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Del Riccio M, Caini S, Bonaccorsi G, Lorini C, Paget J, van der Velden K, Meijer A, Haag M, McGovern I, Zanobini P. Global analysis of respiratory viral circulation and timing of epidemics in the pre-COVID-19 and COVID-19 pandemic eras, based on data from the Global Influenza Surveillance and Response System (GISRS). Int J Infect Dis 2024; 144:107052. [PMID: 38636684 DOI: 10.1016/j.ijid.2024.107052] [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: 01/17/2024] [Revised: 03/30/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024] Open
Abstract
OBJECTIVES The COVID-19 pandemic significantly changed respiratory viruses' epidemiology due to non-pharmaceutical interventions and possible viral interactions. This study investigates whether the circulation patterns of respiratory viruses have returned to pre-pandemic norms by comparing their peak timing and duration during the first three SARS-CoV-2 seasons to pre-pandemic times. METHODS Global Influenza Surveillance and Response System data from 194 countries (2014-2023) was analyzed for epidemic peak timing and duration, focusing on pre-pandemic and pandemic periods across both hemispheres and the intertropical belt. The analysis was restricted to countries meeting specific data thresholds to ensure robustness. RESULTS In 2022/2023, the northern hemisphere experienced earlier influenza and respiratory syncytial virus (RSV) peaks by 1.9 months (P <0.001). The duration of influenza epidemics increased by 2.2 weeks (P <0.001), with RSV showing a similar trend. The southern hemisphere's influenza peak shift was not significant (P = 0.437). Intertropical regions presented no substantial change in peak timing but experienced a significant reduction in the duration for human metapneumovirus and adenovirus (7.2 and 6.5 weeks shorter, respectively, P <0.001). CONCLUSIONS The pandemic altered the typical patterns of influenza and RSV, with earlier peaks in 2022 in temperate areas. These findings highlight the importance of robust surveillance data to inform public health strategies on evolving viral dynamics in the years to come.
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Affiliation(s)
- Marco Del Riccio
- Department of Health Sciences, University of Florence, Florence, Italy; Department of Primary and Community Care, Radboud University Medical Centre, HB Nijmegen, The Netherlands
| | - Saverio Caini
- Netherlands Institute for Health Services Research, CR Utrecht, The Netherlands.
| | | | - Chiara Lorini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - John Paget
- Netherlands Institute for Health Services Research, CR Utrecht, The Netherlands
| | - Koos van der Velden
- Department of Primary and Community Care, Radboud University Medical Centre, HB Nijmegen, The Netherlands
| | - Adam Meijer
- National Institute for Public Health and the Environment, BA Bilthoven, The Netherlands
| | | | - Ian McGovern
- Center for Outcomes Research and Epidemiology, Seqirus Inc, Cambridge, USA
| | - Patrizio Zanobini
- Department of Health Sciences, University of Florence, Florence, Italy
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2
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Ayoub HH, Tomy M, Chemaitelly H, Altarawneh HN, Coyle P, Tang P, Hasan MR, Al Kanaani Z, Al Kuwari E, Butt AA, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Nasrallah GK, Benslimane FM, Al Khatib HA, Yassine HM, Al Kuwari MG, Al Romaihi HE, Abdul-Rahim HF, Al-Thani MH, Al Khal A, Bertollini R, Abu-Raddad LJ. Estimating protection afforded by prior infection in preventing reinfection: applying the test-negative study design. Am J Epidemiol 2024; 193:883-897. [PMID: 38061757 PMCID: PMC11145912 DOI: 10.1093/aje/kwad239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 06/04/2024] Open
Abstract
The COVID-19 pandemic has highlighted the need to use infection testing databases to rapidly estimate effectiveness of prior infection in preventing reinfection ($P{E}_S$) by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. Mathematical modeling was used to demonstrate a theoretical foundation for applicability of the test-negative, case-control study design to derive $P{E}_S$. Apart from the very early phase of an epidemic, the difference between the test-negative estimate for $P{E}_S$ and true value of $P{E}_S$ was minimal and became negligible as the epidemic progressed. The test-negative design provided robust estimation of $P{E}_S$ and its waning. Assuming that only 25% of prior infections are documented, misclassification of prior infection status underestimated $P{E}_S$, but the underestimate was considerable only when > 50% of the population was ever infected. Misclassification of latent infection, misclassification of current active infection, and scale-up of vaccination all resulted in negligible bias in estimated $P{E}_S$. The test-negative design was applied to national-level testing data in Qatar to estimate $P{E}_S$ for SARS-CoV-2. $P{E}_S$ against SARS-CoV-2 Alpha and Beta variants was estimated at 97.0% (95% CI, 93.6-98.6) and 85.5% (95% CI, 82.4-88.1), respectively. These estimates were validated using a cohort study design. The test-negative design offers a feasible, robust method to estimate protection from prior infection in preventing reinfection.
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Affiliation(s)
- Houssein H Ayoub
- Mathematics Program, Department of Mathematics and Statistics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Milan Tomy
- Mathematics Program, Department of Mathematics and Statistics, College of Arts and Sciences, Qatar University, Doha, Qatar
- Infectious Disease Epidemiology Group, Weill Cornell Medicine–Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation–Education City, Doha, Qatar
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine–Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation–Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY 10065, United States
| | - Heba N Altarawneh
- Infectious Disease Epidemiology Group, Weill Cornell Medicine–Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation–Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY 10065, United States
| | - Peter Coyle
- Hamad Medical Corporation, Doha, Qatar
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast BT9 7BL, United Kingdom
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha, Qatar
| | | | | | | | - Adeel A Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY 10065, United States
- Hamad Medical Corporation, Doha, Qatar
| | | | | | | | | | - Gheyath K Nasrallah
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Fatiha M Benslimane
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Hebah A Al Khatib
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | | | | | - Hanan F Abdul-Rahim
- Department of Public Health, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | | | | | | | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine–Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation–Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY 10065, United States
- Department of Public Health, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
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3
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Sukik L, Chemaitelly H, Ayoub HH, Coyle P, Tang P, Yassine HM, Al Thani AA, Hasan MR, Al-Kanaani Z, Al-Kuwari E, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Abdul-Rahim HF, Nasrallah GK, Al-Kuwari MG, Butt AA, Al-Romaihi HE, Al-Thani MH, Al-Khal A, Bertollini R, Abdel-Rahman ME, Abu-Raddad LJ. Effectiveness of two and three doses of COVID-19 mRNA vaccines against infection, symptoms, and severity in the pre-omicron era: A time-dependent gradient. Vaccine 2024; 42:3307-3320. [PMID: 38616439 DOI: 10.1016/j.vaccine.2024.04.026] [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: 02/29/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Vaccines were developed and deployed to combat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aimed to characterize patterns in the protection provided by the BNT162b2 and mRNA-1273 mRNA vaccines against a spectrum of SARS-CoV-2 infection symptoms and severities. METHODS A national, matched, test-negative, case-control study was conducted in Qatar between January 1 and December 18, 2021, utilizing a sample of 238,896 PCR-positive tests and 6,533,739 PCR-negative tests. Vaccine effectiveness was estimated against asymptomatic, symptomatic, severe coronavirus disease 2019 (COVID-19), critical COVID-19, and fatal COVID-19 infections. Data sources included Qatar's national databases for COVID-19 laboratory testing, vaccination, hospitalization, and death. RESULTS Effectiveness of two-dose BNT162b2 vaccination was 75.6% (95% CI: 73.6-77.5) against asymptomatic infection and 76.5% (95% CI: 75.1-77.9) against symptomatic infection. Effectiveness against each of severe, critical, and fatal COVID-19 infections surpassed 90%. Immediately after the second dose, all categories-namely, asymptomatic, symptomatic, severe, critical, and fatal COVID-19-exhibited similarly high effectiveness. However, from 181 to 270 days post-second dose, effectiveness against asymptomatic and symptomatic infections declined to below 40%, while effectiveness against each of severe, critical, and fatal COVID-19 infections remained consistently high. However, estimates against fatal COVID-19 often had wide 95% confidence intervals. Analogous patterns were observed in three-dose BNT162b2 vaccination and two- and three-dose mRNA-1273 vaccination. Sensitivity analyses confirmed the results. CONCLUSION A gradient in vaccine effectiveness exists and is linked to the symptoms and severity of infection, providing higher protection against more symptomatic and severe cases. This gradient intensifies over time as vaccine immunity wanes after the last vaccine dose. These patterns appear consistent irrespective of the vaccine type or whether the vaccination involves the primary series or a booster.
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Affiliation(s)
- Layan Sukik
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Houssein H Ayoub
- Mathematics Program, Department of Mathematics and Statistics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Peter Coyle
- Hamad Medical Corporation, Doha, Qatar; Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar; Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, United Kingdom
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Asmaa A Al Thani
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Mohammad R Hasan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | | | | | | | | | | | | | - Hanan F Abdul-Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Gheyath K Nasrallah
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | | | - Adeel A Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA; Hamad Medical Corporation, Doha, Qatar; Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | | | | | | | | | - Manar E Abdel-Rahman
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar; World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar; Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar; Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA; College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar.
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4
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Chemaitelly H, Ayoub HH, Tang P, Coyle PV, Yassine HM, Al Thani AA, Al-Khatib HA, Hasan MR, Al-Kanaani Z, Al-Kuwari E, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Abdul-Rahim HF, Nasrallah GK, Al-Kuwari MG, Butt AA, Al-Romaihi HE, Al-Thani MH, Al-Khal A, Bertollini R, Abu-Raddad LJ. History of primary-series and booster vaccination and protection against Omicron reinfection. SCIENCE ADVANCES 2023; 9:eadh0761. [PMID: 37792951 PMCID: PMC10550237 DOI: 10.1126/sciadv.adh0761] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 07/26/2023] [Indexed: 10/06/2023]
Abstract
Laboratory evidence suggests a possibility of immune imprinting for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We investigated the differences in the incidence of SARS-CoV-2 reinfection in a cohort of persons who had a primary Omicron infection, but different vaccination histories using matched, national, retrospective, cohort studies. Adjusted hazard ratio for reinfection incidence, factoring adjustment for differences in testing rate, was 0.43 [95% confidence interval (CI): 0.39 to 0.49] comparing history of two-dose vaccination to no vaccination, 1.47 (95% CI: 1.23 to 1.76) comparing history of three-dose vaccination to two-dose vaccination, and 0.57 (95% CI: 0.48 to 0.68) comparing history of three-dose vaccination to no vaccination. Divergence in cumulative incidence curves increased markedly when the incidence was dominated by BA.4/BA.5 and BA.2.75* Omicron subvariants. The history of primary-series vaccination enhanced immune protection against Omicron reinfection, but history of booster vaccination compromised protection against Omicron reinfection. These findings do not undermine the public health utility of booster vaccination.
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Affiliation(s)
- Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Houssein H. Ayoub
- Mathematics Program, Department of Mathematics, Statistics, and Physics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha, Qatar
| | - Peter V. Coyle
- Hamad Medical Corporation, Doha, Qatar
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, UK
| | - Hadi M. Yassine
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Asmaa A. Al Thani
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Hebah A. Al-Khatib
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | | | | | | | | | | | | | | | - Hanan F. Abdul-Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Gheyath K. Nasrallah
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | | | - Adeel A. Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
- Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | | | | | | | | | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
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5
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Qassim SH, Chemaitelly H, Ayoub HH, Coyle P, Tang P, Yassine HM, Al Thani AA, Al-Khatib HA, Hasan MR, Al-Kanaani Z, Al-Kuwari E, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Abdul-Rahim HF, Nasrallah GK, Al-Kuwari MG, Butt AA, Al-Romaihi HE, Al-Thani MH, Al-Khal A, Bertollini R, Abu-Raddad LJ. Population immunity of natural infection, primary-series vaccination, and booster vaccination in Qatar during the COVID-19 pandemic: an observational study. EClinicalMedicine 2023; 62:102102. [PMID: 37533414 PMCID: PMC10393554 DOI: 10.1016/j.eclinm.2023.102102] [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: 04/28/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Background Waning of natural infection protection and vaccine protection highlight the need to evaluate changes in population immunity over time. Population immunity of previous SARS-CoV-2 infection or of COVID-19 vaccination are defined, respectively, as the overall protection against reinfection or against breakthrough infection at a given point in time in a given population. Methods We estimated these population immunities in Qatar's population between July 1, 2020 and November 30, 2022, to discern generic features of the epidemiology of SARS-CoV-2. Effectiveness of previous infection, mRNA primary-series vaccination, and mRNA booster (third-dose) vaccination in preventing infection were estimated, month by month, using matched, test-negative, case-control studies. Findings Previous-infection effectiveness against reinfection was strong before emergence of Omicron, but declined with time after a wave and rebounded after a new wave. Effectiveness dropped after Omicron emergence from 88.3% (95% CI: 84.8-91.0%) in November 2021 to 51.0% (95% CI: 48.3-53.6%) in December 2021. Primary-series effectiveness against infection was 84.0% (95% CI: 83.0-85.0%) in April 2021, soon after introduction of vaccination, before waning gradually to 52.7% (95% CI: 46.5-58.2%) by November 2021. Effectiveness declined linearly by ∼1 percentage point every 5 days. After Omicron emergence, effectiveness dropped from 52.7% (95% CI: 46.5-58.2%) in November 2021 to negligible levels in December 2021. Booster effectiveness dropped after Omicron emergence from 83.0% (95% CI: 65.6-91.6%) in November 2021 to 32.9% (95% CI: 26.7-38.5%) in December 2021, and continued to decline thereafter. Effectiveness of previous infection and vaccination against severe, critical, or fatal COVID-19 were generally >80% throughout the study duration. Interpretation High population immunity against infection may not be sustained beyond a year, but population immunity against severe COVID-19 is durable with slow waning even after Omicron emergence. Funding The Biomedical Research Program and the Biostatistics, Epidemiology, and the Biomathematics Research Core, both at Weill Cornell Medicine-Qatar, Ministry of Public Health, Hamad Medical Corporation, Sidra Medicine, Qatar Genome Programme, Qatar University Biomedical Research Center, and Qatar University Internal Grant ID QUCG-CAS-23/24-114.
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Affiliation(s)
- Suelen H. Qassim
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Houssein H. Ayoub
- Mathematics Program, Department of Mathematics, Statistics, and Physics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Peter Coyle
- Hamad Medical Corporation, Doha, Qatar
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, United Kingdom
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha, Qatar
| | - Hadi M. Yassine
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Asmaa A. Al Thani
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Hebah A. Al-Khatib
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | | | | | | | | | | | | | | | - Hanan F. Abdul-Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Gheyath K. Nasrallah
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | | | - Adeel A. Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
- Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | | | | | | | | | - Laith J. Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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6
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Bobrovitz N, Ware H, Ma X, Li Z, Hosseini R, Cao C, Selemon A, Whelan M, Premji Z, Issa H, Cheng B, Abu Raddad LJ, Buckeridge DL, Van Kerkhove MD, Piechotta V, Higdon MM, Wilder-Smith A, Bergeri I, Feikin DR, Arora RK, Patel MK, Subissi L. Protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against the omicron variant and severe disease: a systematic review and meta-regression. THE LANCET. INFECTIOUS DISEASES 2023; 23:556-567. [PMID: 36681084 PMCID: PMC10014083 DOI: 10.1016/s1473-3099(22)00801-5] [Citation(s) in RCA: 243] [Impact Index Per Article: 243.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/01/2022] [Accepted: 11/21/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The global surge in the omicron (B.1.1.529) variant has resulted in many individuals with hybrid immunity (immunity developed through a combination of SARS-CoV-2 infection and vaccination). We aimed to systematically review the magnitude and duration of the protective effectiveness of previous SARS-CoV-2 infection and hybrid immunity against infection and severe disease caused by the omicron variant. METHODS For this systematic review and meta-regression, we searched for cohort, cross-sectional, and case-control studies in MEDLINE, Embase, Web of Science, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, the WHO COVID-19 database, and Europe PubMed Central from Jan 1, 2020, to June 1, 2022, using keywords related to SARS-CoV-2, reinfection, protective effectiveness, previous infection, presence of antibodies, and hybrid immunity. The main outcomes were the protective effectiveness against reinfection and against hospital admission or severe disease of hybrid immunity, hybrid immunity relative to previous infection alone, hybrid immunity relative to previous vaccination alone, and hybrid immunity relative to hybrid immunity with fewer vaccine doses. Risk of bias was assessed with the Risk of Bias In Non-Randomized Studies of Interventions Tool. We used log-odds random-effects meta-regression to estimate the magnitude of protection at 1-month intervals. This study was registered with PROSPERO (CRD42022318605). FINDINGS 11 studies reporting the protective effectiveness of previous SARS-CoV-2 infection and 15 studies reporting the protective effectiveness of hybrid immunity were included. For previous infection, there were 97 estimates (27 with a moderate risk of bias and 70 with a serious risk of bias). The effectiveness of previous infection against hospital admission or severe disease was 74·6% (95% CI 63·1-83·5) at 12 months. The effectiveness of previous infection against reinfection waned to 24·7% (95% CI 16·4-35·5) at 12 months. For hybrid immunity, there were 153 estimates (78 with a moderate risk of bias and 75 with a serious risk of bias). The effectiveness of hybrid immunity against hospital admission or severe disease was 97·4% (95% CI 91·4-99·2) at 12 months with primary series vaccination and 95·3% (81·9-98·9) at 6 months with the first booster vaccination after the most recent infection or vaccination. Against reinfection, the effectiveness of hybrid immunity following primary series vaccination waned to 41·8% (95% CI 31·5-52·8) at 12 months, while the effectiveness of hybrid immunity following first booster vaccination waned to 46·5% (36·0-57·3) at 6 months. INTERPRETATION All estimates of protection waned within months against reinfection but remained high and sustained for hospital admission or severe disease. Individuals with hybrid immunity had the highest magnitude and durability of protection, and as a result might be able to extend the period before booster vaccinations are needed compared to individuals who have never been infected. FUNDING WHO COVID-19 Solidarity Response Fund and the Coalition for Epidemic Preparedness Innovations.
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Affiliation(s)
- Niklas Bobrovitz
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada; Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Harriet Ware
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Xiaomeng Ma
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Zihan Li
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Bioengineering, University of California, Berkeley, CA, USA
| | - Reza Hosseini
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Christian Cao
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Anabel Selemon
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mairead Whelan
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, BC, Canada
| | - Hanane Issa
- Institute of Health Informatics, University College London, London, UK
| | - Brianna Cheng
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laith J Abu Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - David L Buckeridge
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University, Montreal, QC, Canada
| | | | - Vanessa Piechotta
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Melissa M Higdon
- International Vaccine Access Center, Department of International Health, John Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Annelies Wilder-Smith
- Department of Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland; Heidelberg Institute of Global Health, University of Heidelberg, Germany
| | - Isabel Bergeri
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Daniel R Feikin
- Department of Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Rahul K Arora
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Minal K Patel
- Department of Immunizations, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Lorenzo Subissi
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
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7
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Chemaitelly H, Nagelkerke N, Ayoub HH, Coyle P, Tang P, Yassine HM, Al-Khatib HA, Smatti MK, Hasan MR, Al-Kanaani Z, Al-Kuwari E, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Abdul-Rahim HF, Nasrallah GK, Al-Kuwari MG, Butt AA, Al-Romaihi HE, Al-Thani MH, Al-Khal A, Bertollini R, Abu-Raddad LJ. Duration of immune protection of SARS-CoV-2 natural infection against reinfection. J Travel Med 2022; 29:6731972. [PMID: 36179099 PMCID: PMC9619565 DOI: 10.1093/jtm/taac109] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The future of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic hinges on virus evolution and duration of immune protection of natural infection against reinfection. We investigated the duration of protection afforded by natural infection, the effect of viral immune evasion on duration of protection and protection against severe reinfection, in Qatar, between 28 February 2020 and 5 June 2022. METHODS Three national, matched, retrospective cohort studies were conducted to compare the incidence of SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) severity among unvaccinated persons with a documented SARS-CoV-2 primary infection, to incidence among those infection-naïve and unvaccinated. Associations were estimated using Cox proportional hazard regression models. RESULTS Effectiveness of pre-Omicron primary infection against pre-Omicron reinfection was 85.5% [95% confidence interval (CI): 84.8-86.2%]. Effectiveness peaked at 90.5% (95% CI: 88.4-92.3%) in the 7th month after the primary infection, but waned to ~ 70% by the 16th month. Extrapolating this waning trend using a Gompertz curve suggested an effectiveness of 50% in the 22nd month and < 10% by the 32nd month. Effectiveness of pre-Omicron primary infection against Omicron reinfection was 38.1% (95% CI: 36.3-39.8%) and declined with time since primary infection. A Gompertz curve suggested an effectiveness of < 10% by the 15th month. Effectiveness of primary infection against severe, critical or fatal COVID-19 reinfection was 97.3% (95% CI: 94.9-98.6%), irrespective of the variant of primary infection or reinfection, and with no evidence for waning. Similar results were found in sub-group analyses for those ≥50 years of age. CONCLUSIONS Protection of natural infection against reinfection wanes and may diminish within a few years. Viral immune evasion accelerates this waning. Protection against severe reinfection remains very strong, with no evidence for waning, irrespective of variant, for over 14 months after primary infection.
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Affiliation(s)
- Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Research Department, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.,World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Nico Nagelkerke
- Infectious Disease Epidemiology Group, Research Department, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
| | - Houssein H Ayoub
- Mathematics Program, Department of Mathematics, Statistics, and Physics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Peter Coyle
- Hamad Medical Corporation, Doha, Qatar.,Biomedical Research Center, QU Health, Qatar University, Doha, Qatar.,Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, UK
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar.,Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Hebah A Al-Khatib
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar.,Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Maria K Smatti
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar.,Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | | | | | | | | | | | | | | | - Hanan F Abdul-Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Gheyath K Nasrallah
- Biomedical Research Center, QU Health, Qatar University, Doha, Qatar.,Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | | | - Adeel A Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA.,Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine, Cornell University,New York, NY, USA
| | | | | | | | | | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Research Department, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.,World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA.,Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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8
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Chung H, Austin PC, Brown KA, Buchan SA, Fell DB, Fong C, Gubbay JB, Nasreen S, Schwartz KL, Sundaram ME, Tadrous M, Wilson K, Wilson SE, Kwong JC. Effectiveness of COVID-19 vaccines over time prior to Omicron emergence in Ontario, Canada: test-negative design study. Open Forum Infect Dis 2022; 9:ofac449. [PMID: 36147595 PMCID: PMC9487707 DOI: 10.1093/ofid/ofac449] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/05/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Background
Waning protection from two doses of COVID-19 vaccines led to third dose availability in multiple countries even prior to emergence of the Omicron variant.
Methods
We used the test-negative study design to estimate vaccine effectiveness (VE) against any SARS-CoV-2 infection, symptomatic infection, and severe outcomes (COVID-19-related hospitalizations or death) by time since second dose of any combination of BNT162b2, mRNA-1273, and ChAdOx1 between 11 January and 21 November 2021 for subgroups based on patient and vaccine characteristics.
Results
We included 261,360 test-positive cases (of any SARS-CoV-2 lineage) and 2,783,699 individuals as test-negative controls. VE of two mRNA vaccine doses decreased from 90% (95%CI, 90-90%) 7-59 days after the second dose to 75% (95%CI, 72-78%) after ≥240 days against infection, from 94% (95%CI, 84-95%) to 87% (95%CI, 85-89%) against symptomatic infection, and remained stable (98% [95%CI, 97-98%] to 98% [95%CI, 96-99%])against severe outcomes. Similar trends were seen with heterologous ChAdOx1 and mRNA vaccine schedules. VE estimates for dosing intervals <35 days were lower than for longer intervals (e.g., VE of two mRNA vaccines against symptomatic infection at 120-179 days was 86% [95%CI, 85-88%] for dosing intervals <35 days, 92% [95%CI, 91-93%] for 35-55 days, and 91% [95%CI, 90-92%] for ≥56 days), but when stratified by age group and subperiod, there were no differences between dosing intervals.
Conclusions
Prior to Omicron emergence, VE of any two-dose primary series, including heterologous schedules and varying dosing intervals, decreased over time against any infection and symptomatic infection but remained high against severe outcomes.
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Affiliation(s)
| | - Peter C Austin
- ICES , Toronto, ON , Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, ON , Canada
| | - Kevin A Brown
- ICES , Toronto, ON , Canada
- Dalla Lana School of Public Health, University of Toronto , Toronto, ON , Canada
- Public Health Ontario , ON , Canada
| | - Sarah A Buchan
- ICES , Toronto, ON , Canada
- Dalla Lana School of Public Health, University of Toronto , Toronto, ON , Canada
- Public Health Ontario , ON , Canada
- Centre for Vaccine Preventable Diseases, University of Toronto , Toronto, ON , Canada
| | - Deshayne B Fell
- ICES , Toronto, ON , Canada
- School of Epidemiology and Public Health, University of Ottawa , ON , Canada
- Children’s Hospital of Eastern Ontario Research Institute , Ottawa, ON , Canada
| | | | | | | | - Kevin L Schwartz
- ICES , Toronto, ON , Canada
- Dalla Lana School of Public Health, University of Toronto , Toronto, ON , Canada
- Public Health Ontario , ON , Canada
| | - Maria E Sundaram
- ICES , Toronto, ON , Canada
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute , Marshfield, WI , USA
| | - Mina Tadrous
- ICES , Toronto, ON , Canada
- Women’s College Hospital , Toronto, ON , Canada
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa and Bruyere Hospital Research Institutes , Ottawa, ON , Canada
| | - Sarah E Wilson
- ICES , Toronto, ON , Canada
- Dalla Lana School of Public Health, University of Toronto , Toronto, ON , Canada
- Public Health Ontario , ON , Canada
- Centre for Vaccine Preventable Diseases, University of Toronto , Toronto, ON , Canada
| | - Jeffrey C Kwong
- ICES , Toronto, ON , Canada
- Dalla Lana School of Public Health, University of Toronto , Toronto, ON , Canada
- Public Health Ontario , ON , Canada
- Centre for Vaccine Preventable Diseases, University of Toronto , Toronto, ON , Canada
- Department of Family and Community Medicine, University of Toronto , Toronto, ON , Canada
- University Health Network , Toronto, ON , Canada
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9
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Hitchings MDT, Ranzani OT, Lind ML, Dorion M, D'Agostini TL, de Paula RC, de Paula OFP, de Moura Villela EF, Scaramuzzini Torres MS, de Oliveira SB, Schulz W, Almiron M, Said R, de Oliveira RD, Vieira da Silva P, de Araújo WN, Gorinchteyn JC, Dean NE, Andrews JR, Cummings DAT, Ko AI, Croda J. Change in covid-19 risk over time following vaccination with CoronaVac: test negative case-control study. BMJ 2022; 377:e070102. [PMID: 35697361 PMCID: PMC9189440 DOI: 10.1136/bmj-2022-070102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To estimate the change in odds of covid-19 over time following primary series completion of the inactivated whole virus vaccine CoronaVac (Sinovac Biotech) in São Paulo State, Brazil. DESIGN Test negative case-control study. SETTING Community testing for covid-19 in São Paulo State, Brazil. PARTICIPANTS Adults aged ≥18 years who were residents of São Paulo state, had received two doses of CoronaVac, did not have a laboratory confirmed SARS-CoV-2 infection before vaccination, and underwent reverse transcription polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 from 17 January to 14 December 2021. Cases were matched to test negative controls by age (in 5 year bands), municipality of residence, healthcare worker status, and epidemiological week of RT-PCR test. MAIN OUTCOME MEASURES RT-PCR confirmed symptomatic covid-19 and associated hospital admissions and deaths. Conditional logistic regression was adjusted for sex, number of covid-19 associated comorbidities, race, and previous acute respiratory illness. RESULTS From 202 741 eligible people, 52 170 cases with symptomatic covid-19 and 69 115 test negative controls with covid-19 symptoms were formed into 43 257 matched sets. Adjusted odds ratios of symptomatic covid-19 increased with time since completion of the vaccination series. The increase in odds was greater in younger people and among healthcare workers, although sensitivity analyses suggested that this was in part due to bias. In addition, the adjusted odds ratios of covid-19 related hospital admission or death significantly increased with time compared with the odds 14-41 days after series completion: from 1.25 (95% confidence interval 1.04 to 1.51) at 70-97 days up to 1.94 (1.41 to 2.67) from 182 days onwards. CONCLUSIONS Significant increases in the risk of moderate and severe covid-19 outcomes occurred three months after primary vaccination with CoronaVac among people aged 65 and older. These findings provide supportive evidence for the implementation of vaccine boosters in these populations who received this inactivated vaccine. Studies of waning should include analyses designed to uncover common biases.
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Affiliation(s)
- Matt D T Hitchings
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Otavio T Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Margaret L Lind
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Murilo Dorion
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | | | | | | | | | | | | | - Wade Schulz
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Maria Almiron
- Pan American Health Organization, Brasília, DF, Brazil
| | - Rodrigo Said
- Pan American Health Organization, Brasília, DF, Brazil
| | | | | | - Wildo Navegantes de Araújo
- Pan American Health Organization, Brasília, DF, Brazil
- Universidade de Brasília, Brasília, DF, Brazil
- National Institute for Science and Technology for Health Technology Assessment, Porto Alegre, RS, Brazil
| | | | - Natalie E Dean
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
- Contributed equally
| | - Derek A T Cummings
- Department of Biology, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
- Contributed equally
| | - Albert I Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil
- Contributed equally
| | - Julio Croda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Universidade Federal de Mato Grosso do Sul - UFMS, Campo Grande, MS, Brazil
- Fiocruz Mato Grosso do Sul, Fundação Oswaldo Cruz, Campo Grande, MS, Brazil
- Contributed equally
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10
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Chemaitelly H, Ayoub HH, AlMukdad S, Coyle P, Tang P, Yassine HM, Al-Khatib HA, Smatti MK, Hasan MR, Al-Kanaani Z, Al-Kuwari E, Jeremijenko A, Kaleeckal AH, Latif AN, Shaik RM, Abdul-Rahim HF, Nasrallah GK, Al-Kuwari MG, Butt AA, Al-Romaihi HE, Al-Thani MH, Al-Khal A, Bertollini R, Abu-Raddad LJ. Duration of mRNA vaccine protection against SARS-CoV-2 Omicron BA.1 and BA.2 subvariants in Qatar. Nat Commun 2022; 13:3082. [PMID: 35654888 PMCID: PMC9163167 DOI: 10.1038/s41467-022-30895-3] [Citation(s) in RCA: 129] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/24/2022] [Indexed: 12/14/2022] Open
Abstract
SARS-CoV-2 Omicron BA.1 and BA.2 subvariants are genetically divergent. We conducted a matched, test-negative, case-control study to estimate duration of protection of the second and third/booster doses of mRNA COVID-19 vaccines against BA.1 and BA.2 infections in Qatar. BNT162b2 effectiveness was highest at 46.6% (95% CI: 33.4-57.2%) against symptomatic BA.1 and at 51.7% (95% CI: 43.2-58.9%) against symptomatic BA.2 infections in the first three months after the second dose, but declined to ~10% or below thereafter. Effectiveness rebounded to 59.9% (95% CI: 51.2-67.0%) and 43.7% (95% CI: 36.5-50.0%), respectively, in the first month after the booster dose, before declining again. Effectiveness against COVID-19 hospitalization and death was 70-80% after the second dose and >90% after the booster dose. mRNA-1273 vaccine protection showed similar patterns. mRNA vaccines provide comparable, moderate, and short-lived protection against symptomatic BA.1 and BA.2 Omicron infections, but strong and durable protection against COVID-19 hospitalization and death.
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Affiliation(s)
- Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Qatar Foundation-Education City, Cornell University, Doha, Qatar.
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA.
| | - Houssein H Ayoub
- Mathematics Program, Department of Mathematics, Statistics, and Physics, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Sawsan AlMukdad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Qatar Foundation-Education City, Cornell University, Doha, Qatar
| | - Peter Coyle
- Hamad Medical Corporation, Doha, Qatar
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Wellcome-Wolfson Institute for Experimental Medicine, Queens University, Belfast, UK
| | - Patrick Tang
- Department of Pathology, Sidra Medicine, Doha, Qatar
| | - Hadi M Yassine
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Hebah A Al-Khatib
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | - Maria K Smatti
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | | | | | | | | | | | | | | | - Hanan F Abdul-Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Gheyath K Nasrallah
- Biomedical Research Center, Member of QU Health, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, Member of QU Health, Qatar University, Doha, Qatar
| | | | - Adeel A Butt
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
- Hamad Medical Corporation, Doha, Qatar
- Department of Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | | | | | | | | | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar.
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine-Qatar, Qatar Foundation-Education City, Cornell University, Doha, Qatar.
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA.
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
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11
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Hu W, Sjoberg PA, Fries AC, DeMarcus LS, Robbins AS. Waning Vaccine Protection against Influenza among Department of Defense Adult Beneficiaries in the United States, 2016–2017 through 2019–2020 Influenza Seasons. Vaccines (Basel) 2022; 10:vaccines10060888. [PMID: 35746496 PMCID: PMC9229659 DOI: 10.3390/vaccines10060888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 02/05/2023] Open
Abstract
The objective of this study was to assess inactivated influenza vaccine effectiveness (VE) by time since vaccination in adults aged ≥ 18 years using a test-negative design. All data were obtained from the US Department of Defense Global Respiratory Pathogen Surveillance Program over four influenza seasons, from 2016–2017 through 2019–2020. Analyses were performed to estimate VE using a generalized linear mixed model with logit link and binomial distribution. The adjusted overall VE against any medically attended, laboratory-confirmed influenza decreased from 50% (95% confidence interval (CI): 41–58%) in adults vaccinated 14 to 74 days prior to the onset of influenza-like illness (ILI), to 39% (95% CI: 31–47%) in adults vaccinated 75 to 134 days prior to the onset of ILI, then to 17% (95% CI: 0–32%) in adults vaccinated 135 to 194 days prior to the onset of ILI. The pattern and magnitude of VE change with increasing time since vaccination differed by influenza (sub)types. Compared to VE against influenza A(H1N1)pdm09 and influenza B, the decrease of VE against influenza A(H3N2) was more pronounced with increasing time since vaccination. In conclusion, based on the analysis of 2536 influenza-positive cases identified from 7058 adults over multiple influenza seasons, the effectiveness of inactivated influenza vaccine wanes within 180 days after 14 days of influenza vaccination.
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Affiliation(s)
- Wenping Hu
- The Department of Defense Global Emerging Infections Surveillance Branch, Armed Forces Health Surveillance Division, Wright-Patterson Air Force Base, Dayton, OH 45433, USA; (P.A.S.); (L.S.D.); (A.S.R.)
- JYG Innovations, LLC, Dayton, OH 45414, USA
- Correspondence:
| | - Paul A. Sjoberg
- The Department of Defense Global Emerging Infections Surveillance Branch, Armed Forces Health Surveillance Division, Wright-Patterson Air Force Base, Dayton, OH 45433, USA; (P.A.S.); (L.S.D.); (A.S.R.)
- JYG Innovations, LLC, Dayton, OH 45414, USA
| | - Anthony C. Fries
- U.S. Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base, Dayton, OH 45433, USA;
| | - Laurie S. DeMarcus
- The Department of Defense Global Emerging Infections Surveillance Branch, Armed Forces Health Surveillance Division, Wright-Patterson Air Force Base, Dayton, OH 45433, USA; (P.A.S.); (L.S.D.); (A.S.R.)
- JYG Innovations, LLC, Dayton, OH 45414, USA
| | - Anthony S. Robbins
- The Department of Defense Global Emerging Infections Surveillance Branch, Armed Forces Health Surveillance Division, Wright-Patterson Air Force Base, Dayton, OH 45433, USA; (P.A.S.); (L.S.D.); (A.S.R.)
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12
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McMenamin ME, Bond HS, Sullivan SG, Cowling BJ. Estimation of Relative Vaccine Effectiveness in Influenza: A Systematic Review of Methodology. Epidemiology 2022; 33:334-345. [PMID: 35213508 PMCID: PMC8983951 DOI: 10.1097/ede.0000000000001473] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/31/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND When new vaccine components or platforms are developed, they will typically need to demonstrate noninferiority or superiority over existing products, resulting in the assessment of relative vaccine effectiveness (rVE). This review aims to identify how rVE evaluation is being performed in studies of influenza to inform a more standardized approach. METHODS We conducted a systematic search on PubMed, Google Scholar, and Web of Science for studies reporting rVE comparing vaccine components, dose, or vaccination schedules. We screened titles, abstracts, full texts, and references to identify relevant articles. We extracted information on the study design, relative comparison made, and the definition and statistical approach used to estimate rVE in each study. RESULTS We identified 63 articles assessing rVE in influenza virus. Studies compared multiple vaccine components (n = 38), two or more doses of the same vaccine (n = 17), or vaccination timing or history (n = 9). One study compared a range of vaccine components and doses. Nearly two-thirds of all studies controlled for age, and nearly half for comorbidities, region, and sex. Assessment of 12 studies presenting both absolute and relative effect estimates suggested proportionality in the effects, resulting in implications for the interpretation of rVE effects. CONCLUSIONS Approaches to rVE evaluation in practice is highly varied, with improvements in reporting required in many cases. Extensive consideration of methodologic issues relating to rVE is needed, including the stability of estimates and the impact of confounding structure on the validity of rVE estimates.
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Affiliation(s)
- Martina E. McMenamin
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Helen S. Bond
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Sheena G. Sullivan
- WHO Collaborating Centre for Reference and Research on Influenza, Royal Melbourne Hospital, Doherty Department, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Benjamin J. Cowling
- From the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong, China
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13
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Hitchings MD, Ranzani OT, Lind ML, Dorion M, D’Agostini TL, de Paula RC, de Paula OFP, de Moura Villela EF, Torres MSS, de Oliveira SB, Schulz W, Almiron M, Said R, de Oliveira RD, da Silva PV, de Araújo WN, Gorinchteyn JC, Dean NE, Andrews JR, Cummings DA, Ko AI, Croda J. Change in COVID-19 risk over time following vaccination with CoronaVac: A testnegative case-control study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.12.23.21268335. [PMID: 34988559 PMCID: PMC8728874 DOI: 10.1101/2021.12.23.21268335] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate the change in odds of covid-19 over time following primary series completion of the inactivated whole virus vaccine, CoronaVac (Sinovac Biotech) in São Paulo state, Brazil. DESIGN Test negative case-control study. SETTING Community testing for covid-19 in São Paulo state, Brazil. PARTICIPANTS Adults aged 18-120 years who were residents of São Paulo state, without a previous laboratory-confirmed covid-19 infection, who received only two doses of CoronaVac, and underwent reverse transcription polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 from 17 January to 30 September 2021. MAIN OUTCOME MEASURES RT-PCR-confirmed symptomatic covid-19 and associated hospital admissions and deaths. Cases were pair-matched to test-negative controls by age (in 5-year bands), municipality of residence, healthcare worker (HCW) status, and date of RT-PCR test (±3 days). Conditional logistic regression was adjusted for sex, number of covid-19-associated comorbidities, race, and previous acute respiratory infection. RESULTS From 137,820 eligible individuals, 37,929 cases with symptomatic covid-19 and 25,756 test-negative controls with covid-19 symptoms were formed into 37,929 matched pairs. Adjusted odds ratios of symptomatic covid-19 increased with time since series completion, and this increase was greater in younger individuals, and among HCWs compared to non-HCWs. Adjusted odds ratios of covid-19 hospitalisation or death were significantly increased from 98 days since series completion, compared to individuals vaccinated 14-41 days previously: 1.40 (95% confidence interval 1.09 to 1.79) from 98-125 days, 1.55 (1.16 to 2.07) from 126-153 days, 1.56 (1.12 to 2.18) from 154-181 days, and 2.12 (1.39-3.22) from 182 days. CONCLUSIONS In the general population of São Paulo state, Brazil, an increase in odds of moderate and severe covid-19 outcomes was observed over time following primary series completion with CoronaVac.
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Affiliation(s)
- Matt D.T. Hitchings
- Department of Biostatistics, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| | - Otavio T. Ranzani
- Barcelona Institute for Global Health, ISGlobal, Barcelona, Spain
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Margaret L. Lind
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Murilo Dorion
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | | | | | | | | | | | | | - Wade Schulz
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Maria Almiron
- Pan American Health Organization, Brasília, DF, Brazil
| | - Rodrigo Said
- Pan American Health Organization, Brasília, DF, Brazil
| | | | | | - Wildo Navegantes de Araújo
- Pan American Health Organization, Brasília, DF, Brazil
- Universidade de Brasília, Brasília, DF, Brazil
- National Institute for Science and Technology for Health Technology Assessment, Porto Alegre, RS, Brazil
| | | | - Natalie E. Dean
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University
| | - Jason R. Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Derek A.T. Cummings
- Department of Biology, University of Florida, Gainesville, FL, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Albert I. Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil
| | - Julio Croda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- Universidade Federal de Mato Grosso do Sul - UFMS, Campo Grande, MS, Brazil
- Fiocruz Mato Grosso do Sul, Fundação Oswaldo Cruz, Campo Grande, MS, Brazil
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14
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Ferdinands JM, Gaglani M, Martin ET, Monto AS, Middleton D, Silveira F, Talbot HK, Zimmerman R, Patel M. Waning Vaccine Effectiveness Against Influenza-Associated Hospitalizations Among Adults, 2015-2016 to 2018-2019, United States Hospitalized Adult Influenza Vaccine Effectiveness Network. Clin Infect Dis 2021; 73:726-729. [PMID: 33462610 PMCID: PMC8499703 DOI: 10.1093/cid/ciab045] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Indexed: 11/12/2022] Open
Abstract
We observed decreased effectiveness of influenza vaccine with increasing time since vaccination for prevention of influenza A(H3N2), influenza A(H1N1)pdm09, and influenza B/Yamagata-associated hospitalizations among adults. Maximum vaccine effectiveness (VE) was observed shortly after vaccination, followed by an absolute decline in VE of about 8%-9% per month postvaccination.
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Affiliation(s)
- Jill M Ferdinands
- Influenza Division, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
| | | | - Emily T Martin
- University of Michigan School of Public
Health, Ann Arbor, Michigan, USA
| | - Arnold S Monto
- University of Michigan School of Public
Health, Ann Arbor, Michigan, USA
| | - Donald Middleton
- University of Pittsburgh and University of Pittsburgh
Medical Center, Pittsburgh, Pennsylvania, USA
| | - Fernanda Silveira
- University of Pittsburgh and University of Pittsburgh
Medical Center, Pittsburgh, Pennsylvania, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center,
Nashville, Tennessee, USA
| | - Richard Zimmerman
- University of Pittsburgh and University of Pittsburgh
Medical Center, Pittsburgh, Pennsylvania, USA
| | - Manish Patel
- Influenza Division, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA
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15
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Tokars JI, Patel MM, Foppa IM, Reed C, Fry AM, Ferdinands JM. Waning of Measured Influenza Vaccine Effectiveness Over Time: The Potential Contribution of Leaky Vaccine Effect. Clin Infect Dis 2021; 71:e633-e641. [PMID: 32227109 DOI: 10.1093/cid/ciaa340] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Several observational studies have shown decreases in measured influenza vaccine effectiveness (mVE) during influenza seasons. One study found decreases of 6-11%/month during the 2011-2012 to 2014-2015 seasons. These findings could indicate waning immunity but could also occur if vaccine effectiveness is stable and vaccine provides partial protection in all vaccinees ("leaky") rather than complete protection in a subset of vaccinees. Since it is unknown whether influenza vaccine is leaky, we simulated the 2011-2012 to 2014-2015 influenza seasons to estimate the potential contribution of leaky vaccine effect to the observed decline in mVE. METHODS We used available data to estimate daily numbers of vaccinations and infections with A/H1N1, A/H3N2, and B viruses. We assumed that vaccine effect was leaky, calculated mVE as 1 minus the Mantel-Haenszel relative risk of vaccine on incident cases, and determined the mean mVE change per 30 days since vaccination. Because change in mVE was highly dependent on infection rates, we performed simulations using low (15%) and high (31%) total (including symptomatic and asymptomatic) seasonal infection rates. RESULTS For the low infection rate, decreases (absolute) in mVE per 30 days after vaccination were 2% for A/H1N1 and 1% for A/H3N2and B viruses. For the high infection rate, decreases were 5% for A/H1N1, 4% for A/H3, and 3% for B viruses. CONCLUSIONS The leaky vaccine bias could account for some, but probably not all, of the observed intraseasonal decreases in mVE. These results underscore the need for strategies to deal with intraseasonal vaccine effectiveness decline.
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Affiliation(s)
- Jerome I Tokars
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manish M Patel
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ivo M Foppa
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Battelle, Atlanta, Georgia, USA
| | - Carrie Reed
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alicia M Fry
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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16
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Kahn R, Kennedy-Shaffer L, Grad YH, Robins JM, Lipsitch M. Potential Biases Arising From Epidemic Dynamics in Observational Seroprotection Studies. Am J Epidemiol 2021; 190:328-335. [PMID: 32870977 PMCID: PMC7499481 DOI: 10.1093/aje/kwaa188] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022] Open
Abstract
The extent and duration of immunity following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are critical outstanding questions about the epidemiology of this novel virus, and studies are needed to evaluate the effects of serostatus on reinfection. Understanding the potential sources of bias and methods for alleviating biases in these studies is important for informing their design and analysis. Confounding by individual-level risk factors in observational studies like these is relatively well appreciated. Here, we show how geographic structure and the underlying, natural dynamics of epidemics can also induce noncausal associations. We take the approach of simulating serological studies in the context of an uncontrolled or controlled epidemic, under different assumptions about whether prior infection does or does not protect an individual against subsequent infection, and using various designs and analytical approaches to analyze the simulated data. We find that in studies assessing whether seropositivity confers protection against future infection, comparing seropositive persons with seronegative persons with similar time-dependent patterns of exposure to infection by stratifying or matching on geographic location and time of enrollment is essential in order to prevent bias.
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Affiliation(s)
| | | | | | | | - Marc Lipsitch
- Correspondence to Dr. Marc Lipsitch, Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 (e-mail: )
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17
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Abstract
Influenza vaccine effectiveness (VE) wanes over the course of a temperate climate winter season but little data are available from tropical countries with year-round influenza virus activity. In Singapore, a retrospective cohort study of adults vaccinated from 2013 to 2017 was conducted. Influenza vaccine failure was defined as hospital admission with polymerase chain reaction-confirmed influenza infection 2–49 weeks after vaccination. Relative VE was calculated by splitting the follow-up period into 8-week episodes (Lexis expansion) and the odds of influenza infection in the first 8-week period after vaccination (weeks 2–9) compared with subsequent 8-week periods using multivariable logistic regression adjusting for patient factors and influenza virus activity. Records of 19 298 influenza vaccinations were analysed with 617 (3.2%) influenza infections. Relative VE was stable for the first 26 weeks post-vaccination, but then declined for all three influenza types/subtypes to 69% at weeks 42–49 (95% confidence interval (CI) 52–92%, P = 0.011). VE declined fastest in older adults, in individuals with chronic pulmonary disease and in those who had been previously vaccinated within the last 2 years. Vaccine failure was significantly associated with a change in recommended vaccine strains between vaccination and observation period (adjusted odds ratio 1.26, 95% CI 1.06–1.50, P = 0.010).
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18
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Abstract
Supplemental Digital Content is available in the text. We use simulated data to examine the consequences of depletion of susceptibles for hazard ratio (HR) estimators based on a propensity score (PS). First, we show that the depletion of susceptibles attenuates marginal HRs toward the null by amounts that increase with the incidence of the outcome, the variance of susceptibility, and the impact of susceptibility on the outcome. If susceptibility is binary then the Bross bias multiplier, originally intended to quantify bias in a risk ratio from a binary confounder, also quantifies the ratio of the instantaneous marginal HR to the conditional HR as susceptibles are depleted differentially. Second, we show how HR estimates that are conditioned on a PS tend to be between the true conditional and marginal HRs, closer to the conditional HR if treatment status is strongly associated with susceptibility and closer to the marginal HR if treatment status is weakly associated with susceptibility. We show that associations of susceptibility with the PS matter to the marginal HR in the treated (ATT) though not to the marginal HR in the entire cohort (ATE). Third, we show how the PS can be updated periodically to reduce depletion-of-susceptibles bias in conditional estimators. Although marginal estimators can hit their ATE or ATT targets consistently without updating the PS, we show how their targets themselves can be misleading as they are attenuated toward the null. Finally, we discuss implications for the interpretation of HRs and their relevance to underlying scientific and clinical questions. See video Abstract: http://links.lww.com/EDE/B727.
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19
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Kahn R, Kennedy-shaffer L, Grad YH, Robins JM, Lipsitch M. Potential biases arising from epidemic dynamics in observational seroprotection studies.. [PMID: 32511485 PMCID: PMC7273253 DOI: 10.1101/2020.05.02.20088765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The extent and duration of immunity following SARS-CoV-2 infection are critical outstanding questions about the epidemiology of this novel virus, and studies are needed to evaluate the effects of serostatus on reinfection. Understanding the potential sources of bias and methods to alleviate biases in these studies is important for informing their design and analysis. Confounding by individual-level risk factors in observational studies like these is relatively well appreciated. Here, we show how geographic structure and the underlying, natural dynamics of epidemics can also induce noncausal associations. We take the approach of simulating serologic studies in the context of an uncontrolled or a controlled epidemic, under different assumptions about whether prior infection does or does not protect an individual against subsequent infection, and using various designs and analytic approaches to analyze the simulated data. We find that in studies assessing the efficacy of serostatus on future infection, comparing seropositive individuals to seronegative individuals with similar time-dependent patterns of exposure to infection, by stratifying or matching on geographic location and time of enrollment, is essential to prevent bias.
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20
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Lipsitch M, Goldstein E, Ray GT, Fireman B. Depletion-of-susceptibles bias in influenza vaccine waning studies: how to ensure robust results. Epidemiol Infect 2019; 147:e306. [PMID: 31774051 PMCID: PMC7003633 DOI: 10.1017/s0950268819001961] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/08/2019] [Accepted: 10/28/2019] [Indexed: 12/05/2022] Open
Abstract
Vaccine effectiveness studies are subject to biases due to depletion-of-persons at risk of infection, or at especially high risk of infection, at different rates from different groups (depletion-of-susceptibles bias), a problem that can also lead to biased estimates of waning effectiveness, including spurious inference of waning when none exists. An alternative study design to identify waning is to study only vaccinated persons, and compare for each day the incidence in persons with earlier or later dates of vaccination to assess waning in vaccine protection as a function of vaccination time (namely whether earlier vaccination would result in lower subsequent protection compared to later vaccination). Prior studies suggested under what conditions this alternative would yield correct estimates of waning. Here we define the depletion-of-susceptibles process formally and show mathematically that for influenza vaccine waning studies, a randomised trial or corresponding observational study that compares incidence at a specific calendar time among individuals vaccinated at different times before the influenza season begins will not be vulnerable to depletion-of-susceptibles bias in its inference of waning as a function of vaccination time under the null hypothesis that none exists, and will - if waning does actually occur - underestimate the extent of waning. Such a design is thus robust in the sense that a finding of waning in that inference framework reflects actual waning of vaccine-induced immunity. We recommend such a design for future studies of waning, whether observational or randomised.
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Affiliation(s)
- M. Lipsitch
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA02115, USA
| | - E. Goldstein
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA
| | - G. T. Ray
- Division of Research, Kaiser Permanente, 2000 Broadway Oakland, CA94612, USA
| | - B. Fireman
- Division of Research, Kaiser Permanente, 2000 Broadway Oakland, CA94612, USA
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21
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Hönemann M, Martin D, Pietsch C, Maier M, Bergs S, Bieck E, Liebert UG. Influenza B virus infections in Western Saxony, Germany in three consecutive seasons between 2015 and 2018: Analysis of molecular and clinical features. Vaccine 2019; 37:6550-6557. [PMID: 31521415 PMCID: PMC7115636 DOI: 10.1016/j.vaccine.2019.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The impact of annual influenza epidemics and prevailing strains varies worldwide and regional. The majority of vaccines used contained two influenza A strains and only one influenza B strain (trivalent vaccine). AIM The aim of the study was to compare laboratory confirmed influenza B cases during three consecutive years with respect to vaccination history, clinical symptoms and molecular virology. METHODS Partial HA gene sequences were analyzed for lineage determination and complete HA sequence in cases with reported vaccination and in fatal cases. Clinical data were retrieved from patient charts. FINDINGS During the 2015/16 season, 75 influenza B cases were retrieved; 11 in 2016/17, and 274 in 2017/18. The frequency of Yamagata-lineage strains increased from 7.6% to 100%. No difference was detected in the relative frequency of co-morbidities in season 2017/18. 37.7% of the adult patients and 4.5% of pediatric patients were vaccinated against influenza. INTERPRETATION Phylogenetically, Yamagata strains clustered similarly in 2017/2018 when compared to the previous two influenza seasons. While the relative frequency of influenza B cases differed, the clinical symptoms remained similar. CONCLUSION World Health Organization recommendations for the use of tetravalent vaccines that contain two influenza B strains (Yamagata and Victoria) in addition to the two influenza A strains (H1N1 and H3N2) should be implemented in national vaccination guidelines. FUNDING This research was partially supported by the Association of Sponsors and Friends of Leipzig University.
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Affiliation(s)
- M Hönemann
- Institute of Virology, Leipzig University, Johannisallee 30, 04103 Leipzig, Germany.
| | - D Martin
- Institute of Virology, Leipzig University, Johannisallee 30, 04103 Leipzig, Germany
| | - C Pietsch
- Institute of Virology, Leipzig University, Johannisallee 30, 04103 Leipzig, Germany
| | - M Maier
- Institute of Virology, Leipzig University, Johannisallee 30, 04103 Leipzig, Germany
| | - S Bergs
- Institute of Virology, Leipzig University, Johannisallee 30, 04103 Leipzig, Germany
| | - E Bieck
- Kreiskrankenhaus Torgau "J. Kentmann" gGmbH, 04860 Torgau, Germany
| | - U G Liebert
- Institute of Virology, Leipzig University, Johannisallee 30, 04103 Leipzig, Germany
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