaths from COVID-19. The estimated rates of prevented events by vaccination were 16.33 hospitalisations and 3.39 deaths per 1000 inhabitants, which was 70.9% and 74.7% of expected events without vaccination, respectively. People aged 80 years and older or with major chronic conditions accounted for the majority of hospitalizations and deaths prevented by COVID-19 vaccination. One hospitalisation and death due to COVID-19 were averted for every 53 and 258 people vaccinated, respectively. The high COVID-19 vaccine effect in reducing the risk of severe outcomes and the high vaccination coverage in risk populations prevented three out of four hospitalisations and deaths due to COVID-19 during a period of intense circulation of SARS-CoV-2.
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Affiliation(s)
- Iván Martínez-Baz
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Camino Trobajo-Sanmartín
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Ana Miqueleiz
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Nerea Egüés
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Manuel García Cenoz
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Itziar Casado
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Ana Navascués
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Miguel Fernández-Huerta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Aitziber Echeverría
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Marcela Guevara
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Carmen Ezpeleta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (I.M.-B.); (C.T.-S.); (M.G.C.)
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
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27
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Chenchula S, Chandra MB, Adusumilli MB, Ghanta SN, Bommasani A, Kuttiappan A, Padmavathi R, Amerneni KC, Chikatipalli R, Ghanta MK, Reddy SS, Mythili Bai K, Prakash S, Jogender G, Chavan M, Balakrishnan S. Immunogenicity, clinical efficacy and safety of additional second COVID-19 booster vaccines against Omicron and its subvariants: A systematic review. Rev Med Virol 2024; 34:e2515. [PMID: 38282403 DOI: 10.1002/rmv.2515] [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: 07/25/2023] [Revised: 12/20/2023] [Accepted: 01/11/2024] [Indexed: 01/30/2024]
Abstract
The Omicron variant of severe acute respiratory syndrome coronavirus 2 is a new variant of concern (VOC) and an emerging subvariant that exhibits heightened infectivity, transmissibility, and immune evasion, escalating the incidence of moderate to severe coronavirus disease 2019 (COVID-19). It resists monoclonal antibodies and diminishes vaccine efficacy. Notably, new sublineages have outpaced earlier predominant sublineages. Although the primary vaccination series and initial boosters were robust against previous VOCs, their efficacy waned against Omicron and its subvariants. In this systematic review, we assessed real-world evidence on the immunogenicity, clinical efficacy, and safety of a second booster or fourth COVID-19 vaccine dose against the Omicron VOC and its subvariants. A comprehensive literature search was conducted in Medline/PubMed, Google Scholar, bioRxiv, and medRxiv, and relevant studies published between 2022 and 30 May 2023 were reviewed. We found a total of 40 relevant articles focusing on a second booster dose for COVID-19, including clinical trials and observational studies, involving 3,972,856 patients. The results consistently revealed that an additional second booster dose restored and prolonged waning immunity, activating both humoral and cellular responses against Omicron and its subvariants. A second booster treatment correlated with enduring protection against COVID-19, notably preventing substantial symptomatic disease and mortality associated with severe Omicron infection. Both monovalent messenger RNA (mRNA) and nonmRNA vaccines demonstrated similar efficacy and safety, with bivalent mRNA vaccines exhibiting broader protection against emerging subvariants of Omicron. The safety profiles of second booster were favourable with only mild systemic and local symptoms reported in some recipients. In conclusion, this systematic review underscores the additional COVID-19 vaccine boosters, particularly with bivalent or multivalent mRNA vaccines, for countering the highly infectious emerging subvariants of Omicron.
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Affiliation(s)
| | | | | | | | | | - Anitha Kuttiappan
- School of Pharmacy and Technology Management, SVKM'S NMIMS, Shirpur, Maharashtra, India
| | - R Padmavathi
- SVS Medical College and Hospital, Mahbubnagar, Telangana, India
| | | | | | | | | | - K Mythili Bai
- Siddhartha Medical College, Vijayawada, Andhra Pradesh, India
| | - Satya Prakash
- All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - G Jogender
- All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Madhavrao Chavan
- All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - S Balakrishnan
- All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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28
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Teodorescu DL, Kote A, Reaso JN, Rosenberg C, Liu X, Kwan AC, Cheng S, Chen PS. Postural orthostatic tachycardia syndrome after COVID-19 vaccination. Heart Rhythm 2024; 21:74-81. [PMID: 38176772 PMCID: PMC10767226 DOI: 10.1016/j.hrthm.2023.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/13/2023] [Accepted: 09/11/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND There is an association between coronavirus disease 2019 (COVID-19) mRNA vaccination and the incidence or exacerbation of postural orthostatic tachycardia syndrome (POTS). OBJECTIVE The purpose of this study was to characterize patients reporting new or exacerbated POTS after receiving the mRNA COVID-19 vaccine. METHODS We prospectively collected data from sequential patients in a POTS clinic between July 2021 and June 2022 reporting new or exacerbated POTS symptoms after COVID-19 vaccination. Heart rate variability (HRV) and skin sympathetic nerve activity (SKNA) were compared against those of 24 healthy controls. RESULTS Ten patients (6 women and 4 men; age 41.5 ± 7.9 years) met inclusion criteria. Four patients had standing norepinephrine levels > 600 pg/mL. All patients had conditions that could raise POTS risk, including previous COVID-19 infection (N = 4), hypermobile Ehlers-Danlos syndrome (N = 6), mast cell activation syndrome (N = 6), and autoimmune (N = 7), cardiac (N = 7), neurological (N = 6), or gastrointestinal conditions (N = 4). HRV analysis indicated a lower ambulatory root mean square of successive differences (46.19 ±24 ms; P = .042) vs control (72.49 ± 40.8 ms). SKNA showed a reduced mean amplitude (0.97 ± 0.052 μV; P = .011) vs control (1.2 ± 0.31 μV) and burst amplitude (1.67 ± 0.16 μV; P = .018) vs control (4. 3 ± 4.3 μV). After 417.2 ± 131.4 days of follow-up, all patients reported improvement with the usual POTS care, although 2 with COVID-19 reinfection and 1 with small fiber neuropathy did have relapses of POTS symptoms. CONCLUSION All patients with postvaccination POTS had pre-existing conditions. There was no evidence of myocardial injuries or echocardiographic abnormalities. The decreased HRV suggests a sympathetic dominant state. Although all patients improved with guideline-directed care, there is a risk of relapse.
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Affiliation(s)
- Debbie Lin Teodorescu
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Anxhela Kote
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jewel N Reaso
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Carine Rosenberg
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Xiao Liu
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alan C Kwan
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Peng-Sheng Chen
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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29
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Black KC, Snyder NA, Zhou M, Zhu Z, Uptegraft C, Chintalapani A, Orwoll B. An Electronic Health Record Alert for Inpatient Coronavirus Disease 2019 Vaccinations Increases Vaccination Ordering and Uncovers Workflow Inefficiencies. Appl Clin Inform 2024; 15:192-198. [PMID: 38253337 PMCID: PMC10917607 DOI: 10.1055/a-2250-6305] [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: 07/03/2023] [Accepted: 01/19/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Despite mortality benefits, only 19.9% of U.S. adults are fully vaccinated against the coronavirus disease 2019 (COVID-19). The inpatient setting is an opportune environment to update vaccinations, and inpatient electronic health record (EHR) alerts have been shown to increase vaccination rates. OBJECTIVE Our objective was to evaluate whether an EHR alert could increase COVID-19 vaccinations in eligible hospitalized adults by prompting providers to order the vaccine. METHODS This was a quasiexperimental pre-post-interventional design study at an academic and community hospital in the western United States between 1 January, 2021 and 31 October, 2021. Inclusion criteria were unvaccinated hospitalized adults. A soft-stop, interruptive EHR alert prompted providers to order COVID-19 vaccines for those with an expected discharge date within 48 hours and interest in vaccination. The outcome measured was the proportion of all eligible patients for whom vaccines were ordered and administered before and after alert implementation. RESULTS Vaccine ordering rates increased from 4.0 to 13.0% at the academic hospital (odds ratio [OR]: 4.01, 95% confidence interval [CI]: 3.39-4.74, p < 0.001) and from 7.4 to 11.6% at the community hospital (OR: 1.62, 95% CI: 1.23-2.13, p < 0.001) after alert implementation. Administration increased postalert from 3.6 to 12.7% at the academic hospital (OR: 3.21, 95% CI: 2.70-3.82, p < 0.001) but was unchanged at the community hospital, 6.7 to 6.7% (OR: 0.99, 95% CI: 0.73-1.37, p = 0.994). Further analysis revealed infrequent vaccine availability at the community hospital. CONCLUSION Vaccine ordering rates improved at both sites after alert implementation. Vaccine administration rates, however, only improved at the academic hospital, likely due in part to vaccine dispensation inefficiency at the community hospital. This study demonstrates the potential impact of complex workflow patterns on new EHR alert success and provides a rationale for subsequent qualitative workflow analysis with alert implementation.
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Affiliation(s)
| | | | - Mengyu Zhou
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Zhen Zhu
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Colby Uptegraft
- Health Informatics Directorate, Defense Health Agency, Falls Church, Virginia
| | - Ani Chintalapani
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
| | - Benjamin Orwoll
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
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Walmsley S, Nabipoor M, Lovblom LE, Ravindran R, Colwill K, McGeer A, Dayam RM, Manase D, Gingras AC. Predictors of Breakthrough SARS-CoV-2 Infection after Vaccination. Vaccines (Basel) 2023; 12:36. [PMID: 38250849 PMCID: PMC10820583 DOI: 10.3390/vaccines12010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
The initial two-dose vaccine series and subsequent booster vaccine doses have been effective in modulating SARS-CoV-2 disease severity and death but do not completely prevent infection. The correlates of infection despite vaccination continue to be under investigation. In this prospective decentralized study (n = 1286) comparing antibody responses in an older- (≥70 years) to a younger-aged cohort (aged 30-50 years), we explored the correlates of breakthrough infection in 983 eligible subjects. Participants self-reported data on initial vaccine series, subsequent booster doses and COVID-19 infections in an online portal and provided self-collected dried blood spots for antibody testing by ELISA. Multivariable survival analysis explored the correlates of breakthrough infection. An association between higher antibody levels and protection from breakthrough infection observed during the Delta and Omicron BA.1/2 waves of infection no longer existed during the Omicron BA.4/5 wave. The older-aged cohort was less likely to have a breakthrough infection at all time-points. Receipt of an original/Omicron vaccine and the presence of hybrid immunity were associated with protection of infection during the later Omicron BA.4/5 and XBB waves. We were unable to determine a threshold antibody to define protection from infection or to guide vaccine booster schedules.
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Affiliation(s)
- Sharon Walmsley
- Division of Infectious Diseases, Department of Medicine, University Health Network, Toronto, ON M5G1L7, Canada;
- Department of Medicine, University of Toronto, Toronto, ON M5S1A1, Canada
| | - Majid Nabipoor
- Biostatistics Department, University Health Network, Toronto, ON M5G1L7, Canada; (M.N.); (L.E.L.)
| | - Leif Erik Lovblom
- Biostatistics Department, University Health Network, Toronto, ON M5G1L7, Canada; (M.N.); (L.E.L.)
| | - Rizani Ravindran
- Division of Infectious Diseases, Department of Medicine, University Health Network, Toronto, ON M5G1L7, Canada;
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON M5G1X5, Canada; (K.C.); (R.M.D.); (A.-C.G.)
| | - Alison McGeer
- Mount Sinai Hospital, Sinai Health, Toronto, ON M5G1X5, Canada;
| | - Roya Monica Dayam
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON M5G1X5, Canada; (K.C.); (R.M.D.); (A.-C.G.)
| | - Dorin Manase
- DATA Team, University Health Network, Toronto, ON M5G1L7, Canada;
| | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON M5G1X5, Canada; (K.C.); (R.M.D.); (A.-C.G.)
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5S1A1, Canada
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Liang Y, Sun Y. Awareness of and attitude toward COVID-19 vaccination among individuals with COPD and the strategies to overcome vaccine hesitation: A mini review. Hum Vaccin Immunother 2023; 19:2286686. [PMID: 38059434 PMCID: PMC10732662 DOI: 10.1080/21645515.2023.2286686] [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: 09/01/2023] [Accepted: 11/19/2023] [Indexed: 12/08/2023] Open
Abstract
Coronavirus Disease 2019 (COVID-19) vaccines have a protective effect on individuals with chronic obstructive pulmonary disease (COPD), preventing them from developing severe illnesses and reducing the risk of hospitalization and mortality. However, the coverage rate of COVID-19 vaccination among this population is not satisfactory, which is associated with their lack of awareness of and negative attitudes toward COVID-19 vaccination, that is, vaccine hesitancy. We reviewed recent literatures on the vaccination status of COPD patients and vaccine hesitancy, described the factors related to vaccine hesitancy among COPD patients, and proposed strategies to improve the vaccine coverage, such as providing accurate and consistent vaccine information to the public, patient health education program, improving self-management capabilities, easy access to vaccination service, etc., which can hopefully help to improve patients' ability to cope with SARS-CoV-2 infection and reduce the COVID-19 related mortality.
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Affiliation(s)
- Ying Liang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
- Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
- Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, People’s Republic of China
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Wettengel JM, Strehle K, von Lucke C, Roggendorf H, Jeske SD, Christa C, Zelger O, Haller B, Protzer U, Knolle PA. Improved detection of infection with SARS-CoV-2 Omicron variants of concern in healthcare workers by a second-generation rapid antigen test. Microbiol Spectr 2023; 11:e0176823. [PMID: 37831440 PMCID: PMC10714798 DOI: 10.1128/spectrum.01768-23] [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: 04/27/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
IMPORTANCE The results from this study demonstrate the usefulness of a second-generation rapid antigen test for early detection of infection with the SARS-CoV-2 Omicron variant of concern (VoC) and reveal a higher sensitivity to detect immune escape Omicron VoCs compared to a first-generation rapid antigen test (89.4% vs 83.7%) in the high-risk group of healthcare workers.
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Affiliation(s)
- Jochen M. Wettengel
- Institute of Virology, School of Medicine and Health, Technical University of Munich (TUM), München, Germany
- German Center for Infection Research (DZIF), Munich Partner Site, München, Germany
| | - Katharina Strehle
- Institute of Molecular Immunology, School of Medicine and Health, TUM, München, Germany
- Coronavirus Diagnostic Center of the University Hospital München Rechts der Isar, School of Medicine, TUM, München, Germany
| | - Catharina von Lucke
- Coronavirus Diagnostic Center of the University Hospital München Rechts der Isar, School of Medicine, TUM, München, Germany
| | - Hedwig Roggendorf
- Institute of Molecular Immunology, School of Medicine and Health, TUM, München, Germany
- Coronavirus Diagnostic Center of the University Hospital München Rechts der Isar, School of Medicine, TUM, München, Germany
| | - Samuel D. Jeske
- Institute of Virology, School of Medicine and Health, Technical University of Munich (TUM), München, Germany
| | - Catharina Christa
- Institute of Virology, School of Medicine and Health, Technical University of Munich (TUM), München, Germany
| | - Otto Zelger
- Coronavirus Diagnostic Center of the University Hospital München Rechts der Isar, School of Medicine, TUM, München, Germany
| | - Bernhard Haller
- Institute for AI and Informatics in Medicine Statistics, School of Medicine and Health, TUM, München, Germany
| | - Ulrike Protzer
- Institute of Virology, School of Medicine and Health, Technical University of Munich (TUM), München, Germany
- German Center for Infection Research (DZIF), Munich Partner Site, München, Germany
- Institute of Virology, Helmholtz Munich, München, Germany
| | - Percy A. Knolle
- German Center for Infection Research (DZIF), Munich Partner Site, München, Germany
- Institute of Molecular Immunology, School of Medicine and Health, TUM, München, Germany
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Sallam M, Abbasi H, Obeidat RJ, Badayneh R, Alkhashman F, Obeidat A, Oudeh D, Uqba Z, Mahafzah A. Unraveling the association between vaccine attitude, vaccine conspiracies and self-reported side effects following COVID-19 vaccination among nurses and physicians in Jordan. Vaccine X 2023; 15:100405. [PMID: 38161986 PMCID: PMC10755110 DOI: 10.1016/j.jvacx.2023.100405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 01/03/2024] Open
Abstract
Background The negative impact of vaccine conspiracies is linked with negative health behavior. The aim of the current study was to examine the association between attitudes toward booster COVID-19, influenza, and monkeypox (mpox) vaccinations with post-COVID-19 vaccine side effects, vaccine conspiracies, and attitude towards mandatory vaccination among nurses and physicians in Jordan. Methods A structured closed-ended questionnaire was used to collect data on demographics, COVID-19 history, COVID-19 vaccine type and doses received, self-reported side effects post-COVID-19 vaccination, acceptance of booster COVID-19, seasonal influenza, and mpox vaccinations, attitudes towards mandatory vaccination, and beliefs in vaccine conspiracies. Results The study sample comprised a total of 341 participants. Acceptance of yearly booster COVID-19 vaccination was expressed by 46.6% of the sample, while 73.3% accepted seasonal influenza vaccination, and only 37.0% accepted mpox vaccination. A higher frequency of self-reported side effects following the first COVID-19 vaccine dose was associated with embrace of vaccine conspiracies and vaccine type. For the second vaccine dose, a higher frequency of self-reported side effects was associated with the embrace of vaccine conspiracies, older age, and affiliation to private sector. In multinomial logistic regression analyses, the lower embrace of vaccine conspiracies was associated with lower odds of reporting side effects post-COVID-19 vaccination. The lower embrace of vaccine conspiracies and favorable attitude towards mandatory vaccination were associated with the willingness to get COVID-19, influenza, and mpox vaccinations. Conclusion The study findings highlighted the negative impact of embracing vaccine conspiracies on health-seeking behavior among nurses and physicians. The findings indicated that the willingness to get vaccinated was associated with lower endorsement of vaccine conspiracies. Additionally, the lower embrace of vaccine conspiracies was associated with a lower frequency of self-reported side effects following COVID-19 vaccination. These results emphasize the importance of addressing vaccine misinformation and promoting accurate information to ensure optimal vaccine uptake and public health outcomes.
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Affiliation(s)
- Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman, Jordan
| | - Hiba Abbasi
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
- Department of Internal Medicine, Jordan University Hospital, Amman, Jordan
| | - Rawan J. Obeidat
- The Office of Infection Prevention and Control, Jordan University Hospital, Amman, Jordan
| | - Reham Badayneh
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Farah Alkhashman
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Aseel Obeidat
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Dana Oudeh
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Zena Uqba
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Azmi Mahafzah
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman, Jordan
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Man HSJ, Moosa VA, Singh A, Wu L, Granton JT, Juvet SC, Hoang CD, de Perrot M. Unlocking the potential of RNA-based therapeutics in the lung: current status and future directions. Front Genet 2023; 14:1281538. [PMID: 38075698 PMCID: PMC10703483 DOI: 10.3389/fgene.2023.1281538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/06/2023] [Indexed: 02/12/2024] Open
Abstract
Awareness of RNA-based therapies has increased after the widespread adoption of mRNA vaccines against SARS-CoV-2 during the COVID-19 pandemic. These mRNA vaccines had a significant impact on reducing lung disease and mortality. They highlighted the potential for rapid development of RNA-based therapies and advances in nanoparticle delivery systems. Along with the rapid advancement in RNA biology, including the description of noncoding RNAs as major products of the genome, this success presents an opportunity to highlight the potential of RNA as a therapeutic modality. Here, we review the expanding compendium of RNA-based therapies, their mechanisms of action and examples of application in the lung. The airways provide a convenient conduit for drug delivery to the lungs with decreased systemic exposure. This review will also describe other delivery methods, including local delivery to the pleura and delivery vehicles that can target the lung after systemic administration, each providing access options that are advantageous for a specific application. We present clinical trials of RNA-based therapy in lung disease and potential areas for future directions. This review aims to provide an overview that will bring together researchers and clinicians to advance this burgeoning field.
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Affiliation(s)
- H. S. Jeffrey Man
- Temerty Faculty of Medicine, Institute of Medical Science, Toronto, ON, Canada
- Department of Immunology, University of Toronto, Toronto, ON, Canada
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, ON, Canada
- Division of Respirology and Critical Care Medicine, Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Vaneeza A. Moosa
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, ON, Canada
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - Anand Singh
- Thoracic Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Licun Wu
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, ON, Canada
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - John T. Granton
- Division of Respirology and Critical Care Medicine, Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Stephen C. Juvet
- Temerty Faculty of Medicine, Institute of Medical Science, Toronto, ON, Canada
- Department of Immunology, University of Toronto, Toronto, ON, Canada
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, ON, Canada
- Division of Respirology and Critical Care Medicine, Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Chuong D. Hoang
- Thoracic Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Marc de Perrot
- Department of Immunology, University of Toronto, Toronto, ON, Canada
- Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, Toronto, ON, Canada
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada
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Hau D, Pflughoeft KJ, Gates-Hollingsworth MA, Kaur S, Hill HJ, Arias-Umana J, Chung CC, Smith VL, Riddle MS, Healy SA, AuCoin DP. Serum antibody levels to SARS-CoV-2 receptor-binding domain (RBD) in convalescent patients and vaccinated individuals of northern Nevada. PLoS One 2023; 18:e0288713. [PMID: 37917669 PMCID: PMC10621914 DOI: 10.1371/journal.pone.0288713] [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: 06/15/2022] [Accepted: 07/04/2023] [Indexed: 11/04/2023] Open
Abstract
Antibodies reactive with the SARS-CoV-2 receptor-binding domain (RBD) of the spike protein are associated with viral neutralization, however low antibody titers, specifically against SARS-CoV-2 variants, may result in reduced viral immunity post naturally acquired infection. A cohort study comprised of 121 convalescent individuals from northern Nevada was conducted looking at anti-RBD antibody levels by enzyme-linked immunosorbent assay. Serum was collected from volunteers by staff at the University of Nevada, Reno School of Medicine Clinical Research Center and assessed for antibodies reactive to various SARS-CoV-2 RBD domains relevant to the time of the study (2020-2021). A nonpaired group of vaccinated individuals were assessed in parallel. The goal of the study was to identify antibody levels against the RBD subunit in convalescent and vaccinated individuals from northern Nevada.
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Affiliation(s)
- Derrick Hau
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, United States of America
| | - Kathryn J. Pflughoeft
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, United States of America
| | | | - Simranjit Kaur
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, United States of America
| | - Haydon J. Hill
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, United States of America
| | - Jose Arias-Umana
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, United States of America
| | - Chelsea C. Chung
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, United States of America
| | - Valerie L. Smith
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, Nevada, United States of America
| | - Mark S. Riddle
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, Nevada, United States of America
| | - Sara A. Healy
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, United States of America
- Renown Health, Reno, Nevada, United States of America
| | - David P. AuCoin
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, United States of America
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Fernández-González M, Agulló V, García JA, Padilla S, García-Abellán J, de la Rica A, Mascarell P, Masiá M, Gutiérrez F. T-Cell Immunity Against Severe Acute Respiratory Syndrome Coronavirus 2 Measured by an Interferon-γ Release Assay Is Strongly Associated With Patient Outcomes in Vaccinated Persons Hospitalized With Delta or Omicron Variants. J Infect Dis 2023; 228:1240-1252. [PMID: 37418551 DOI: 10.1093/infdis/jiad260] [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: 03/30/2023] [Revised: 06/08/2023] [Accepted: 07/06/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND We measured T-cell and antibody responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in vaccinated patients hospitalized for coronavirus disease 2019 (COVID-19) and explored their potential value to predict outcomes. METHODS This was a prospective, longitudinal study including vaccinated patients hospitalized with Delta and Omicron SARS-CoV-2 variants. TrimericS-IgG antibodies and SARS-CoV-2 T-cell response were measured using a specific quantitative interferon-γ release assay (IGRA). Primary outcome was all-cause 28-day mortality or need for intensive care unit (ICU) admission. Cox models were used to assess associations with outcomes. RESULTS Of 181 individuals, 158 (87.3%) had detectable SARS-CoV-2 antibodies, 92 (50.8%) showed SARS-CoV-2-specific T-cell responses, and 87 (48.1%) had both responses. Patients who died within 28 days or were admitted to ICU were less likely to have both unspecific and specific T-cell responses in IGRA. In adjusted analyses (adjusted hazard ratio [95% confidence interval]), for the entire cohort, having both T-cell and antibody responses at admission (0.16 [.05-.58]) and Omicron variant (0.38 [.17-.87]) reduced the hazard of 28-day mortality or ICU admission, whereas higher Charlson comorbidity index score (1.27 [1.07-1.51]) and lower oxygen saturation to fraction of inspired oxygen ratio (2.36 [1.51-3.67]) increased the risk. CONCLUSIONS Preexisting immunity against SARS-CoV-2 is strongly associated with patient outcomes in vaccinated individuals requiring hospital admission for COVID-19. Persons showing both T-cell and antibody responses have the lowest risk of severe outcomes.
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Affiliation(s)
- Marta Fernández-González
- Infectious Diseases Unit, Hospital General Universitario de Elche, Elche
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid
| | - Vanesa Agulló
- Infectious Diseases Unit, Hospital General Universitario de Elche, Elche
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid
| | - José Alberto García
- Infectious Diseases Unit, Hospital General Universitario de Elche, Elche
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid
| | - Sergio Padilla
- Infectious Diseases Unit, Hospital General Universitario de Elche, Elche
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid
- Clinical Medicine Department, Universidad Miguel Hernández, San Juan de Alicante
| | - Javier García-Abellán
- Infectious Diseases Unit, Hospital General Universitario de Elche, Elche
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid
- Clinical Medicine Department, Universidad Miguel Hernández, San Juan de Alicante
| | - Alba de la Rica
- Infectious Diseases Unit, Hospital General Universitario de Elche, Elche
- Microbiology Service, Hospital General Universitario de Elche, Elche, Spain
| | - Paula Mascarell
- Infectious Diseases Unit, Hospital General Universitario de Elche, Elche
| | - Mar Masiá
- Infectious Diseases Unit, Hospital General Universitario de Elche, Elche
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid
- Clinical Medicine Department, Universidad Miguel Hernández, San Juan de Alicante
| | - Félix Gutiérrez
- Infectious Diseases Unit, Hospital General Universitario de Elche, Elche
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid
- Clinical Medicine Department, Universidad Miguel Hernández, San Juan de Alicante
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Stephenson KE, Marcelin JR, Pettifor AE, Janes H, Brown E, Neradilek M, Yen C, Andriesen J, Grunenberg N, Espy N, Trahey M, Fischer RSB, DeSouza CA, Shisler JL, Connick E, Houpt ER, Chu HY, McCulloh RJ, Becker-Dreps S, Vielot NA, Kalbaugh CA, Cherabuddi K, Krueger KM, Rosenberg M, Greenberg RN, Joaquin A, Immergluck LC, Corey L, Kublin JG. Efficacy of Messenger RNA-1273 Against Severe Acute Respiratory Syndrome Coronavirus 2 Acquisition in Young Adults From March to December 2021. Open Forum Infect Dis 2023; 10:ofad511. [PMID: 38023544 PMCID: PMC10655942 DOI: 10.1093/ofid/ofad511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background The efficacy of messenger RNA (mRNA)-1273 against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is not well defined, particularly among young adults. Methods Adults aged 18-29 years with no known history of SARS-CoV-2 infection or prior vaccination for coronavirus disease 2019 (COVID-19) were recruited from 44 US sites from 24 March to 13 September 2021 and randomized 1:1 to immediate vaccination (receipt of 2 doses of mRNA-1273 vaccine at months 0 and 1) or the standard of care (receipt of COVID-19 vaccine). Randomized participants were followed up for SARS-CoV-2 infection measured by nasal swab testing and symptomatic COVID-19 measured by nasal swab testing plus symptom assessment and assessed for the primary efficacy outcome. A vaccine-declined observational group was also recruited from 16 June to 8 November 2021 and followed up for SARS-CoV-2 infection as specified for the randomized participants. Results The study enrolled 1149 in the randomized arms and 311 in the vaccine-declined group and collected >122 000 nasal swab samples. Based on randomized participants, the efficacy of 2 doses of mRNA-1273 vaccine against SARS-CoV-2 infection was 52.6% (95% confidence interval, -14.1% to 80.3%), with the majority of infections due to the Delta variant. Vaccine efficacy against symptomatic COVID-19 was 71.0% (95% confidence interval, -9.5% to 92.3%). Precision was limited owing to curtailed study enrollment and off-study vaccination censoring. The incidence of SARS-CoV-2 infection in the vaccine-declined group was 1.8 times higher than in the standard-of-care group. Conclusions mRNA-1273 vaccination reduced the incidence of SARS-CoV-2 infection from March to September 2021, but vaccination was only one factor influencing risk. Clinical Trials Registration NCT04811664.
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Affiliation(s)
- Kathryn E Stephenson
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
| | - Jasmine R Marcelin
- Division of Infectious Diseases, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Audrey E Pettifor
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Holly Janes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Elizabeth Brown
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Moni Neradilek
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Catherine Yen
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, USA
| | - Jessica Andriesen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Nicole Grunenberg
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Nicole Espy
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Meg Trahey
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Rebecca S B Fischer
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Christopher A DeSouza
- Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Joanna L Shisler
- Department of Microbiology, University of Illinois, Urbana, Illinois, USA
| | | | - Eric R Houpt
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Helen Y Chu
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Russel J McCulloh
- Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sylvia Becker-Dreps
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nadja A Vielot
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Corey A Kalbaugh
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Kartik Cherabuddi
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Karen M Krueger
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Molly Rosenberg
- Center for Sexual Health Promotion, Indiana University School of Public Health–Bloomington, Bloomington, Indiana, USA
| | | | - Arnel Joaquin
- Department of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Lilly Cheng Immergluck
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Lawrence Corey
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Laboratory Medicine, University of Washington,Seattle, Washington, USA
| | - James G Kublin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
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Patel P, Schrader KE, Rice CE, Rowley E, Cree RA, DeSilva MB, Embi PJ, Gaglani M, Grannis SJ, Ong TC, Stenehjem E, Naleway AL, Ball S, Natarajan K, Klein NP, Adams K, Kharbanda A, Ray C, Link-Gelles R, Tenforde MW. Effectiveness of the Original Monovalent Coronavirus Disease 2019 Vaccines in Preventing Emergency Department or Urgent Care Encounters and Hospitalizations Among Adults With Disabilities: VISION Network, June 2021-September 2022. Open Forum Infect Dis 2023; 10:ofad474. [PMID: 37965644 PMCID: PMC10642729 DOI: 10.1093/ofid/ofad474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/18/2023] [Indexed: 11/16/2023] Open
Abstract
Adults with disabilities are at increased risk for severe coronavirus disease 2019 (COVID-19). Using data across 9 states during Delta- and Omicron-predominant periods (June 2021-September 2022), we evaluated the effectiveness of the original monovalent COVID-19 messenger RNA vaccines among 521 206 emergency department/urgent care encounters (11 471 [2%] in patients with a documented disability) and 139 548 hospitalizations (16 569 [12%] in patients with a disability) for laboratory-confirmed COVID-19 illness in adults (aged ≥18 years). Across variant periods and for the primary series or booster doses, vaccine effectiveness was similar in those with and those without a disability. These findings highlight the importance of adults with disabilities staying up to date with COVID-19 vaccinations.
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Affiliation(s)
- Palak Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Catherine E Rice
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth Rowley
- Department of Clinical Research, Westat, Rockville, Maryland, USA
| | - Robyn A Cree
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Malini B DeSilva
- Department of Research, Health Partners Institute, Minneapolis, Minnesota, USA
| | - Peter J Embi
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manjusha Gaglani
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Baylor Scott & White Health, Temple, Texas, USA
- Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Allison L Naleway
- Department of Science Programs, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Sarah Ball
- Department of Clinical Research, Westat, Rockville, Maryland, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, NewYork, New York, USA
- Medical Informatics Services, NewYork-Presbyterian Hospital, NewYork, New York, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anupam Kharbanda
- Department of Emergency Medicine, Children’s Minnesota, Minneapolis, Minnesota, USA
| | - Caitlin Ray
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ruth Link-Gelles
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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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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40
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Gül F, Kasapoğlu US, Sabaz MS, Ay P, Doruk Oktay B, Çalışkan G, Demir N, Sayan İ, Kabadayı F, Altuntaş G, Gümüş A, Kırca H, Şanlı D, Acil F, Dedeoğlu A, Ural SG, Akın Şen İ, Macit Aydın E, Dayanır H, Yelken B, Ceylan İ, Aydın OÖ, Eskidemir G, Aytekin A, Cengiz M, Arslan Ü, Akdağ D, Alay GH, Tekin E, Yarar V, Saracoğlu KT, Gök F, Alparslan V, Tuna V, Yıldız M, Şenoğlu N, Kıraklı C, Yıldırım S, Saçar Kübüç K, Erer A, Gültekin H, Özmen Süner K, Kuzgun Ö, Öztürk ÇE, Karahan A, Deveci O, Ay M, Tüfek Öztan D, Akıncı SB, Solak MY, Bozbay S, Özçiftçi S, Gönderen K, Küçük AO, Uyan B, Elay G, Boyacı N, Timurkaan M, Karakoç E, Doğan L, Yalçınkaya E, Kazancıoğlu L, Erdal Dönmez G, Yılmaz B, Ergül DF, Boran M, Özkarakaş H, Karakaş B, Ergin Özcan P, Anaklı İ, Bayar MK, Yüksel D, Akdağ Ş, Pişkin Ö, Temur S, Eyüpoğlu S, Tekir Yılmaz E, Avcı GZ, Turan R, Alkan Bayburt F, Şahintürk H, Güçyetmez B, Alparslan MM, Yarıcı M, Yıldırım F, Yektaş A, Yaman G, Demirkıran O, Cinel İ. The Impact of CoronaVac Vaccination on 28-day Mortality Rate of Critically Ill Patients with COVID-19 in Türkiye. Balkan Med J 2023; 40:435-444. [PMID: 37867428 PMCID: PMC10613737 DOI: 10.4274/balkanmedj.galenos.2023.2023-6-90] [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: 07/05/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023] Open
Abstract
Background Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear. Aims To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19. Study Design Multicenter prospective observational clinical study. Methods This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated. Results As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004). Conclusion Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.
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Affiliation(s)
- Fethi Gül
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, Marmara University Faculty of Medicine, İstanbul, Türkiye
| | - Umut Sabri Kasapoğlu
- Clinic of Critical Care Medicine, Malatya Training and Research Hospital, Malatya, Türkiye
| | - Mehmet Süleyman Sabaz
- Clinic of Critical Care Medicine, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
| | - Pınar Ay
- Department of Public Health, Marmara University Faculty of Medicine, İstanbul, Türkiye
| | - Burçin Doruk Oktay
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, Marmara University Faculty of Medicine, İstanbul, Türkiye
| | - Gülbahar Çalışkan
- Department of Anesthesiology and Reanimation, University of Health Sciences Türkiye, Bursa Faculty of Medicine, Bursa, Türkiye
| | - Nalan Demir
- Division of Critical Care Medicine, Clinic of Chest Diseases, University of Health Sciences Türkiye, Ankara City Hospital, Ankara, Türkiye
| | - İsmet Sayan
- Clinic of Critical Care Medicine, Sancaktepe Training and Research Hospital, İstanbul, Türkiye
| | - Feyyaz Kabadayı
- Clinic of Critical Care Medicine, Sancaktepe Training and Research Hospital, İstanbul, Türkiye
| | - Gülsüm Altuntaş
- Clinic of Critical Care Medicine, Elazığ City Hospital, Elazığ, Türkiye
| | - Ayça Gümüş
- Clinic of Critical Care Medicine, Antalya Kepez State Hospital, Antalya, Türkiye
| | - Hülya Kırca
- Clinic of Critical Care Medicine, Antalya Kepez State Hospital, Antalya, Türkiye
| | - Deniz Şanlı
- Clinic of Critical Care Medicine, Batman Training and Research Hospital, Batman, Türkiye
| | - Fatma Acil
- Clinic of Anesthesiology and Reanimation, University of Health Sciences Türkiye, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyabakır, Türkiye
| | - Andaç Dedeoğlu
- Clinic of Anesthesiology and Reanimation, University of Health Sciences Türkiye, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyabakır, Türkiye
| | - Sedef Gülçin Ural
- Clinic Critical Care Medicine, University of Health Sciences Türkiye, Erzurum City Hospital, Erzurum, Türkiye
| | - İrem Akın Şen
- Clinic Critical Care Medicine, University of Health Sciences Türkiye, Erzurum City Hospital, Erzurum, Türkiye
| | - Eda Macit Aydın
- Division of Critical Care Medicine, Clinic of Anesthesiology and Reanimation, University of Health Sciences Türkiye, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Türkiye
| | - Hakan Dayanır
- Division of Critical Care Medicine, Clinic of Anesthesiology and Reanimation, University of Health Sciences Türkiye, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Türkiye
| | - Birgül Yelken
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Türkiye
| | - İlkay Ceylan
- Clinic of Critical Care Medicine, University of Health Sciences Türkiye, Bursa High Specialization Training and Research Hospital, Bursa, Türkiye
| | - Osman Özcan Aydın
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Türkiye
| | - Güneş Eskidemir
- Clinic of Critical Care Medicine, Gaziosmanpaşa Training and Research Hospital, İstanbul, Türkiye
| | - Ahmet Aytekin
- Clinic of Anesthesiology and Reanimation, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Türkiye
| | - Melike Cengiz
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, Akdeniz University Faculty of Medicine, Antalya, Türkiye
| | - Ülkü Arslan
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, Akdeniz University Faculty of Medicine, Antalya, Türkiye
| | - Devrim Akdağ
- Clinic of Critical Care Medicine, University of Health Sciences Türkiye, Adana City Hospital, Adana, Türkiye
| | - Gülçin Hilal Alay
- Department of Anesthesiology and Reanimation, University of Health Sciences Türkiye, İstanbul Başakşehir Çam and Sakura City Hospital, İstanbul, Türkiye
| | - Esra Tekin
- Clinic of Critical Care Medicine, Denizli State Hospital, Denizli, Türkiye
| | - Volkan Yarar
- Clinic of Critical Care Medicine, Balıkesir Atatürk City Hospital, Balıkesir, Türkiye
| | - Kemal Tolga Saracoğlu
- Clinic of Anesthesiology and Reanimation, University of Health Sciences Türkiye, Kartal Lütfi Kırdar Training and Research Hospital, İstanbul, Türkiye
| | - Funda Gök
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, Necmettin Erbakan University Faculty of Medicine, Konya, Türkiye
| | - Volkan Alparslan
- Clinic of Critical Care Medicine, Hatay Training and Research Hospital, Hatay, Türkiye
| | - Verda Tuna
- Clinic of Critical Care Medicine, Adıyaman Training and Research Hospital, Adıyaman, Türkiye
| | - Murside Yıldız
- Clinic of Critical Care Medicine, Ağrı Training and Research Hospital, Ağrı, Türkiye
| | - Nimet Şenoğlu
- Division of Critical Care Medicine, Clinic of Anesthesiology and Reanimation, University of Health Sciences Türkiye, Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Cenk Kıraklı
- Department of Critical Care Medicine, University of Health Sciences Türkiye, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Türkiye
| | - Süleyman Yıldırım
- Department of Critical Care Medicine, University of Health Sciences Türkiye, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Türkiye
| | - Kübra Saçar Kübüç
- Clinic of Critical Care Medicine, University of Health Sciences Türkiye, Van Training and Research Hospital, Van, Türkiye
| | - Ayşen Erer
- Clinic of Critical Care Medicine, Tekirdağ İsmail Fehmi Cumalioğlu City Hospital, Tekirdag, Türkiye
| | - Hamza Gültekin
- Clinic of Critical Care Medicine, Şırnak State Hospital, Şırnak, Türkiye
| | - Kezban Özmen Süner
- Clinic of Critical Care Medicine, Sakarya Training and Research Hospital, Sakarya, Türkiye
| | - Özge Kuzgun
- Clinic of Critical Care Medicine, Sakarya Training and Research Hospital, Sakarya, Türkiye
| | - Çağatay Erman Öztürk
- Clinic of Critical Care Medicine, University of Health Sciences Türkiye, Samsun Training and Research Hospital, Samsun, Türkiye
| | - Aydın Karahan
- Clinic of Critical Care Medicine, Mersin City Hospital, Mersin, Türkiye
| | - Okan Deveci
- Clinic of Critical Care Medicine, Mersin City Hospital, Mersin, Türkiye
| | - Mustafa Ay
- Clinic of Anesthesiology and Reanimation, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Dilara Tüfek Öztan
- Clinic of Anesthesiology and Reanimation, Antalya Training and Research Hospital, Antalya, Türkiye
| | - Seda Banu Akıncı
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Melahat Yalçın Solak
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Süha Bozbay
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, Hitit University Faculty of Medicine, Çorum, Türkiye
| | - Serhat Özçiftçi
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, Hitit University Faculty of Medicine, Çorum, Türkiye
| | - Kamil Gönderen
- Department of Critical Care Medicine, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Türkiye
| | - Ahmet Oğuzhan Küçük
- Division of Critical Care Medicine, Department of Chest Diseases, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Berna Uyan
- Department Critical Care Medicine, Gaziantep Şehit Kamil State Hospital, Gaziantep, Türkiye
| | - Gülseren Elay
- Division of Critical Care Medicine, Department of Internal Medicine, Gaziantep University Faculty of Medicine, Gaziantep, Türkiye
| | - Nazlıhan Boyacı
- Division of Critical Care Medicine, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Mustafa Timurkaan
- Clinic of Critical Care Medicine, Elazığ City Hospital, Elazığ, Türkiye
| | - Ebru Karakoç
- Department of Critical Care Medicine, Çankırı State Hospital, Çankırı, Türkiye
| | - Lerzan Doğan
- Department of Critical Care Medicine, Altunizade Acıbadem Hospital, İstanbul, Türkiye
| | - Erdem Yalçınkaya
- Department of Critical Care Medicine, Sivas Numune Hospital, Sivas, Türkiye
| | - Leyla Kazancıoğlu
- Department of Anesthesiology and Reanimation, Recep Tayyip Erdoğan University Faculty of Medicine, Rize, Türkiye
| | - Gül Erdal Dönmez
- Department of Critical Care Medicine, University of Health Sciences Türkiye, İstanbul Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Barış Yılmaz
- Department of Critical Care Medicine, University of Health Sciences Türkiye, İstanbul Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Dursun Fırat Ergül
- Department of Critical Care Medicine, Amasya University Sabuncuoğlu Şerafettin Training and Research Hospital, Amasya, Türkiye
| | - Maruf Boran
- Department of Critical Care Medicine, Amasya University Sabuncuoğlu Şerafettin Training and Research Hospital, Amasya, Türkiye
| | - Hüseyin Özkarakaş
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, University of Health Sciences Türkiye, İzmir Bozyaka Training and Research Hospital, İzmir, Türkiye
| | - Buğra Karakaş
- Clinic of Critical Care Medicine, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye
| | - Perihan Ergin Özcan
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, İstanbul University Capa Faculty of Medicine, İstanbul, Türkiye
| | - İlkay Anaklı
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, İstanbul University Capa Faculty of Medicine, İstanbul, Türkiye
| | - Mustafa Kemal Bayar
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Didem Yüksel
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Şükriye Akdağ
- Department of Anesthesiology and Reanimation, Yasar Eryılmaz Ağrı Doğubeyazıt State Hospital, Ağrı, Türkiye
| | - Özcan Pişkin
- Department of Anesthesiology and Reanimation, Zonguldak Bülent Ecevit University Faculty of Medicine, Zonguldak, Türkiye
| | - Sibel Temur
- Department of Anesthesiology and Reanimation, Yeditepe University Faculty of Medicine, İstanbul, Türkiye
| | - Selin Eyüpoğlu
- Clinic of Critical Care Medicine, Giresun Training and Research Hospital, Giresun, Türkiye
| | - Elvan Tekir Yılmaz
- Clinic of Anesthesiology and Reanimation, Giresun University Faculty of Medicine, Giresun Training and Research Hospital, Giresun, Türkiye
| | - Gizem Zaim Avcı
- Clinic of Anesthesiology and Reanimation, Giresun Prof. Dr. İlhan Özdemir State Hospital, Giresun Türkiye
| | - Raziye Turan
- Clinic of Anesthesiology and Reanimation, Giresun Prof. Dr. İlhan Özdemir State Hospital, Giresun Türkiye
| | - Fatma Alkan Bayburt
- Clinic of Anesthesiology and Reanimation, Giresun Prof. Dr. İlhan Özdemir State Hospital, Giresun Türkiye
| | - Helin Şahintürk
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, Başkent University Faculty of Medicine, Ankara, Türkiye
| | - Bülent Güçyetmez
- Department of Anesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Türkiye
| | - Mustafa Muhlis Alparslan
- Clinic of Anesthesiology and Reanimation, Aksaray University Training and Research Hospital, Aksaray, Türkiye
| | - Metin Yarıcı
- Department of Critical Care Medicine, University of Health Sciences Türkiye, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Türkiye
| | - Fatma Yıldırım
- Department of Chest Diseases, University of Health Sciences Türkiye, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Türkiye
| | - Abdulkadir Yektaş
- Department of Anesthesiology and Reanimation, Siirt University Faculty of Medicine, Siirt, Türkiye
| | | | - Oktay Demirkıran
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, İstanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye
| | - İsmail Cinel
- Division of Critical Care Medicine, Department of Anesthesiology and Reanimation, Marmara University Faculty of Medicine, İstanbul, Türkiye
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41
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Meier N, Perner A, Plovsing R, Christensen S, Poulsen LM, Brøchner AC, Rasmussen BS, Helleberg M, Jensen JUS, Andersen LPK, Siegel H, Ibsen M, Jørgensen VL, Winding R, Iversen S, Pedersen HP, Sølling C, Garcia RS, Michelsen J, Mohr T, Michagin G, Espelund US, Bundgaard H, Kirkegaard L, Smitt M, Sigurdsson S, Buck DL, Ribergaard NE, Pedersen HS, Toft MH, Jonassen TB, Mølgaard Nielsen F, Madsen EK, Haberlandt TN, Bredahl LS, Haase N. Long-term outcomes in COVID-19 patients admitted to intensive care in Denmark: A nationwide observational study. Acta Anaesthesiol Scand 2023; 67:1239-1248. [PMID: 37288935 DOI: 10.1111/aas.14290] [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: 03/25/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Among ICU patients with COVID-19, it is largely unknown how the overall outcome and resource use have changed with time, different genetic variants, and vaccination status. METHODS For all Danish ICU patients with COVID-19 from March 10, 2020 to March 31, 2022, we manually retrieved data on demographics, comorbidities, vaccination status, use of life support, length of stay, and vital status from medical records. We compared patients based on the period of admittance and vaccination status and described changes in epidemiology related to the Omicron variant. RESULTS Among all 2167 ICU patients with COVID-19, 327 were admitted during the first (March 10-19, 2020), 1053 during the second (May 20, 2020 to June 30, 2021) and 787 during the third wave (July 1, 2021 to March 31, 2022). We observed changes over the three waves in age (median 72 vs. 68 vs. 65 years), use of invasive mechanical ventilation (81% vs. 58% vs. 51%), renal replacement therapy (26% vs. 13% vs. 12%), extracorporeal membrane oxygenation (7% vs. 3% vs. 2%), duration of invasive mechanical ventilation (median 13 vs. 13 vs. 9 days) and ICU length of stay (median 13 vs. 10 vs. 7 days). Despite these changes, 90-day mortality remained constant (36% vs. 35% vs. 33%). Vaccination rates among ICU patients were 42% as compared to 80% in society. Unvaccinated versus vaccinated patients were younger (median 57 vs. 73 years), had less comorbidity (50% vs. 78%), and had lower 90-day mortality (29% vs. 51%). Patient characteristics changed significantly after the Omicron variant became dominant including a decrease in the use of COVID-specific pharmacological agents from 95% to 69%. CONCLUSIONS In Danish ICUs, the use of life support declined, while mortality seemed unchanged throughout the three waves of COVID-19. Vaccination rates were lower among ICU patients than in society, but the selected group of vaccinated patients admitted to the ICU still had very severe disease courses. When the Omicron variant became dominant a lower fraction of SARS-CoV-2 positive patients received COVID treatment indicating other causes for ICU admission.
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Affiliation(s)
- Nick Meier
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Ronni Plovsing
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, Copenhagen, Denmark
| | - Steffen Christensen
- Department of Anaesthesiology and Intensive Care, Århus University Hospital, Århus, Denmark
| | - Lone M Poulsen
- Department of Anaesthesiology and Intensive Care, Zealand University Hospital, Køge, Denmark
| | - Anne C Brøchner
- Department of Anaesthesiology and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Denmark
| | - Bodil S Rasmussen
- Department of Anaesthesiology and Intensive Care, Ålborg University Hospital, Ålborg, Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Jens U S Jensen
- Department of Respiratory Medicine, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Lars P K Andersen
- Department of Anaesthesiology and Intensive Care, Bispebjerg Hospital, Copenhagen, Denmark
| | - Hanna Siegel
- Department of Anaesthesiology and Intensive Care, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Michael Ibsen
- Department of Anaesthesiology and Intensive Care, North Zealand Hospital, Hillerød, Denmark
| | - Vibeke L Jørgensen
- Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - Robert Winding
- Department of Anaesthesiology and Intensive Care, Herning Hospital, Herning, Denmark
| | - Susanne Iversen
- Department of Anaesthesiology and Intensive Care, Slagelse Hospital, Slagelse, Denmark
| | - Henrik P Pedersen
- Department of Anaesthesiology and Intensive Care, Zealand University Hospital, Roskilde, Denmark
| | - Christoffer Sølling
- Department of Anaesthesiology and Intensive Care, Viborg Hospital, Viborg, Denmark
| | - Ricardo S Garcia
- Department of Anaesthesiology and Intensive Care, Esbjerg Hospital, Esbjerg, Denmark
| | - Jens Michelsen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Thomas Mohr
- Department of Anaesthesiology and Intensive Care, Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - George Michagin
- Department of Anaesthesiology and Intensive Care, Svendborg Hospital, Svendborg, Denmark
| | - Ulrick S Espelund
- Department of Anaesthesiology and Intensive Care, Horsens Hospital, Horsens, Denmark
| | - Helle Bundgaard
- Department of Anaesthesiology and Intensive Care, Randers Hospital, Randers, Denmark
| | - Lynge Kirkegaard
- Department of Anaesthesiology and Intensive Care, Åbenrå Hospital, Åbenrå, Denmark
| | - Margit Smitt
- Department of Anaesthesiology and Intensive Care, Glostrup Hospital, Copenhagen, Denmark
| | | | - David L Buck
- Department of Anaesthesiology and Intensive Care, Holbaek Hospital, Holbaek, Denmark
| | - Niels-Erik Ribergaard
- Department of Anaesthesiology and Intensive Care, Hjørring Hospital, Hjørring, Denmark
| | - Helle S Pedersen
- Department of Anaesthesiology and Intensive Care, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Mette Helene Toft
- Department of Anaesthesiology and Intensive Care, Bornholms Hospital, Rønne, Denmark
| | - Trine B Jonassen
- Department of Anaesthesiology and Intensive Care, Hvidovre Hospital, Copenhagen, Denmark
| | | | - Emilie K Madsen
- Department of Anaesthesiology and Intensive Care, Århus University Hospital, Århus, Denmark
| | - Trine N Haberlandt
- Department of Anaesthesiology and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Denmark
| | - Louise Sophie Bredahl
- Department of Anaesthesiology and Intensive Care, Hjørring Hospital, Hjørring, Denmark
| | - Nicolai Haase
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
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Plumb ID, Mohr NM, Hagen M, Wiegand R, Dumyati G, Harland KK, Krishnadasan A, Gist JJ, Abedi G, Fleming-Dutra KE, Chea N, Lee J, Barter D, Brackney M, Fridkin SK, Wilson LE, Lovett SA, Ocampo V, Phipps EC, Marcus TM, Smithline HA, Hou PC, Lee LC, Moran GJ, Krebs E, Steele MT, Lim SC, Schrading WA, Chinnock B, Beiser DG, Faine B, Haran JP, Nandi U, Chipman AK, LoVecchio F, Talan DA, Pilishvili T. Effectiveness of a Messenger RNA Vaccine Booster Dose Against Coronavirus Disease 2019 Among US Healthcare Personnel, October 2021-July 2022. Open Forum Infect Dis 2023; 10:ofad457. [PMID: 37799130 PMCID: PMC10549208 DOI: 10.1093/ofid/ofad457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023] Open
Abstract
Background Protection against symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (coronavirus disease 2019 [COVID-19]) can limit transmission and the risk of post-COVID conditions, and is particularly important among healthcare personnel. However, lower vaccine effectiveness (VE) has been reported since predominance of the Omicron SARS-CoV-2 variant. Methods We evaluated the VE of a monovalent messenger RNA (mRNA) booster dose against COVID-19 from October 2021 to June 2022 among US healthcare personnel. After matching case-participants with COVID-19 to control-participants by 2-week period and site, we used conditional logistic regression to estimate the VE of a booster dose compared with completing only 2 mRNA doses >150 days previously, adjusted for multiple covariates. Results Among 3279 case-participants and 3998 control-participants who had completed 2 mRNA doses, we estimated that the VE of a booster dose against COVID-19 declined from 86% (95% confidence interval, 81%-90%) during Delta predominance to 65% (58%-70%) during Omicron predominance. During Omicron predominance, VE declined from 73% (95% confidence interval, 67%-79%) 14-60 days after the booster dose, to 32% (4%-52%) ≥120 days after a booster dose. We found that VE was similar by age group, presence of underlying health conditions, and pregnancy status on the test date, as well as among immunocompromised participants. Conclusions A booster dose conferred substantial protection against COVID-19 among healthcare personnel. However, VE was lower during Omicron predominance, and waning effectiveness was observed 4 months after booster dose receipt during this period. Our findings support recommendations to stay up to date on recommended doses of COVID-19 vaccines for all those eligible.
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Affiliation(s)
- Ian D Plumb
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Melissa Hagen
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ryan Wiegand
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ghinwa Dumyati
- New York State Emerging Infections Program, University of Rochester Medical Center, Rochester, New York, USA
| | - Karisa K Harland
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Anusha Krishnadasan
- Department of Emergency Medicine, Olive View–UCLA Education and Research Institute, Los Angeles, California, USA
| | - Jade James Gist
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Glen Abedi
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine E Fleming-Dutra
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nora Chea
- National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jane Lee
- Healthcare-Associated Infections, California Emerging Infections Program, Oakland, California, USA
| | - Devra Barter
- Healthcare-associated Infections / Antimicrobial Resistance Program, Colorado Department of Public Health & Environment, Denver, Colorado, USA
| | - Monica Brackney
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Scott K Fridkin
- Georgia Emerging Infections Program and Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lucy E Wilson
- Maryland Emerging Infections Program, Maryland Department of Health, and University of Maryland,Baltimore County, Baltimore, Maryland, USA
| | - Sara A Lovett
- Infectious Disease Epidemiology, Prevention and Control Divison, Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Valerie Ocampo
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Erin C Phipps
- New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, New Mexico, USA
| | - Tiffanie M Marcus
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Howard A Smithline
- Department of Emergency Medicine, University of Massachusetts Chan Medical School - Baystate, Springfield, Massachusetts, USA
| | - Peter C Hou
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lilly C Lee
- Emergency Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Gregory J Moran
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Elizabeth Krebs
- Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mark T Steele
- Department of Emergency Medicine, University of Missouri–Kansas City, Kansas City, Missouri, USA
| | - Stephen C Lim
- Section of Emergency Medicine, University Medical Center New Orleans, LSU Health Sciences Center, New Orleans, Louisiana, USA
| | - Walter A Schrading
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brian Chinnock
- Department of Emergency Medicine, University of California San Francisco, Fresno, California, USA
| | - David G Beiser
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois, USA
| | - Brett Faine
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Utsav Nandi
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Anne K Chipman
- Emergency Department, University of Washington, Seattle, Washington, USA
| | - Frank LoVecchio
- Emergency Medicine, Valleywise Health Medical Center, Phoenix, Arizona, USA
| | - David A Talan
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Tamara Pilishvili
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Abstract
PURPOSE OF REVIEW The successes of the coronavirus disease 2019 (COVID-19) mRNA vaccines have accelerated the development of mRNA vaccines against other respiratory pathogens. The aim of this review is to highlight COVID-19 mRNA vaccine advances and provide an update on the progress of mRNA vaccine development against other respiratory pathogens. RECENT FINDINGS The COVID-19 mRNA vaccines demonstrated effectiveness in preventing severe COVID-19 and death. H7N9 and H10N8 avian influenza mRNA vaccines have demonstrated safety and immunogenicity in phase 1 clinical trials. Numerous seasonal influenza mRNA vaccines are in phase 1-3 clinical trials. Respiratory syncytial virus (RSV) mRNA vaccines have progressed to phase 2-3 clinical trials in adults and a phase 1 clinical trial in children. A combined human metapneumovirus and parainfluenza-3 mRNA vaccines was found to be well tolerated and immunogenic in a phase 1 trial among adults and trials are being conducted among children. Clinical trials of mRNA vaccines combining antigens from multiple respiratory viruses are underway. SUMMARY The development of mRNA vaccines against respiratory viruses has progressed rapidly in recent years. Promising vaccine candidates are moving through the clinical development pathway to test their efficacy in preventing disease against respiratory viral pathogens.
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Affiliation(s)
| | - Hana M El Sahly
- Department of Molecular Virology and Microbiology
- Department of Medicine
| | - C Mary Healy
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
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Ko JY, Pham H, Anglin O, Chai SJ, Alden NB, Meek J, Anderson EJ, Weigel A, Kohrman A, Lynfield R, Rudin D, Barney G, Bennett NM, Billing LM, Sutton M, Talbot HK, Swain A, Havers FP, Taylor CA. Vaccination Status and Trends in Adult Coronavirus Disease 2019-Associated Hospitalizations by Race and Ethnicity: March 2020-August 2022. Clin Infect Dis 2023; 77:827-838. [PMID: 37132204 PMCID: PMC11019819 DOI: 10.1093/cid/ciad266] [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: 12/14/2022] [Revised: 04/14/2023] [Accepted: 04/28/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND We sought to determine whether race/ethnicity disparities in severe coronavirus disease 2019 (COVID-19) outcomes persist in the era of vaccination. METHODS Population-based age-adjusted monthly rate ratios (RRs) of laboratory-confirmed COVID-19-associated hospitalizations were calculated among adult patients from the COVID-19-Associated Hospitalization Surveillance Network, March 2020 - August 2022 by race/ethnicity. Among randomly sampled patients July 2021 - August 2022, RRs for hospitalization, intensive care unit (ICU) admission, and in-hospital mortality were calculated for Hispanic, Black, American Indian/Alaskan Native (AI/AN), and Asian/Pacific Islander (API) persons vs White persons. RESULTS Based on data from 353 807 patients, hospitalization rates were higher among Hispanic, Black, and AI/AN vs White persons March 2020 - August 2022, yet the magnitude declined over time (for Hispanic persons, RR = 6.7; 95% confidence interval [CI], 6.5-7.1 in June 2020 vs RR < 2.0 after July 2021; for AI/AN persons, RR = 8.4; 95% CI, 8.2-8.7 in May 2020 vs RR < 2.0 after March 2022; and for Black persons RR = 5.3; 95% CI, 4.6-4.9 in July 2020 vs RR < 2.0 after February 2022; all P ≤ .001). Among 8706 sampled patients July 2021 - August 2022, hospitalization and ICU admission RRs were higher for Hispanic, Black, and AI/AN patients (range for both, 1.4-2.4) and lower for API (range for both, 0.6-0.9) vs White patients. All other race and ethnicity groups had higher in-hospital mortality rates vs White persons (RR range, 1.4-2.9). CONCLUSIONS Race/ethnicity disparities in COVID-19-associated hospitalizations declined but persist in the era of vaccination. Developing strategies to ensure equitable access to vaccination and treatment remains important.
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Affiliation(s)
- Jean Y Ko
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
- US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Huong Pham
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
| | - Onika Anglin
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
| | - Shua J Chai
- California Emerging Infections Program, Oakland, California, USA
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nisha B Alden
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Evan J Anderson
- Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Department of Public Health, Georgia Emerging Infections Program, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Andy Weigel
- Iowa Department of Public Health, Des Moines, Iowa, USA
| | - Alexander Kohrman
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Ruth Lynfield
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | - Dominic Rudin
- New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA
| | - Grant Barney
- New York State Department of Health, Albany, New York, USA
| | - Nancy M Bennett
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ashley Swain
- Salt Lake County Health Department, Salt Lake City, Utah, USA
| | - Fiona P Havers
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
- US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Christopher A Taylor
- Centers for Disease Control and Prevention COVID-19 Response, Atlanta, Georgia, USA
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Farnsworth CW, O’Neil CA, Dalton C, McDonald D, Vogt L, Hock K, Arter O, Wallace MA, Muenks C, Amor M, Alvarado K, Peacock K, Jolani K, Fraser VJ, Burnham CAD, Babcock HM, Budge PJ, Kwon JH. Association between SARS-CoV-2 Symptoms, Ct Values, and Serological Response in Vaccinated and Unvaccinated Healthcare Personnel. J Appl Lab Med 2023; 8:871-886. [PMID: 37478837 PMCID: PMC10482509 DOI: 10.1093/jalm/jfad042] [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: 01/12/2023] [Accepted: 05/15/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND SARS-CoV-2 vaccines are effective at reducing symptomatic and asymptomatic COVID-19. Limited studies have compared symptoms, threshold cycle (Ct) values from reverse transcription (RT)-PCR testing, and serological testing results between previously vaccinated vs unvaccinated populations with SARS-CoV-2 infection. METHODS Healthcare personnel (HCP) with a positive SARS-CoV-2 RT-PCR test within the previous 14 to 28 days completed surveys including questions about demographics, medical conditions, social factors, and symptoms of COVID-19. Ct values were observed, and serological testing was performed for anti-nucleocapsid (anti-N) and anti-Spike (anti-S) antibodies at enrollment and 40 to 90 days later. Serological results were compared to HCP with no known SARS-CoV-2 infection and negative anti-N testing. RESULTS There were 104 unvaccinated/not fully vaccinated and 77 vaccinated HCP with 2 doses of an mRNA vaccine at time of infection. No differences in type or duration of symptoms were reported (P = 0.45). The median (interquartile range [IQR]) Ct was 21.4 (17.6-24.6) and 21.5 (18.1-24.6) for the unvaccinated and vaccinated HCP, respectively. Higher anti-N IgG was observed in unvaccinated HCP (5.08 S/CO, 3.08-6.92) than vaccinated (3.61 signal to cutoff ratio [S/CO], 2.16-5.05). Anti-S IgG was highest among vaccinated HCP with infection (34 285 aribitrary units [AU]/mL, 17 672-61 775), followed by vaccinated HCP with no prior infection (1452 AU/mL, 791-2943), then unvaccinated HCP with infection (829 AU/mL, 290-1555). Anti-S IgG decreased 1.56% (0.9%-1.79%) per day in unvaccinated and 0.38% (0.03%-0.94%) in vaccinated HCP. CONCLUSIONS Vaccinated HCP infected with SARS-CoV-2 reported comparable symptoms and had similar Ct values relative to unvaccinated. However, vaccinated HCP had increased and prolonged anti-S and decreased anti-N response relative to unvaccinated.
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Affiliation(s)
- Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Caroline A O’Neil
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Claire Dalton
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - David McDonald
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Lucy Vogt
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Karl Hock
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Olivia Arter
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Meghan A Wallace
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Carol Muenks
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Mostafa Amor
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Kelly Alvarado
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Kate Peacock
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Kevin Jolani
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Victoria J Fraser
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Carey-Ann D Burnham
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Hilary M Babcock
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Phillip J Budge
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
| | - Jennie H Kwon
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States
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McCormick N, Jackson BN, Durham SH, Hohmann NS, Westrick SC. Qualitative analysis of community pharmacy-based COVID-19 immunization service operations. J Am Pharm Assoc (2003) 2023; 63:1574-1582.e6. [PMID: 37394061 DOI: 10.1016/j.japh.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The unprecedented coronavirus disease 2019 (COVID-19) pandemic has generated worldwide impacts while positioning community pharmacies as easily accessible immunizers to rollout the COVID-19 vaccine. OBJECTIVES This study describes community pharmacists' experiences, success stories, and lessons learned from providing COVID-19 immunization services. METHODS This study was conducted in February to March 2022 using semistructured interviews with licensed pharmacists practicing full-time in Alabama community pharmacies. Transcribed interviews' content analysis was conducted by 2 independent coders in ATLAS.ti software. RESULTS Nineteen interviews were completed. Pharmacists' experiences in the implementation of COVID-19 immunization services are described across 4 themes: (1) on-site and off-site immunization locations, (2) roles and responsibilities of pharmacy personnel, (3) vaccine storage and administration, and (4) vaccine waste reduction and immunization uptake strategies. This study found that pharmacists' ability to adapt is vital to maintaining their ability to offer immunization services and other services. Pharmacists' capacity for adapting is exemplified through their ability to acclimate to becoming a primary hub of outpatient health care services, accommodating to COVID-19 social distancing and vaccine guidelines, and disseminating a novel vaccine with varying supply and demand. In addition, pharmacies gathered and maintained waitlists of patients and adopted an appointment-based model as to predict, plan, and provide for patients. Pharmacists also used reactive techniques and workflow aspects to dissuade COVID-19 vaccine waste such as in contacting interested patients on waitlists or switching to a walk-in acceptance model. The COVID-19 pandemic elicited unprecedented alterations to the legal, health care responsibilities granted to pharmacy staff with participants describing pharmacy technicians as making a considerable impact to pharmacies' workflow. CONCLUSIONS Pharmacists stepped up as frontline providers during a time of public health emergency with their diverse experiences granting policy makers and researchers much to learn from as, in their communities, pharmacists have continued to increase access to care during a national health crisis.
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van Diepen S, McAlister FA, Chu LM, Youngson E, Kaul P, Kadri SS. Association Between Vaccination Status and Outcomes in Patients Admitted to the ICU With COVID-19. Crit Care Med 2023; 51:1201-1209. [PMID: 37192450 DOI: 10.1097/ccm.0000000000005928] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
OBJECTIVES Although COVID-19 vaccines can reduce the need for intensive care unit admission in COVID-19, their effect on outcomes in critical illness remains unclear. We evaluated outcomes in vaccinated patients admitted to the ICU with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and the association between vaccination and booster status on clinical outcomes. DESIGN Retrospective cohort. SETTING AND PATIENTS All patients were admitted to an ICU between January 2021 (after vaccination was available) and July 2022 with a diagnosis of COVID-19 based on a SARS-CoV-2 polymerase chain reaction test in Alberta, Canada. INTERVENTIONS None. MEASUREMENT The propensity-matched primary outcome of all-cause in-hospital mortality was compared between vaccinated and unvaccinated patients, and vaccinated patients were stratified by booster dosing. Secondary outcomes were mechanical ventilation (MV) duration ICU length of stay (LOS). MAIN RESULTS The study included 3,293 patients: 743 (22.6%) were fully vaccinated (54.6% with booster), 166 (5.0%) were partially vaccinated, and 2,384 (72.4%) were unvaccinated. Unvaccinated patients were more likely to require invasive MV (78.4% vs 68.2%), vasopressor use (71.1% vs 66.6%), and extracorporeal membrane oxygenation (2.1% vs 0.5%). In a propensity-matched analysis, in-hospital mortality was similar (31.8% vs 34.0%, adjusted odds ratio [OR], 1.25; 95% CI, 0.97-1.61), but median duration MV (7.6 vs 4.7 d; p < 0.001) and ICU LOS (6.6 vs 5.2 d; p < 0.001) were longer in unvaccinated compared to fully vaccinated patients. Among vaccinated patients, greater than or equal to 1 booster had lower in-hospital mortality (25.5% vs 40.9%; adjusted OR, 0.50; 95% CI, 0.0.36-0.68) and duration of MV (3.8 vs 5.6 d; p = 0.025). CONCLUSIONS Nearly one in four patients admitted to the ICU with COVID-19 after widespread COVID-19 vaccine availability represented a vaccine-breakthrough case. Mortality risk remains substantial in vaccinated patients and similar between vaccinated and unvaccinated patients after the onset of critical illness. However, COVID-19 vaccination is associated with reduced ICU resource utilization and booster dosing may increase survivability from COVID-19-related critical illness.
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Affiliation(s)
- Sean van Diepen
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
- The Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Finlay A McAlister
- The Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
- The Alberta Strategy for Patient Oriented Research Support Unit, AB, Canada
- Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Luan Manh Chu
- The Alberta Strategy for Patient Oriented Research Support Unit, AB, Canada
- Provincial Research Data Services, Alberta Health Services, Edmonton, AB, Canada
| | - Erik Youngson
- The Alberta Strategy for Patient Oriented Research Support Unit, AB, Canada
- Provincial Research Data Services, Alberta Health Services, Edmonton, AB, Canada
| | - Padma Kaul
- The Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada
- The Alberta Strategy for Patient Oriented Research Support Unit, AB, Canada
| | - Sameer S Kadri
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD
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Prins MLM, Prins C, de Vries JJC, Visser LG, Roukens AHE. Establishing immunogenicity and safety of needle-free intradermal delivery by nanoporous ceramic skin patch of mRNA SARS-CoV-2 vaccine as a revaccination strategy in healthy volunteers. Virus Res 2023; 334:199175. [PMID: 37473964 PMCID: PMC10392605 DOI: 10.1016/j.virusres.2023.199175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Nanoporous microneedle arrays (npMNA) are being developed as skin patches for vaccine delivery. As alternative for needle-based immunisation, they may potentially result in higher vaccine acceptance, which is important for future mass vaccination campaigns to control outbreaks, such as COVID-19, and for public vaccination in general. In this study we investigated the safety and immunogenicity of needle-free intradermal delivery of a fractional third or fourth dose of mRNA-1273 vaccine by npMNA. METHODS This study was an open-label, randomised-controlled, proof-of-concept study. Healthy adults were eligible if they had received a primary immunisation series against SARS-CoV-2 with two doses of mRNA-1273 (Moderna) or BNT162b2 (Pfizer-BioNTech) mRNA vaccine. A history of a COVID-19 infection or booster vaccination with mRNA-1273 or BNT162b2 was allowed if it occurred at least three months before inclusion. Participants were randomised in a 1:1 ratio to receive 20 µg mRNA-1273 vaccine, either through npMNA patch applied on the skin (ID-patch group), or through intramuscular (IM) injection (IM-control group). Primary outcomes were reactogenicity up to two weeks after vaccination, and fold-increase of SARS-CoV-2 spike S1-specific IgG antibodies 14 days post-vaccination. RESULTS In April 2022, 20 participants were enroled. The geometric mean concentration (GMC) did not increase in the ID-patch group after vaccination, in contrast to the IM-control group (GMC was 1,006 BAU/mL (95% CI 599-1,689), 3,855 (2,800-5,306), and 3,513 (2,554-4,833) at day 1, 15 and 29, respectively). In addition, SARS-CoV-2-specific T cell responses were lower after ID vaccination through npMNA. CONCLUSION Needle-free delivery of 20 µg mRNA-1273 vaccine by npMNA failed to induce antibody and T cell responses. As this is a potentially very useful vaccination method, it is important to determine which adjustments are needed to make this npMNA successful. CLINICAL TRIAL REGISTRY (ON CLINICALTRIAL.GOV): NCT05315362.
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Affiliation(s)
- Manon L M Prins
- Department of Infectious Diseases, Leiden University Medical Centre, C5-P Albinusdreef 2, Leiden, ZA 2333, the Netherlands.
| | - Corine Prins
- Department of Infectious Diseases, Leiden University Medical Centre, C5-P Albinusdreef 2, Leiden, ZA 2333, the Netherlands
| | - Jutte J C de Vries
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Centre, C5-P Albinusdreef 2, Leiden, ZA 2333, the Netherlands
| | - Anna H E Roukens
- Department of Infectious Diseases, Leiden University Medical Centre, C5-P Albinusdreef 2, Leiden, ZA 2333, the Netherlands
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Embi PJ, Levy ME, Patel P, DeSilva MB, Gaglani M, Dascomb K, Dunne MM, Klein NP, Ong TC, Grannis SJ, Natarajan K, Yang DH, Stenehjem E, Zerbo O, McEvoy C, Rao S, Thompson MG, Konatham D, Irving SA, Dixon BE, Han J, Schrader KE, Grisel N, Lewis N, Kharbanda AB, Barron MA, Reynolds S, Liao IC, Fadel WF, Rowley EA, Arndorfer J, Goddard K, Murthy K, Valvi NR, Weber ZA, Fireman B, Reese SE, Ball SW, Naleway AL. Effectiveness of COVID-19 vaccines at preventing emergency department or urgent care encounters and hospitalizations among immunocompromised adults: An observational study of real-world data across 10 US states from August-December 2021. Vaccine 2023; 41:5424-5434. [PMID: 37479609 PMCID: PMC10201325 DOI: 10.1016/j.vaccine.2023.05.038] [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: 01/13/2023] [Revised: 05/06/2023] [Accepted: 05/16/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Immunocompromised (IC) persons are at increased risk for severe COVID-19 outcomes and are less protected by 1-2 COVID-19 vaccine doses than are immunocompetent (non-IC) persons. We compared vaccine effectiveness (VE) against medically attended COVID-19 of 2-3 mRNA and 1-2 viral-vector vaccine doses between IC and non-IC adults. METHODS Using a test-negative design among eight VISION Network sites, VE against laboratory-confirmed COVID-19-associated emergency department (ED) or urgent care (UC) events and hospitalizations from 26 August-25 December 2021 was estimated separately among IC and non-IC adults and among specific IC condition subgroups. Vaccination status was defined using number and timing of doses. VE for each status (versus unvaccinated) was adjusted for age, geography, time, prior positive test result, and local SARS-CoV-2 circulation. RESULTS We analyzed 8,848 ED/UC events and 18,843 hospitalizations among IC patients and 200,071 ED/UC events and 70,882 hospitalizations among non-IC patients. Among IC patients, 3-dose mRNA VE against ED/UC (73% [95% CI: 64-80]) and hospitalization (81% [95% CI: 76-86]) was lower than that among non-IC patients (ED/UC: 94% [95% CI: 93-94]; hospitalization: 96% [95% CI: 95-97]). Similar patterns were observed for viral-vector vaccines. Transplant recipients had lower VE than other IC subgroups. CONCLUSIONS During B.1.617.2 (Delta) variant predominance, IC adults received moderate protection against COVID-19-associated medical events from three mRNA doses, or one viral-vector dose plus a second dose of any product. However, protection was lower in IC versus non-IC patients, especially among transplant recipients, underscoring the need for additional protection among IC adults.
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Affiliation(s)
- Peter J Embi
- Vanderbilt University Medical Center, Nashville, TN, USA; Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA.
| | | | - Palak Patel
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | | | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M College of Medicine, Temple, TX, USA; Texas A&M University College of Medicine, Temple, Texas, USA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA
| | | | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | | | - Suchitra Rao
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Deepika Konatham
- Baylor Scott & White Health, Texas A&M College of Medicine, Temple, TX, USA
| | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Jungmi Han
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | | | - Michelle A Barron
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sue Reynolds
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - I-Chia Liao
- Baylor Scott & White Health, Texas A&M College of Medicine, Temple, TX, USA
| | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | | | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Kempapura Murthy
- Baylor Scott & White Health, Texas A&M College of Medicine, Temple, TX, USA
| | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | | | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | | | | | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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Zizza A, Sedile R, Bagordo F, Panico A, Guido M, Grassi T, Banchelli F, Grima P. Factors Associated with Pneumonia in Patients Hospitalized with COVID-19 and the Role of Vaccination. Vaccines (Basel) 2023; 11:1342. [PMID: 37631910 PMCID: PMC10458032 DOI: 10.3390/vaccines11081342] [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] [Received: 06/28/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023] Open
Abstract
Patients with COVID-19 can develop different forms of the illness with more or less severe symptoms. A 2-year retrospective cohort study was conducted to evaluate the factors associated with the development of pneumonia in patients hospitalized with COVID-19 from March 2020 to February 2022. A total of 385 patients (59.0% males) with a mean age of 69.0 ± 16.0 years were included. At hospital admission, 318 patients (82.6%) reported one or more comorbidities, namely 201 (52.2%) subjects were affected by hypertension, 98 (25.5%) type 2 diabetes, 84 (21.8%) obesity, 36 (9.4%) cancer, and 14 (3.6%) suffered from kidney disease and were being treated with dialysis, and 76 (19.7%) resulted in being vaccinated with a higher prevalence of BNT162b2 vaccine (15.0%). Pneumonia was diagnosed in 276 (71.7%) patients. Multivariate regression analysis showed that pneumonia in COVID-19 patients was positively associated with type 2 diabetes (OR 1.81; 95% CI 1.00-3.27), obesity (OR 2.52; 95% CI 1.27-4.98), and negatively with hypertension (OR 0.58; 95% CI 0.35-0.96). Vaccination against SARS-CoV-2 resulted in a strongly protective factor against the development of pneumonia in COVID-19 patients (OR 0.49; 95% CI 0.28-0.85).
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Affiliation(s)
- Antonella Zizza
- Institute of Clinical Physiology, National Research Council, 73100 Lecce, Italy;
| | - Raffaella Sedile
- Institute of Clinical Physiology, National Research Council, 73100 Lecce, Italy;
| | - Francesco Bagordo
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Alessandra Panico
- Department of Biological and Environmental Science and Technology, University of Salento, 73100 Lecce, Italy; (A.P.); (M.G.); (T.G.)
| | - Marcello Guido
- Department of Biological and Environmental Science and Technology, University of Salento, 73100 Lecce, Italy; (A.P.); (M.G.); (T.G.)
| | - Tiziana Grassi
- Department of Biological and Environmental Science and Technology, University of Salento, 73100 Lecce, Italy; (A.P.); (M.G.); (T.G.)
| | - Federico Banchelli
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41121 Modena, Italy;
- Unit of Statistical and Methodological Support to Clinical Research, University Hospital of Modena, 41121 Modena, Italy
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