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Majumder MAA, Bharatha A, Kumar S, Chatterjee M, Gupta S, Harewood H, Singh K, Johnson WMS, Rajasundaram A, Dutta SB, Prasad SV, Rahman S, Kabir R, Parsa AD, Gaur U, Rabbi AMF, Krishnamurthy K, Mohammad S, Chode V, Haque M, Campbell MH. Self-reported side effects of COVID-19 vaccines among health professions students in India. PeerJ 2024; 12:e17083. [PMID: 38590705 PMCID: PMC11000642 DOI: 10.7717/peerj.17083] [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: 09/28/2023] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
Studies focusing on the safety and common side effects of vaccines play a crucial role in enhancing public acceptance of vaccination. Research is scarce regarding the usage of COVID-19 vaccines and the side effects experienced by health professions students in India and other countries. This study aimed to document self-reported side effects associated with COVID-19 vaccination among medical and dental students of six medical and dental colleges and teaching hospitals in four states (Tamil Nadu, Madhya Pradesh, Gujarat, and West Bengal) of India. A cross-sectional survey using purposive sampling of medical and dental students was conducted from 26 April to 26 May 2021. Data was collected using a Google Forms questionnaire capturing information regarding receiving COVID-19 vaccines, side effects and symptoms, onset and duration of symptoms, use of treatment to alleviate symptoms, awareness of haematologic risks associated with vaccination, and side effects from previous (non-COVID-19) vaccinations. The majority (94.5%) of participants received both doses of the Covishield/AstraZeneca COVID-19 vaccine. Among participants (n = 492), 45.3% (n = 223) reported one or more side effects. The most frequently reported side effects were soreness of the injected arm (80.3%), tiredness (78.5%), fever (71.3%), headache (64.1%), and hypersomnia (58.7%). The two most common severe symptoms were fever (14.8%) and headache (13%). Most side effects appeared on the day of vaccination: soreness of the injection site (57%), fever (43.1%), and tiredness (42.6%). Most reported symptoms persisted for one to three days-soreness of the injection site (53%), fever (47.1%), and headache (42.6%). Logistic regression showed that women were almost 85% less likely to report side effects. The study's findings corroborate the safety of the Covishield/AstraZeneca vaccine's first dose, evidenced by the relatively minor and transient nature of the side effects. However, the study underscores the necessity for ongoing research to assess the long-term impacts of COVID-19 vaccines, especially in the context of booster doses, thereby contributing to the global understanding of vaccine safety and efficacy.
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Affiliation(s)
- Md Anwarul Azim Majumder
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
- Public Health Foundation of Bangladesh, Dhaka, Bangladesh
| | - Ambadasu Bharatha
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | | | - Madhuri Chatterjee
- Shri Ramkrishna Institute of Medical Science, Durgapur, West Bengal, India
| | - Subir Gupta
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Heather Harewood
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Keerti Singh
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - WMS Johnson
- Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| | | | - Sudeshna Banerjee Dutta
- Department of Medical Surgical Nursing (Critical care nursing), Shri Anand Institute of Nursing, Rajkot, Gujarat, India
| | | | - Sayeeda Rahman
- American University of Integrative Sciences (AUIS), Bridgetown, Barbados
| | - Russell Kabir
- Anglia Ruskin University, Chelmsford, Essex, United Kingdom
| | | | - Uma Gaur
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | | | - Kandamaran Krishnamurthy
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Shegufta Mohammad
- Health Education Department, Empower Me First College, Geneva, Switzerland
| | | | - Mainul Haque
- National Defence University of Malaysia, Kuala Lumpur, Malaysia
| | - Michael H. Campbell
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
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2
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Guedalia J, Lipschuetz M, Cahen-Peretz A, Cohen SM, Sompolinsky Y, Shefer G, Melul E, Ergaz-Shaltiel Z, Goldman-Wohl D, Yagel S, Calderon-Margalit R, Beharier O. Maternal hybrid immunity and risk of infant COVID-19 hospitalizations: national case-control study in Israel. Nat Commun 2024; 15:2846. [PMID: 38565530 PMCID: PMC10987618 DOI: 10.1038/s41467-024-46694-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Hybrid immunity, acquired through vaccination followed or preceded by a COVID-19 infection, elicits robust antibody augmentation. We hypothesize that maternal hybrid immunity will provide greater infant protection than other forms of COVID-19 immunity in the first 6 months of life. We conducted a case-control study in Israel, enrolling 661 infants up to 6 months of age, hospitalized with COVID-19 (cases) and 59,460 age-matched non-hospitalized infants (controls) between August 24, 2021, and March 15, 2022. Infants were grouped by maternal immunity status at delivery: Naïve (never vaccinated or tested positive, reference group), Hybrid-immunity (vaccinated and tested positive), Natural-immunity (tested positive before or during the study period), Full-vaccination (two-shot regimen plus 1 booster), and Partial-vaccination (less than full three shot regimen). Applying Cox proportional hazards models to estimate the hazard ratios, which was then converted to percent vaccine effectiveness, and using the Naïve group as the reference, maternal hybrid-immunity provided the highest protection (84% [95% CI 75-90]), followed by full-vaccination (66% [95% CI 56-74]), natural-immunity (56% [95% CI 39-68]), and partial-vaccination (29% [95% CI 15-41]). Maternal hybrid-immunity was associated with a reduced risk of infant hospitalization for Covid-19, as compared to natural-immunity, regardless of exposure timing or sequence. These findings emphasize the benefits of vaccinating previously infected individuals during pregnancy to reduce COVID-19 hospitalizations in early infancy.
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Affiliation(s)
- Joshua Guedalia
- Braun School of Public Health, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Lipschuetz
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel.
- Henrietta Szold Hadassah Hebrew University School of Nursing in the Faculty of Medicine Jerusalem, Jerusalem, Israel.
- The Jerusalem Center for Personalized Computational Medicine Jerusalem, Jerusalem, Israel.
| | - Adva Cahen-Peretz
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarah M Cohen
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yishai Sompolinsky
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Galit Shefer
- TIMNA-Israel Ministry of Health's Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Eli Melul
- TIMNA-Israel Ministry of Health's Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Zivanit Ergaz-Shaltiel
- Neonatology Department Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Debra Goldman-Wohl
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Simcha Yagel
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer Beharier
- Obstetrics & Gynecology Division, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel.
- The Jerusalem Center for Personalized Computational Medicine Jerusalem, Jerusalem, Israel.
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Yu B, Tamargo C, Brennan DC, Kant S. Measures to Increase Immunogenicity of SARS-CoV-2 Vaccines in Solid Organ Transplant Recipients: A Narrative Review. Vaccines (Basel) 2023; 11:1755. [PMID: 38140160 PMCID: PMC10748337 DOI: 10.3390/vaccines11121755] [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: 10/25/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
Purpose of review: To review the data on the immunogenicity of COVID-19 vaccines, administered by different strategies, in solid organ transplant recipients (SOTRs). Recent findings: COVID-19 booster vaccines were given to SOTRs as a widespread practice in many transplant centers, mostly as the third and/or fourth dose in an extended vaccine series, with a significantly improved humoral response compared with the initial two-dose scheme. However, one-third of SOTRs remained unresponsive, despite these boosters. Next steps: Vaccination with standard dosing remains the most feasible strategy for attaining protection against COVID-19. Additional booster doses and temporarily holding or reducing mycophenolate mofetil/mycophenolic acid may provide immunogenicity to vaccines, according to recent studies demonstrating some efficacy with these measures. Preexposure prophylaxis with monoclonal antibodies showed benefit in immunocompromised patients but is no longer recommended by the National Institutes of Health (NIH) due to diminished efficacy against Omicron and recent variants. Screening for the presence and titers of SARS-CoV-2-specific antibodies in SOTRs is not recommended in most clinical settings. T cell-based techniques are needed to evaluate vaccine efficacy and risk of infection. As SARS-CoV-2 continues to evolve, new vaccines based on conservative protein component/complexes of the COVID virus, in addition to its spike protein, are warranted to offer prolonged protection.
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Affiliation(s)
- Bo Yu
- Department of Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, MD 21201, USA;
| | - Christina Tamargo
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Daniel C. Brennan
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Sam Kant
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
- Comprehensive Transplant Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Maeda M, Murata F, Fukuda H. Effect of COVID-19 vaccination on household transmission of SARS-CoV-2 in the Omicron era: The Vaccine Effectiveness, Networking, and Universal Safety (VENUS) study. Int J Infect Dis 2023; 134:200-206. [PMID: 37356650 PMCID: PMC10289267 DOI: 10.1016/j.ijid.2023.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023] Open
Abstract
OBJECTIVES To evaluate the effectiveness of vaccination on reducing household transmission of SARS-CoV-2 among common household types in Japan during the Omicron variant wave. METHODS This retrospective study was conducted using vaccination records, COVID-19 infection data, and resident registry data from two Japanese municipalities. Households that experienced their first COVID-19 case between January and April 2022 were categorized into two groups according to the presence/absence of children aged ≤11 years. We constructed multivariable logistic regression models with generalized estimating equations to calculate the odds ratios (ORs) and 95% confidence intervals for household transmission according to the vaccination statuses of primary cases and household contacts. RESULTS We analyzed 7326 households with 17,586 contacts. In all households, the OR for household transmission was <0.6 (P <0.001) when the primary case and/or contact were vaccinated. In households with children aged ≤11 years, the OR was 0.71 (P <0.001) when only the contact was vaccinated. In households with all members aged ≥12 years, the OR was <0.5 (P <0.001) when the primary case and/or contact were vaccinated. CONCLUSION COVID-19 vaccination effectively reduced household transmission in Japan during the Omicron variant wave.
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Affiliation(s)
- Megumi Maeda
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Fumiko Murata
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Bhanothu V, Munne K, Pande S, Singh P, Jagtap D, Aranha C, Gogoi D, Bhagat S, Gaonkar R, Kerkar S, Shah K, Mukherjee N, Bhor V, Patel V, Mahale SD, Sachdeva G, Begum S. The dynamics of SARS-CoV-2 infection in unvaccinated and vaccinated populations in Mumbai, India, between 28 December 2020 and 30 August 2021. Arch Virol 2023; 168:188. [PMID: 37351663 DOI: 10.1007/s00705-023-05815-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 02/18/2023] [Indexed: 06/24/2023]
Abstract
The emergence and evolution of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants that could compromise vaccine efficacy (VE) with re-infections in immunized individuals have necessitated continuous surveillance of VE. Here, the occurrence and dynamics of SARS-CoV-2 infections in the context of vaccination during the second wave of infection in Mumbai were evaluated. RT-PCR cycle threshold (Ct) values of the open reading frame (ORF)/envelope (E)/nucleocapsid (N) genes obtained from a total of 42415 samples, comprising unvaccinated (96.88%) and vaccinated cases (3.12%) were analyzed between December 28, 2020, and August 30, 2021. A lower incidence of SARS-CoV-2 infection in fully vaccinated cases (5.07%) compared to partially vaccinated cases (6.5%) and unvaccinated cases (13.453%) was recorded. VE was significant after the first dose of vaccination (ORF gene p-value = 0.003429, and E/N gene p-value = 0.000866). Furthermore, VE was observed to be significant when the post-immunization (first dose) period was stratified to within 30 days (ORF gene p-value = 0.0094 and E/N gene p-value = 0.0023) and to 60 days following the second dose of vaccination (ORF gene p-value = 0.0238). Also, significantly higher efficacy was observed within individuals receiving two doses compared to a single dose (ORF gene p-value = 0.0132 and E/N gene p-value = 0.0387). The emergence of breakthrough infections was also evident (odds ratio= 0.34; 95% confidence interval= 0.27-0.43). Interestingly, viral loads trended towards being higher in some groups of partially vaccinated individuals compared to completely vaccinated and unvaccinated populations. Finally, our results delineated a significantly higher incidence of SARS-CoV-2 acquisition in males, asymptomatic individuals, individuals with comorbidities, and those who were unvaccinated.
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Affiliation(s)
- Venkanna Bhanothu
- Genetic Research Centre, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India.
| | - Kiran Munne
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Shailesh Pande
- Genetic Research Centre, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India.
| | - Priyanka Singh
- Viral Immunopathogenesis Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Dhanashree Jagtap
- Cellular & Structural Biology Division, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Clara Aranha
- Molecular Immunology and Microbiology, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Dimpu Gogoi
- Viral Immunopathogenesis Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Sharad Bhagat
- Viral Immunopathogenesis Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Reshma Gaonkar
- Department of Neuroendocrinology, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Shilpa Kerkar
- Department of Clinical Research, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Karan Shah
- Molecular Immunology and Microbiology, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Nupur Mukherjee
- Department of Molecular and Cellular Biology, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Vikrant Bhor
- Molecular Immunology and Microbiology, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Vainav Patel
- Viral Immunopathogenesis Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Smita D Mahale
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Geetanjali Sachdeva
- ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
| | - Shahina Begum
- Department of Biostatistics, ICMR-National Institute for Research in Reproductive and Child Health, Jehangir Merwanji Street, Parel, Mumbai, 400012, India
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Espín E, Yang C, Shannon CP, Assadian S, He D, Tebbutt SJ. Cellular and molecular biomarkers of long COVID: a scoping review. EBioMedicine 2023; 91:104552. [PMID: 37037165 PMCID: PMC10082390 DOI: 10.1016/j.ebiom.2023.104552] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/01/2023] [Accepted: 03/17/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Long-COVID (LC) encompasses diverse symptoms lasting months after the initial SARS-CoV-2 infection. Symptoms can be debilitating and affect the quality of life of individuals with LC and their families. Although the symptoms of LC are well described, the aetiology of LC remains unclear, and consequently, patients may be underdiagnosed. Identification of LC specific biomarkers is therefore paramount for the diagnosis and clinical management of the syndrome. This scoping review describes the molecular and cellular biomarkers that have been identified to date with potential use for diagnosis or prediction of LC. METHODS This review was conducted using the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. A search was executed in the MEDLINE and EMBASE databases, as well as in the grey literature for original studies, published until October 5th, 2022, reporting biomarkers identified in participants with LC symptoms (from all ages, ethnicities, and sex), with a previous infection of SARS-CoV-2. Non-English studies, cross-sectional studies, studies without a control group, and pre-prints were excluded. Two reviewers independently evaluated the studies, extracted population data and associated biomarkers. FINDINGS 23 cohort studies were identified, involving 2163 LC patients [median age 51.8 years, predominantly female sex (61.10%), white (75%), and non-vaccinated (99%)]. A total of 239 candidate biomarkers were identified, consisting mainly of immune cells, immunoglobulins, cytokines, and other plasma proteins. 19 of the 239 candidate biomarkers identified were evaluated by the authors, by means of receiver operating characteristic (ROC) curves. INTERPRETATION Diverse cellular and molecular biomarkers for LC have been proposed. Validation of candidate biomarkers in independent samples should be prioritized. Modest reported performance (particularly in larger studies) suggests LC may encompass many distinct aetiologies, which should be explored e.g., by stratifying by symptom clusters and/or sex. FUNDING Dr. Tebbutt has received funding from the Canadian Institutes of Health Research (177747) to conduct this work. The funding source was not involved in this scoping review, or in the decision to submit this manuscript for publication.
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Affiliation(s)
- Estefanía Espín
- Prevention of Organ Failure (PROOF) Centre of Excellence, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; UBC Centre for Heart Lung Innovation, Providence Research, St Paul's Hospital, Vancouver, BC, Canada
| | - Chengliang Yang
- Prevention of Organ Failure (PROOF) Centre of Excellence, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; UBC Centre for Heart Lung Innovation, Providence Research, St Paul's Hospital, Vancouver, BC, Canada; Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Casey P Shannon
- Prevention of Organ Failure (PROOF) Centre of Excellence, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; UBC Centre for Heart Lung Innovation, Providence Research, St Paul's Hospital, Vancouver, BC, Canada
| | - Sara Assadian
- Prevention of Organ Failure (PROOF) Centre of Excellence, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; UBC Centre for Heart Lung Innovation, Providence Research, St Paul's Hospital, Vancouver, BC, Canada
| | - Daniel He
- Prevention of Organ Failure (PROOF) Centre of Excellence, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; UBC Centre for Heart Lung Innovation, Providence Research, St Paul's Hospital, Vancouver, BC, Canada
| | - Scott J Tebbutt
- Prevention of Organ Failure (PROOF) Centre of Excellence, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; UBC Centre for Heart Lung Innovation, Providence Research, St Paul's Hospital, Vancouver, BC, Canada; Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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7
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Ouni PD, Namulondo R, Wanume B, Okia D, Olupot PO, Nantale R, Matovu JK, Napyo A, Moses Lubaale YA, Nshakira N, Mukunya D. COVID-19 vaccine hesitancy among health workers in rural Uganda: A mixed methods study. Vaccine X 2023; 13:100260. [PMID: 36643854 PMCID: PMC9824947 DOI: 10.1016/j.jvacx.2023.100260] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/11/2022] [Accepted: 01/06/2023] [Indexed: 01/09/2023] Open
Abstract
Background COVID-19 vaccination is the latest preventive intervention strategy in an attempt to control the global pandemic. Its efficacy has come under scrutiny because of break through infections among the vaccinated and need for booster doses. Besides, although health workers were prioritized for COVID-19 vaccine in most countries, anecdotal evidence points to high levels of reluctance to take the vaccine among health workers. We assessed COVID-19 vaccine hesitancy among health workers in Dokolo district, northern Uganda. Methods This was a mixed-method, cross-sectional descriptive study. A customised self-administered data collection tool was used to collect quantitative data on characteristics, vaccination status and factors for or rejection of vaccine uptake. We conducted multivariable logistic regression to assess the association between selected exposures and vaccine hesitancy using Stata version 15. Conversely, qualitative data were collected using key informant interviews (KIIs) among 15 participants that were purposively selected. Data were analysed using thematic content analysis with the help of NVivo 12.0. Results Of the 346 health workers enrolled, (13.3% [46/346]) were vaccine hesitant. Factors associated with vaccine hesitancy included fear of side effects (Adjusted Odds Ratio [AOR]: 2.55; 95% Confidence Interval [95%CI]: 1.00, 6.49) and health workers' lack of trust in the information provided by health authorities (AOR: 6.74; 95% CI: 2.43, 18.72). Similar factors were associated with vaccine hesitancy when we used the vaccine hesitancy score. Fear of side effects, distrust in vaccine stakeholders, and lack of trust in the vaccine were barriers to COVID-19 vaccination among health workers. Conclusion A small proportion of health workers were found to be hesitant to take the COVID-19 vaccine in this study. The paucity of COVID-19 vaccine safety information, which eroded the health workers' trust in the information they received on the vaccine, was responsible for health workers hesitancy to take up the vaccine in Uganda.
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Affiliation(s)
- Patrick Diox Ouni
- Department of Community and Public Health, Busitema University, Mbale, Uganda
| | - Racheal Namulondo
- Department of Community and Public Health, Busitema University, Mbale, Uganda
| | - Benon Wanume
- Department of Community and Public Health, Busitema University, Mbale, Uganda
| | - David Okia
- Department of Community and Public Health, Busitema University, Mbale, Uganda
| | - Peter Olupot Olupot
- Department of Community and Public Health, Busitema University, Mbale, Uganda
- Department of Research, Mbale Clinical Research Institute, Mbale, Uganda
| | - Ritah Nantale
- Department of Nursing, Busitema University, Mbale City, Uganda
| | - Joseph K.B. Matovu
- Department of Community and Public Health, Busitema University, Mbale, Uganda
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Agnes Napyo
- Department of Community and Public Health, Busitema University, Mbale, Uganda
| | | | - Nathan Nshakira
- Department of Research, Nikao Medical Center, Kampala, Uganda
| | - David Mukunya
- Department of Community and Public Health, Busitema University, Mbale, Uganda
- Department of Public Health, Kabale University, Kabale, Uganda
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8
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Lipschuetz M, Guedalia J, Cohen SM, Sompolinsky Y, Shefer G, Melul E, Ergaz-Shaltiel Z, Goldman-Wohl D, Yagel S, Calderon-Margalit R, Beharier O. Maternal third dose of BNT162b2 mRNA vaccine and risk of infant COVID-19 hospitalization. Nat Med 2023; 29:1155-1163. [PMID: 36959421 DOI: 10.1038/s41591-023-02270-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/22/2023] [Indexed: 03/25/2023]
Abstract
Infants are at a higher risk of Coronavirus Disease 2019 (COVID-19)-related hospitalizations compared to older children. In this study, we investigated the effect of the recommended third maternal dose of BNT162b2 COVID-19 vaccine during pregnancy on rates of infant COVID-19-related hospitalizations. We conducted a nationwide cohort study of all live-born infants delivered in Israel between 24 August 2021 and 15 March 2022 to estimate the effectiveness of the third booster dose versus the second dose against infant COVID-19-related hospitalizations. Data were analyzed for the overall study period, and the Delta and Omicron periods were analyzed separately. Cox proportional hazard regression models estimated hazard ratios and 95% confidence intervals (CIs) for infant hospitalizations according to maternal vaccination status at delivery. Among 48,868 live-born infants included in the analysis, rates of COVID-19 hospitalization were 0.4%, 0.6% and 0.7% in the third-dose, second-dose and unvaccinated groups, respectively. Compared to the second dose, the third dose was associated with reduced infant hospitalization with estimated effectiveness of 53% (95% CI: 36-65%). Greater protection was associated with a shorter interval between vaccination and delivery. A third maternal dose during pregnancy reduced the risk of infant hospitalization for COVID-19 during the first 4 months of life, supporting clinical and public health guidance for maternal booster vaccination to prevent infant COVID-19 hospitalization.
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Affiliation(s)
- Michal Lipschuetz
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
- Henrietta Szold Hadassah Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel
| | - Joshua Guedalia
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sarah M Cohen
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yishai Sompolinsky
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Galit Shefer
- TIMNA-Israel Ministry of Health's Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | - Eli Melul
- TIMNA-Israel Ministry of Health's Big Data Platform, Israel Ministry of Health, Jerusalem, Israel
| | | | - Debra Goldman-Wohl
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Simcha Yagel
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health, Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer Beharier
- Obstetrics & Gynecology Division Hadassah Medical Center, Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel.
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9
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Abstract
This Viewpoint argues that the development of a distinctly improved generation of SARS-CoV-2 vaccines is paramount to offering a greater breadth and depth of protection for a longer duration against COVID-19 disease.
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Affiliation(s)
- Peter W Marks
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Philip A Gruppuso
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Eli Y Adashi
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
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10
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Günes Ö, Gülhan B, Guney AY, Üçkardeş F, Ozen S, Guder L, Mustafaoglu O, Bayraktar P, Yahşi A, Erat T, Kanik-Yuksek S, Bayhan GI, Ozkaya-Parlakay A. Do parents vaccinated against COVID-19 protect their children from hospitalization due to COVID-19? J Trop Pediatr 2022; 69:6957047. [PMID: 36548396 DOI: 10.1093/tropej/fmac105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to determine whether parental vaccination against coronavirus disease 2019 (COVID-19) prevents hospitalization of COVID-19-infected children. METHODS This study was based on data obtained from the records of pediatric patients that were followed up for virologically proven COVID-19 infection between August and October 2021, during which time the delta variant was dominant in Turkey and the children were isolating at home. RESULTS There were 151 patients in the inpatient group and 218 in the outpatient group; the mean age was 172.5 and 145.5 months in the groups, respectively. The rates of obesity (22.5% and 6.4%, respectively, p < 0.001) and neurological-neurodevelopmental disorders (8.6% and 1.4%, respectively, p < 0.001) were significantly higher in the inpatient group than in the outpatient group. Of the outpatients' parents, 67.4% (n = 147) were fully vaccinated vs. 38.4% (n = 58) in the inpatient group. In all, 39.7% (n = 60) of the inpatients' parents were unvaccinated vs. 18.3% (n = 40) in the outpatient group. There was a significant correlation between the vaccination status and the patient groups (p < 0.001); it was determined that the COVID-19 infection would be mild in children if both parents were fully vaccinated. When both parents were fully vaccinated against COVID-19, the hospitalization rate decreased and the outpatient follow-up rate increased. CONCLUSION Having both parents fully vaccinated against COVID-19 can indirectly protect their subsequently infected children from hospitalization and the long-term effects of infection. Nonetheless, more comprehensive research on delta and non-delta variants is needed.
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Affiliation(s)
- Ömer Günes
- Department of Pediatric Infectious Diseases, Ankara City Hospital, 06800 Ankara, Turkey
| | - Belgin Gülhan
- Department of Pediatric Infectious Diseases, Ankara City Hospital, 06800 Ankara, Turkey
| | - Ahmet Yasin Guney
- Department of Pediatric Infectious Diseases, Ankara City Hospital, 06800 Ankara, Turkey
| | - Fatih Üçkardeş
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Adıyaman University, Adıyaman 02040, Turkey
| | - Seval Ozen
- Department of Pediatric Infectious Diseases, Ankara City Hospital, 06800 Ankara, Turkey
| | - Latife Guder
- Department of Pediatric Infectious Diseases, Ankara City Hospital, 06800 Ankara, Turkey
| | - Ozlem Mustafaoglu
- Department of Pediatric Infectious Diseases, Ankara City Hospital, 06800 Ankara, Turkey
| | - Pinar Bayraktar
- Department of Pediatric Infectious Diseases, Ankara City Hospital, 06800 Ankara, Turkey
| | - Aysun Yahşi
- Department of Pediatric Infectious Diseases, Ankara City Hospital, 06800 Ankara, Turkey
| | - Tuğba Erat
- Department of Pediatric Infectious Diseases, Ankara City Hospital, 06800 Ankara, Turkey
| | - Saliha Kanik-Yuksek
- Department of Pediatric Infectious Diseases, Ankara City Hospital, 06800 Ankara, Turkey
| | - Gulsum Iclal Bayhan
- Department of Pediatric Infectious Diseases, Ankara City Hospital, 06800 Ankara, Turkey
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11
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Mosconi G, Fantini M, Righini M, Flachi M, Semprini S, Hu L, Chiappo F, Veterani B, Ambri K, Ferrini F, Milanesi C, Giudicissi A, La Manna G, Rigotti A, Buscaroli A, Sambri V, Cappuccilli M. Efficacy of SARS-CoV-2 Vaccination in Dialysis Patients: Epidemiological Analysis and Evaluation of the Clinical Progress. J Clin Med 2022; 11:jcm11164723. [PMID: 36012962 PMCID: PMC9410204 DOI: 10.3390/jcm11164723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/24/2022] [Accepted: 08/01/2022] [Indexed: 12/16/2022] Open
Abstract
This study investigated the impact of the fourth COVID-19 pandemic wave on dialysis patients of Romagna territory, assessing the associations of vaccination status with infection risk, clinical severity and mortality. From November 2021 to February 2022, an epidemiological search was conducted on 829 patients under dialysis treatment for at least one month. The data were then analyzed with reference to the general population of the same area. A temporal comparison was also carried out with the previous pandemic waves (from March 2020 to October 2021). The epidemiological evolution over time in the dialysis population and in Romagna citizens replicated the global trend, as the peak of the fourth wave corresponded to the time of maximum diffusion of omicron variant (B.1.1.529). Of 771 prevalent dialysis patients at the beginning of the study, 109 (14.1%) contracted SARS-CoV-2 infection during the 4-month observation period. Vaccine adherence in the dialysis population of the reference area was above 95%. Compared to fully or partially vaccinated subjects, the unvaccinated ones showed a significantly higher proportion of infections (12.5% vs. 27.0% p = 0.0341), a more frequent need for hospitalization (22.2% vs. 50.0%) and a 3.3-fold increased mortality risk. These findings confirm the effectiveness of COVID-19 vaccines in keeping infectious risk under control and ameliorating clinical outcomes in immunocompromised patients.
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Affiliation(s)
- Giovanni Mosconi
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
- Correspondence: (G.M.); (F.C.); Tel.: +39-0543-735-312 (G.M.)
| | - Michela Fantini
- Local Healthcare Authority of Romagna (AUSL Romagna), 48121 Ravenna, RA, Italy
| | - Matteo Righini
- Nephrology and Dialysis Unit, AUSL Romagna S. Maria delle Croci Hospital, 48121 Ravenna, RA, Italy
| | - Marta Flachi
- Nephrology and Dialysis Unit, AUSL Romagna Infermi Hospital, 47923 Rimini, RN, Italy
| | - Simona Semprini
- Unit of Microbiology, AUSL Romagna Laboratory, 47023 Pievesestina, FC, Italy
| | - Lilio Hu
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Francesca Chiappo
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
- Correspondence: (G.M.); (F.C.); Tel.: +39-0543-735-312 (G.M.)
| | - Barbara Veterani
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Katia Ambri
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Franca Ferrini
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Catia Milanesi
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Antonio Giudicissi
- Nephrology and Dialysis Unit, AUSL Romagna Morgagni-Pierantoni Hospital, 47121 Forli, FC, Italy
| | - Gaetano La Manna
- Nephrology Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40138 Bologna, BO, Italy
| | - Angelo Rigotti
- Nephrology and Dialysis Unit, AUSL Romagna Infermi Hospital, 47923 Rimini, RN, Italy
| | - Andrea Buscaroli
- Nephrology and Dialysis Unit, AUSL Romagna S. Maria delle Croci Hospital, 48121 Ravenna, RA, Italy
| | - Vittorio Sambri
- Unit of Microbiology, AUSL Romagna Laboratory, 47023 Pievesestina, FC, Italy
| | - Maria Cappuccilli
- Nephrology Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, 40138 Bologna, BO, Italy
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12
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Vaccine hesitancy and health care providers: Using the preferred cognitive styles and decision- making model and empathy tool to make progress. Vaccine X 2022; 11:100174. [PMID: 35782719 PMCID: PMC9241108 DOI: 10.1016/j.jvacx.2022.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/09/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022] Open
Abstract
Low vaccination rates among health care providers (HCPs) pose a risk to themselves, their colleagues, their patients, and the general public. This paper seeks to frame the issues surrounding health care provider vaccine hesitancy and vaccination rates, as well as explore factors influencing respective decision-making, including health care occupation and demographic characteristics. This paper will then propose the use of the Preferred Cognitive Style and Decision-Making (PCSDM) Model and the Empathy Tool to increase health care provider vaccination rates, and will end by discussing several recommendations. It is important while discussing HCP vaccination rates to not view them as a monolithic group or apply “one-size-fits-all” approaches, and thus it is essential to present information and engage in conversations in ways that align with how the HCP takes in and processes information and decisions. Furthermore, it is vital to increase health literacy across the spectrum of HCP programs and professions. To this end, it is important to teach and incorporate the PCSDM Model and Empathy Tool, along with information about how individuals think and make decisions, into vaccine education programs and training sessions.
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13
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Díaz Pinzón JE. Proporción de la población con vacunación completa contra Covid-19 a nivel mundial. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introducción: a pesar del célebre desarrollo, licenciamiento y distribución de vacunas efectivas contra COVID-19, el número de casos y muertes registrados recientemente continuó creciendo a nivel mundial hasta el verano del hemisferio norte de 2021. Objetivo: mostrar los países con los mayores porcentajes de cambio absoluto en las personas vacunadas para COVID-19, entre el 13 de diciembre 2020 al 6 de enero 2022. Metodología: esta investigación se realizó bajo un estudio transversal, la información se obtuvo de la página web de la recolectada por parte de Our World in Data para vacunación contra COVID-19. Resultados: se determinó que los países con mayores cambios absolutos de personas vacunadas en porcentaje fueron: Gibraltar (117,73), Portugal (89,65), Emiratos Árabes Unidos (88,97), Brunéi (87,27), Singapur (87), y Chile (86,35). Conclusión: hay que establecer sistemas de suministro de vacunas y la infraestructura necesaria para certificar el acceso a las vacunas contra la COVID-19 de los grupos poblacionales prioritarios a nivel mundial.
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14
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Madewell ZJ, Yang Y, Longini IM, Halloran ME, Dean NE. Household Secondary Attack Rates of SARS-CoV-2 by Variant and Vaccination Status: An Updated Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e229317. [PMID: 35482308 PMCID: PMC9051991 DOI: 10.1001/jamanetworkopen.2022.9317] [Citation(s) in RCA: 105] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE An overall household secondary attack rate (SAR) of 18.9% (95% CI, 16.2%-22.0%) through June 17, 2021 was previously reported for SARS-CoV-2. Emerging variants of concern and increased vaccination have affected transmission rates. OBJECTIVE To evaluate how reported household SARs changed over time and whether SARs varied by viral variant and index case and contact vaccination status. DATA SOURCES PubMed and medRxiv from June 18, 2021, through March 8, 2022, and reference lists of eligible articles. Preprints were included. STUDY SELECTION Articles with original data reporting the number of infected and total number of household contacts. Search terms included SARS-CoV-2, COVID-19, variant, vaccination, secondary attack rate, secondary infection rate, household, index case, family contacts, close contacts, and family transmission. DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline was followed. Meta-analyses used generalized linear mixed models to obtain SAR estimates and 95% CIs. MAIN OUTCOMES AND MEASURES SAR stratified by covariates according to variant, index case and contact vaccination status, and index case identification period. SARs were used to estimate vaccine effectiveness on the basis of the transmission probability for susceptibility to infection (VES,p), infectiousness given infection (VEI,p), and total vaccine effectiveness (VET,p). RESULTS Household SARs were higher for 33 studies with midpoints in 2021 to 2022 (37.3%; 95% CI, 32.7% to 42.1%) compared with 63 studies with midpoints through April 2020 (15.5%; 95% CI, 13.2% to 18.2%). Household SARs were 42.7% (95% CI, 35.4% to 50.4%) for Omicron (7 studies), 36.4% (95% CI, 33.4% to 39.5%) for Alpha (11 studies), 29.7% (95% CI, 23.0% to 37.3%) for Delta (16 studies), and 22.5% (95% CI, 18.6% to 26.8%) for Beta (3 studies). For full vaccination, VES,p was 78.6% (95% CI, 76.0% to 80.9%) for Alpha, 56.4% (95% CI, 54.6% to 58.1%) for Delta, and 18.1% (95% CI, -18.3% to 43.3%) for Omicron; VEI,p was 75.3% (95% CI, 69.9% to 79.8%) for Alpha, 21.9% (95% CI, 11.0% to 31.5%) for Delta, and 18.2% (95% CI, 0.6% to 32.6%) for Omicron; and VET,p was 94.7% (95% CI, 93.3% to 95.8%) for Alpha, 64.4% (95% CI, 58.0% to 69.8%) for Delta, and 35.8% (95% CI, 13.0% to 52.6%) for Omicron. CONCLUSIONS AND RELEVANCE These results suggest that emerging SARS-CoV-2 variants of concern have increased transmissibility. Full vaccination was associated with reductions in susceptibility and infectiousness, but more so for Alpha than Delta and Omicron. The changes in estimated vaccine effectiveness underscore the challenges of developing effective vaccines concomitant with viral evolution.
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Affiliation(s)
| | - Yang Yang
- Department of Biostatistics, University of Florida, Gainesville
| | - Ira M. Longini
- Department of Biostatistics, University of Florida, Gainesville
| | - M. Elizabeth Halloran
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle
| | - Natalie E. Dean
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
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15
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Hayek S, Shaham G, Ben-Shlomo Y, Kepten E, Dagan N, Nevo D, Lipsitch M, Reis BY, Balicer RD, Barda N. Indirect protection of children from SARS-CoV-2 infection through parental vaccination. Science 2022; 375:1155-1159. [PMID: 35084938 DOI: 10.1126/science.abm3087] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Children not vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may still benefit from vaccines through protection from vaccinated contacts. We estimated the protection provided to children through parental vaccination with the BNT162b2 vaccine. We studied households without prior infection consisting of two parents and unvaccinated children, estimating the effect of parental vaccination on the risk of infection for unvaccinated children. We studied two periods separately-an early period (17 January 2021 to 28 March 2021; Alpha variant, two doses versus no vaccination) and a late period (11 July 2021 to 30 September 2021; Delta variant, booster dose versus two vaccine doses). We found that having a single vaccinated parent was associated with a 26.0 and a 20.8% decreased risk in the early and late periods, respectively, and having two vaccinated parents was associated with a 71.7 and a 58.1% decreased risk, respectively. Thus, parental vaccination confers substantial protection on unvaccinated children in the household.
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Affiliation(s)
- Samah Hayek
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
| | - Galit Shaham
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
| | - Yatir Ben-Shlomo
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
| | - Eldad Kepten
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
| | - Noa Dagan
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
- Software and Information Systems Engineering, Ben Gurion University, Be'er Sheva, Israel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA
| | - Daniel Nevo
- Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, and Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ben Y Reis
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Noam Barda
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
- Software and Information Systems Engineering, Ben Gurion University, Be'er Sheva, Israel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA
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16
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Prunas O, Warren JL, Crawford FW, Gazit S, Patalon T, Weinberger DM, Pitzer VE. Vaccination with BNT162b2 reduces transmission of SARS-CoV-2 to household contacts in Israel. Science 2022; 375:1151-1154. [PMID: 35084937 PMCID: PMC9261115 DOI: 10.1126/science.abl4292] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/21/2022] [Indexed: 12/17/2022]
Abstract
The effectiveness of vaccines against COVID-19 on the individual level is well established. However, few studies have examined vaccine effectiveness against transmission. We used a chain binomial model to estimate the effectiveness of vaccination with BNT162b2 [Pfizer-BioNTech messenger RNA (mRNA)-based vaccine] against household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Israel before and after emergence of the B.1.617.2 (Delta) variant. Vaccination reduced susceptibility to infection by 89.4% [95% confidence interval (CI): 88.7 to 90.0%], whereas vaccine effectiveness against infectiousness given infection was 23.0% (95% CI: -11.3 to 46.7%) during days 10 to 90 after the second dose, before 1 June 2021. Total vaccine effectiveness was 91.8% (95% CI: 88.1 to 94.3%). However, vaccine effectiveness is reduced over time as a result of the combined effect of waning of immunity and emergence of the Delta variant.
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Affiliation(s)
- Ottavia Prunas
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Joshua L. Warren
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Forrest W. Crawford
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
- Department of Statistics and Data Science, Yale School of Public Health, Yale University, New Haven, CT, USA
- Department of Ecology and Evolutionary Biology, Yale School of Public Health, Yale University, New Haven, CT, USA
- Yale School of Management, Yale University, New Haven, CT, USA
| | - Sivan Gazit
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Tal Patalon
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Virginia E. Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
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17
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Salo J, Hägg M, Kortelainen M, Leino T, Saxell T, Siikanen M, Sääksvuori L. The indirect effect of mRNA-based COVID-19 vaccination on healthcare workers' unvaccinated household members. Nat Commun 2022; 13:1162. [PMID: 35246536 PMCID: PMC8897446 DOI: 10.1038/s41467-022-28825-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 02/14/2022] [Indexed: 11/09/2022] Open
Abstract
Mass vaccination is effective in reducing SARS-CoV-2 infections among vaccinated individuals. However, it remains unclear how effectively COVID-19 vaccines prevent people from spreading the virus to their close contacts. Using nationwide administrative datasets on SARS-CoV-2 infections, vaccination records, demographics, and unique household IDs, we conducted an observational cohort study to estimate the direct and indirect effectiveness of mRNA-based COVID-19 vaccines in reducing infections among vaccinated healthcare workers and their unvaccinated household members. Our estimates for adults imply indirect effectiveness of 39.1% (95% CI: −7.1% to 65.3%) two weeks and 39.0% (95% CI: 18.9% to 54.0%) eight weeks after the second dose. We find that the indirect effect of mRNA-based COVID-19 vaccines within households is smaller for unvaccinated children than for adults and statistically insignificant. Here, we show that mRNA-based COVID-19 vaccines are associated with a reduction in SARS-CoV-2 infections not only among vaccinated individuals but also among unvaccinated adult household members in a real-world setting. COVID-19 vaccines are effective in preventing disease, but the extent of protection against transmission is unclear. Here, the authors use data from a cohort of healthcare workers in Finland and show that vaccination is associated with reduced infection in their unvaccinated adult household contacts.
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Affiliation(s)
- Jussipekka Salo
- Department of Economics, University of Helsinki, Arkadiankatu 7, P.O. Box 17, 00014, Helsinki, Finland.,VATT Institute for Economic Research, Arkadiankatu 7, P.O. Box 1279, 00101, Helsinki, Finland.,Department of Economics, Aalto University School of Business, Aalto University, P.O. Box 21210, 00076, Espoo, Finland.,Helsinki GSE, Economicum, Arkadiankatu 7, 00100, Helsinki, Finland
| | - Milla Hägg
- Department of Economics, University of Helsinki, Arkadiankatu 7, P.O. Box 17, 00014, Helsinki, Finland.,VATT Institute for Economic Research, Arkadiankatu 7, P.O. Box 1279, 00101, Helsinki, Finland.,Department of Economics, Aalto University School of Business, Aalto University, P.O. Box 21210, 00076, Espoo, Finland.,Helsinki GSE, Economicum, Arkadiankatu 7, 00100, Helsinki, Finland
| | - Mika Kortelainen
- VATT Institute for Economic Research, Arkadiankatu 7, P.O. Box 1279, 00101, Helsinki, Finland.,Helsinki GSE, Economicum, Arkadiankatu 7, 00100, Helsinki, Finland.,Department of Economics, Turku School of Economics, Rehtorinpellonkatu 3, 20500, Turku, Finland.,InFLAMES Research Flagship Center, University of Turku, Turku, Finland
| | - Tuija Leino
- Infectious Disease Control and Vaccinations Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Tanja Saxell
- VATT Institute for Economic Research, Arkadiankatu 7, P.O. Box 1279, 00101, Helsinki, Finland.,Helsinki GSE, Economicum, Arkadiankatu 7, 00100, Helsinki, Finland
| | - Markku Siikanen
- VATT Institute for Economic Research, Arkadiankatu 7, P.O. Box 1279, 00101, Helsinki, Finland.,Helsinki GSE, Economicum, Arkadiankatu 7, 00100, Helsinki, Finland
| | - Lauri Sääksvuori
- Health Science Unit, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland. .,INVEST Research Flagship Center, University of Turku, Assistentinkatu 7, 20014, Turku, Finland. .,Finnish Institute for Health and Welfare, Centre for Health and Social Economic, P.O. Box 30, 00271, Helsinki, Finland.
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18
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Abu-Raddad LJ, Chemaitelly H, Ayoub HH, Tang P, Coyle P, Hasan MR, Yassine HM, Benslimane FM, Al-Khatib HA, 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-Khal A, Al-Thani MH, Bertollini R. Relative infectiousness of SARS-CoV-2 vaccine breakthrough infections, reinfections, and primary infections. Nat Commun 2022; 13:532. [PMID: 35087035 PMCID: PMC8795418 DOI: 10.1038/s41467-022-28199-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/06/2022] [Indexed: 12/18/2022] Open
Abstract
SARS-CoV-2 breakthrough infections in vaccinated individuals and in those who had a prior infection have been observed globally, but the transmission potential of these infections is unknown. The RT-qPCR cycle threshold (Ct) value is inversely correlated with viral load and culturable virus. Here, we investigate differences in RT-qPCR Ct values across Qatar's national cohorts of primary infections, reinfections, BNT162b2 (Pfizer-BioNTech) breakthrough infections, and mRNA-1273 (Moderna) breakthrough infections. Our matched-cohort analyses of the randomly diagnosed infections show higher mean Ct value in all cohorts of breakthrough infections compared to the cohort of primary infections in unvaccinated individuals. The Ct value is 1.3 (95% CI: 0.9-1.8) cycles higher for BNT162b2 breakthrough infections, 3.2 (95% CI: 1.9-4.5) cycles higher for mRNA-1273 breakthrough infections, and 4.0 (95% CI: 3.5-4.5) cycles higher for reinfections in unvaccinated individuals. Since Ct value correlates inversely with SARS-CoV-2 infectiousness, these differences imply that vaccine breakthrough infections and reinfections are less infectious than primary infections in unvaccinated individuals. Public health benefits of vaccination may have been underestimated, as COVID-19 vaccines not only protect against acquisition of infection, but also appear to protect against transmission of infection.
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Affiliation(s)
- 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.
| | - 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 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
| | | | - 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
| | - 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
- 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
| | | | | | | | | | | | | | | | - 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
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19
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Madewell ZJ, Yang Y, Longini IM, Halloran ME, Dean NE. Household secondary attack rates of SARS-CoV-2 by variant and vaccination status: an updated systematic review and meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.01.09.22268984. [PMID: 35043125 PMCID: PMC8764734 DOI: 10.1101/2022.01.09.22268984] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We previously reported a household secondary attack rate (SAR) for SARS-CoV-2 of 18.9% through June 17, 2021. To examine how emerging variants and increased vaccination have affected transmission rates, we searched PubMed from June 18, 2021, through January 7, 2022. Meta-analyses used generalized linear mixed models to obtain SAR estimates and 95%CI, disaggregated by several covariates. SARs were used to estimate vaccine effectiveness based on the transmission probability for susceptibility ( VE S,p ), infectiousness ( VE I,p ), and total vaccine effectiveness ( VE T,p ). Household SAR for 27 studies with midpoints in 2021 was 35.8% (95%CI, 30.6%-41.3%), compared to 15.7% (95%CI, 13.3%-18.4%) for 62 studies with midpoints through April 2020. Household SARs were 38.0% (95%CI, 36.0%-40.0%), 30.8% (95%CI, 23.5%-39.3%), and 22.5% (95%CI, 18.6%-26.8%) for Alpha, Delta, and Beta, respectively. VE I,p , VE S,p , and VE T,p were 56.6% (95%CI, 28.7%-73.6%), 70.3% (95%CI, 59.3%-78.4%), and 86.8% (95%CI, 76.7%-92.5%) for full vaccination, and 27.5% (95%CI, -6.4%-50.7%), 43.9% (95%CI, 21.8%-59.7%), and 59.9% (95%CI, 34.4%-75.5%) for partial vaccination, respectively. Household contacts exposed to Alpha or Delta are at increased risk of infection compared to the original wild-type strain. Vaccination reduced susceptibility to infection and transmission to others. SUMMARY Household secondary attack rates (SARs) were higher for Alpha and Delta variants than previous estimates. SARs were higher to unvaccinated contacts than to partially or fully vaccinated contacts and were higher from unvaccinated index cases than from fully vaccinated index cases.
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Affiliation(s)
| | - Yang Yang
- Department of Biostatistics, University of Florida, Gainesville, FL
| | - Ira M. Longini
- Department of Biostatistics, University of Florida, Gainesville, FL
| | - M. Elizabeth Halloran
- Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Natalie E. Dean
- Department of Biostatistics, University of Florida, Gainesville, FL
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20
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Prunas O, Warren JL, Crawford FW, Gazit S, Patalon T, Weinberger DM, Pitzer VE. Vaccination with BNT162b2 reduces transmission of SARS-CoV-2 to household contacts in Israel. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.07.13.21260393. [PMID: 34981074 PMCID: PMC8722617 DOI: 10.1101/2021.07.13.21260393] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The individual-level effectiveness of vaccines against clinical disease caused by SARS-CoV-2 is well-established. However, few studies have directly examined the effect of COVID-19 vaccines on transmission. We quantified the effectiveness of vaccination with BNT162b2 (Pfizer-BioNTech mRNA-based vaccine) against household transmission of SARS-CoV-2 in Israel. We fit two time-to-event models - a mechanistic transmission model and a regression model - to estimate vaccine effectiveness against susceptibility to infection and infectiousness given infection in household settings. Vaccine effectiveness against susceptibility to infection was 80-88%. For breakthrough infections among vaccinated individuals, the vaccine effectiveness against infectiousness was 41-79%. The overall vaccine effectiveness against transmission was 88.5%. Vaccination provides substantial protection against susceptibility to infection and slightly lower protection against infectiousness given infection, thereby reducing transmission of SARS-CoV-2 to household contacts. ONE-SENTENCE SUMMARY Vaccination reduced both the rate of infection with SARS-CoV-2 and transmission to household contacts in Israel.
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Affiliation(s)
- Ottavia Prunas
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University; New Haven, CT USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University; New Haven, CT USA
| | - Joshua L. Warren
- Public Health Modeling Unit, Yale School of Public Health, Yale University; New Haven, CT USA
- Department of Biostatistics, Yale School of Public Health, Yale University; New Haven, CT USA
| | - Forrest W. Crawford
- Public Health Modeling Unit, Yale School of Public Health, Yale University; New Haven, CT USA
- Department of Biostatistics, Yale School of Public Health, Yale University; New Haven, CT USA
| | - Sivan Gazit
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services; Tel Aviv, Israel
| | - Tal Patalon
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services; Tel Aviv, Israel
| | - Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University; New Haven, CT USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University; New Haven, CT USA
| | - Virginia E. Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University; New Haven, CT USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University; New Haven, CT USA
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Abstract
Cities around the world are the epicentres of the coronavirus pandemic: both in the first wave, as the disease spread from East Asia, and now, as many countries enter a third wave of infections. These spatial patterns are still far from properly understood, though there is no shortage of possible explanations. I set out the emerging theories about cities’ role in the spread of coronavirus, testing these against existing studies and new analysis for English conurbations, cities and towns. Both reveal an urbanised public health crisis, in which vulnerabilities and health impacts track (a) urban structural inequalities, and (b) wider weaknesses in institutions, their capabilities and leaders. I then turn to ‘post-pandemic’ visions of future cities. I argue that this framing is unhelpful: even with mass vaccination, COVID-19 is likely to remain one of many globalised endemic diseases. Instead, ‘pandemic-resilient’ urban places will require improved economic, social and physical infrastructure, alongside better public policy. Describing such future cities is still highly speculative: I identify five zones of change.
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Affiliation(s)
- Max Nathan
- Max Nathan, Bartlett Centre for Advanced Spatial Analysis, University College London, 90 Tottenham Court Road, London WC1E 6BT, UK.
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22
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Omrani AS, Tleyjeh IM. Which are the best coronavirus disease 2019 vaccines? Clin Microbiol Infect 2021; 27:1729-1732. [PMID: 34428593 PMCID: PMC8379816 DOI: 10.1016/j.cmi.2021.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 12/03/2022]
Affiliation(s)
- Ali S Omrani
- Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Imad M Tleyjeh
- Infectious Diseases Section, Department of Medical Specialties King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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23
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Ng OT, Koh V, Chiew CJ, Marimuthu K, Thevasagayam NM, Mak TM, Chua JK, Ong SSH, Lim YK, Ferdous Z, Johari AKB, Chen MIC, Maurer-Stroh S, Cui L, Lin RTP, Tan KB, Cook AR, Leo PYS, Lee PVJM. Impact of Delta Variant and Vaccination on SARS-CoV-2 Secondary Attack Rate Among Household Close Contacts. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 17:100299. [PMID: 34746899 PMCID: PMC8560026 DOI: 10.1016/j.lanwpc.2021.100299] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Impact of the Delta variant and vaccination on SARS-CoV-2 transmission remains unclear. In Singapore, quarantine of all close contacts, including entry and exit PCR testing, provided the opportunity to determine risk of infection by the Delta variant compared to other variants, vaccine efficacy against SARS-CoV-2 acquisition, symptomatic or severe COVID-19, and risk factors associated with SARS-CoV-2 acquisition and symptomatic disease. METHODS This retrospective cohort study included all close contacts between September 1, 2020 and May 31, 2021. Regardless of symptoms, all were quarantined for 14 days with entry and exit PCR testing. Household contacts were defined as individuals who shared a residence with a Covid-19 index case. Secondary attack rates among household close contacts of Delta variant-infected indexes and other variant-infected indexes were derived from prevalence of diagnosed cases among contacts. Relative risk ratios and bootstrapping at the cluster level was used to determine risk of infection by the Delta variant compared to other variants and vaccine efficacy against SARS-CoV-2 acquisition, symptomatic or severe COVID-19. Logistic regression using generalized estimating equations was used to determine risk factors associated with SARS-CoV-2 acquisition and symptomatic disease. FINDINGS Of 1024 household contacts linked to 301 PCR-confirmed index cases, 753 (73.5%) were linked to Delta-infected indexes and 248 (24.2%) were exposed to indexes with other variants. Household secondary attack rate among unvaccinated Delta-exposed contacts was 25.8% (95% boostrap confidence interval [BCI] 20.6-31.5%) compared with 12.9% (95%BCI 7.0-20.0%) among other variant-exposed contacts. Unvaccinated Delta-exposed contacts were more likely to be infected than those exposed to other variants (Relative risk 2.01, 95%CI 1.24-3.84). Among Delta-exposed contacts, complete vaccination had a vaccine effectiveness of 56.4% (95%BCI 32.6-75.8%) against acquisition, 64.1% (95%BCI 37.8-85.4%) against symptomatic disease and 100% against severe disease. Among Delta-exposed contacts, vaccination status (adjusted odds ratio [aOR] 0.33, 95% robust confidence interval [RCI] 0.17-0.63) and older age of the index (aOR 1.20 per decade, 95%RCI 1.03-1.39) was associated with increased risk of SARS-CoV-2 acquisition by the contact. Vaccination status of the index was not associated with a statistically-significant difference for contact SARS-CoV-2 acquisition (aOR 0.73, 95%RCI 0.38-1.40). INTERPRETATION Increased risk of SARS-CoV-2 Delta acquisition compared with other variants was reduced with vaccination. Close-contacts of vaccinated Delta-infected indexes did not have statistically significant reduced risk of acquisition compared with unvaccinated Delta-infected indexes.
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Affiliation(s)
- Oon Tek Ng
- National Centre for Infectious Diseases, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Vanessa Koh
- National Centre for Infectious Diseases, Singapore
- Tan Tock Seng Hospital, Singapore
| | - Calvin J Chiew
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore
- Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | | | - Tze Minn Mak
- National Centre for Infectious Diseases, Singapore
| | | | | | | | - Zannatul Ferdous
- National Centre for Infectious Diseases, Singapore
- Tan Tock Seng Hospital, Singapore
| | | | - Mark I-Cheng Chen
- National Centre for Infectious Diseases, Singapore
- Communicable Diseases Division, Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Sebastian Maurer-Stroh
- National Centre for Infectious Diseases, Singapore
- Bioinformatics Institute, Agency for Science Technology and Research, Singapore
- Infectious Diseases Labs, Agency for Science Technology and Research, Singapore
- Department of Biological Sciences, National University of Singapore, Singapore
| | - Lin Cui
- National Centre for Infectious Diseases, Singapore
| | - Raymond Tzer Pin Lin
- National Centre for Infectious Diseases, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Centre for Regulatory Excellence, Duke-NUS Medical School
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Prof. Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Prof. Vernon JM Lee
- Communicable Diseases Division, Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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24
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Sachak-Patwa R, Byrne HM, Dyson L, Thompson RN. The risk of SARS-CoV-2 outbreaks in low prevalence settings following the removal of travel restrictions. COMMUNICATIONS MEDICINE 2021; 1:39. [PMID: 35602220 PMCID: PMC9053223 DOI: 10.1038/s43856-021-00038-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background Countries around the world have introduced travel restrictions to reduce SARS-CoV-2 transmission. As vaccines are gradually rolled out, attention has turned to when travel restrictions and other non-pharmaceutical interventions (NPIs) can be relaxed. Methods Using SARS-CoV-2 as a case study, we develop a mathematical branching process model to assess the risk that, following the removal of NPIs, cases arriving in low prevalence settings initiate a local outbreak. Our model accounts for changes in background population immunity due to vaccination. We consider two locations with low prevalence in which the vaccine rollout has progressed quickly – specifically, the Isle of Man (a British crown dependency in the Irish Sea) and the country of Israel. Results We show that the outbreak risk is unlikely to be eliminated completely when travel restrictions and other NPIs are removed. This general result is the most important finding of this study, rather than exact quantitative outbreak risk estimates in different locations. It holds even once vaccine programmes are completed. Key factors underlying this result are the potential for transmission even following vaccination, incomplete vaccine uptake, and the recent emergence of SARS-CoV-2 variants with increased transmissibility. Conclusions Combined, the factors described above suggest that, when travel restrictions are relaxed, it may still be necessary to implement surveillance of incoming passengers to identify infected individuals quickly. This measure, as well as tracing and testing (and/or isolating) contacts of detected infected passengers, remains useful to suppress potential outbreaks while global case numbers are high. The effectiveness of public health measures against COVID-19 has varied between countries, with some experiencing many infections and others containing transmission successfully. As vaccines are deployed, an important challenge is deciding when to relax measures. Here, we consider locations with few cases, and investigate whether vaccination can ever eliminate the risk of COVID-19 outbreaks completely, allowing measures to be removed risk-free. Using a mathematical model, we demonstrate that there is still a risk that imported cases initiate outbreaks when measures are removed, even if most of the population is fully vaccinated. This highlights the need for continued vigilance in low prevalence settings to prevent imported cases leading to local transmission. Until case numbers are reduced globally, so that SARS-CoV-2 spread between countries is less likely, the risk of outbreaks in low prevalence settings will remain. Sachak-Patwa et al. estimate the risk of SARS-CoV-2 outbreaks in low prevalence settings following the removal of travel restrictions and other non-pharmaceutical interventions, with the Isle of Man and Israel as case studies. Using a branching process mathematical model, the authors show that even after a large proportion of the population is vaccinated, there remains a risk of local outbreaks from imported cases.
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25
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Affiliation(s)
- Jake Scott
- Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Aaron Richterman
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, PA, USA
| | - Muge Cevik
- Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, UK
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26
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León TM, Vargo J, Pan ES, Jain S, Shete PB. Nonpharmaceutical Interventions Remain Essential to Reducing Coronavirus Disease 2019 Burden Even in a Well-Vaccinated Society: A Modeling Study. Open Forum Infect Dis 2021; 8:ofab415. [PMID: 34514021 PMCID: PMC8419741 DOI: 10.1093/ofid/ofab415] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Vaccination and nonpharmaceutical interventions (NPIs) reduce transmission of severe acute respiratory syndrome coronavirus 2 infection, but their effectiveness depends on coverage and adherence levels. We used scenario modeling to evaluate their effects on cases and deaths averted and herd immunity. NPIs and vaccines worked synergistically in different parts of the pandemic to reduce disease burden.
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Affiliation(s)
- Tomás M León
- Division of Communicable Diseases, California Department of Public Health, Richmond, California, USA
| | - Jason Vargo
- Division of Communicable Diseases, California Department of Public Health, Richmond, California, USA
- Office of Health Equity, California Department of Public Health, Richmond, California, USA
| | - Erica S Pan
- Division of Communicable Diseases, California Department of Public Health, Richmond, California, USA
| | - Seema Jain
- Division of Communicable Diseases, California Department of Public Health, Richmond, California, USA
| | - Priya B Shete
- Division of Communicable Diseases, California Department of Public Health, Richmond, California, USA
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, California, USA
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27
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Madewell ZJ, Yang Y, Longini IM, Halloran ME, Dean NE. Factors Associated With Household Transmission of SARS-CoV-2: An Updated Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2122240. [PMID: 34448865 PMCID: PMC8397928 DOI: 10.1001/jamanetworkopen.2021.22240] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/19/2021] [Indexed: 12/14/2022] Open
Abstract
Importance A previous systematic review and meta-analysis of household transmission of SARS-CoV-2 that summarized 54 published studies through October 19, 2020, found an overall secondary attack rate (SAR) of 16.6% (95% CI, 14.0%-19.3%). However, the understanding of household secondary attack rates for SARS-CoV-2 is still evolving, and updated analysis is needed. Objective To use newly published data to further the understanding of SARS-CoV-2 transmission in the household. Data Sources PubMed and reference lists of eligible articles were used to search for records published between October 20, 2020, and June 17, 2021. No restrictions on language, study design, time, or place of publication were applied. Studies published as preprints were included. Study Selection Articles with original data that reported at least 2 of the following factors were included: number of household contacts with infection, total number of household contacts, and secondary attack rates among household contacts. Studies that reported household infection prevalence (which includes index cases), that tested contacts using antibody tests only, and that included populations overlapping with another included study were excluded. Search terms were SARS-CoV-2 or COVID-19 with secondary attack rate, household, close contacts, contact transmission, contact attack rate, or family transmission. Data Extraction and Synthesis Meta-analyses were performed using generalized linear mixed models to obtain SAR estimates and 95% CIs. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. Main Outcomes and Measures Overall household SAR for SARS-CoV-2, SAR by covariates (contact age, sex, ethnicity, comorbidities, and relationship; index case age, sex, symptom status, presence of fever, and presence of cough; number of contacts; study location; and variant), and SAR by index case identification period. Results A total of 2722 records (2710 records from database searches and 12 records from the reference lists of eligible articles) published between October 20, 2020, and June 17, 2021, were identified. Of those, 93 full-text articles reporting household transmission of SARS-CoV-2 were assessed for eligibility, and 37 studies were included. These 37 new studies were combined with 50 of the 54 studies (published through October 19, 2020) from our previous review (4 studies from Wuhan, China, were excluded because their study populations overlapped with another recent study), resulting in a total of 87 studies representing 1 249 163 household contacts from 30 countries. The estimated household SAR for all 87 studies was 18.9% (95% CI, 16.2%-22.0%). Compared with studies from January to February 2020, the SAR for studies from July 2020 to March 2021 was higher (13.4% [95% CI, 10.7%-16.7%] vs 31.1% [95% CI, 22.6%-41.1%], respectively). Results from subgroup analyses were similar to those reported in a previous systematic review and meta-analysis; however, the SAR was higher to contacts with comorbidities (3 studies; 50.0% [95% CI, 41.4%-58.6%]) compared with previous findings, and the estimated household SAR for the B.1.1.7 (α) variant was 24.5% (3 studies; 95% CI, 10.9%-46.2%). Conclusions and Relevance The findings of this study suggest that the household remains an important site of SARS-CoV-2 transmission, and recent studies have higher household SAR estimates compared with the earliest reports. More transmissible variants and vaccines may be associated with further changes.
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Affiliation(s)
| | - Yang Yang
- Department of Biostatistics, University of Florida, Gainesville
| | - Ira M. Longini
- Department of Biostatistics, University of Florida, Gainesville
| | - M. Elizabeth Halloran
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Biostatistics, University of Washington, Seattle
| | - Natalie E. Dean
- Department of Biostatistics, University of Florida, Gainesville
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28
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High coverage COVID-19 mRNA vaccination rapidly controls SARS-CoV-2 transmission in long-term care facilities. COMMUNICATIONS MEDICINE 2021; 1:16. [PMID: 35602197 PMCID: PMC9053242 DOI: 10.1038/s43856-021-00015-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background Residents of Long-Term Care Facilities (LTCFs) represent a major share of COVID-19 deaths worldwide. Measuring the vaccine effectiveness among the most vulnerable in these settings is essential to monitor and improve mitigation strategies. Methods We evaluate the early effect of the administration of BNT162b2-mRNA vaccine to individuals older than 64 years residing in LTCFs in Catalonia, Spain. We monitor all the SARS-CoV-2 documented infections and deaths among LTCFs residents once more than 70% of them were fully vaccinated (February–March 2021). We develop a modeling framework based on the relationship between community and LTCFs transmission during the pre-vaccination period (July–December 2020). We compute the total reduction in SARS-CoV-2 documented infections and deaths among residents of LTCFs over time, as well as the reduction in the detected transmission for all the LTCFs. We compare the true observations with the counterfactual predictions. Results We estimate that once more than 70% of the LTCFs population are fully vaccinated, 74% (58–81%, 90% CI) of COVID-19 deaths and 75% (36–86%, 90% CI) of all expected documented infections among LTCFs residents are prevented. Further, detectable transmission among LTCFs residents is reduced up to 90% (76–93%, 90% CI) relative to that expected given transmission in the community. Conclusions Our findings provide evidence that high-coverage vaccination is the most effective intervention to prevent SARS-CoV-2 transmission and death among LTCFs residents. Widespread vaccination could be a feasible avenue to control the COVID-19 pandemic conditional on key factors such as vaccine escape, roll out and coverage. A large number of COVID-19 infections and deaths have occurred in older adults who reside in long-term care facilities (LTCFs). In this study, we determine whether high rates of vaccinations among older adult residents of LTCFs in Catalonia (Spain) reduced transmission of SARS-CoV-2—the virus that causes COVID-19—and prevented infections and deaths after most vaccinations were complete. We use statistical modeling to compare the expected number of infections and deaths in LTCFs if vaccination would not have occurred to those actually observed after vaccinating more than 70% of residents. We estimate that 3 out of 4 SARS-CoV-2 infections and deaths were prevented due to vaccination, and that SARS-CoV-2 transmission in LTCFs was reduced by 90%. Our study shows that high-coverage vaccination is a highly effective way to prevent SARS-CoV-2 transmission and death among vulnerable populations De Salazar et al. quantify the impact of BNT162b2 mRNA vaccination on COVID-19 transmission and deaths in residents of long-term care facilities in Catalonia, Spain using statistical modelling. They find that high vaccination coverage results in a substantial reduction in transmission amongst residents, preventing around 3 in 4 documented infections and COVID-19-related deaths.
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Lipsitch M, Kahn R. Interpreting vaccine efficacy trial results for infection and transmission. Vaccine 2021; 39:4082-4088. [PMID: 34130883 PMCID: PMC8197448 DOI: 10.1016/j.vaccine.2021.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/20/2021] [Accepted: 06/03/2021] [Indexed: 12/14/2022]
Abstract
Randomized controlled trials (RCTs) have shown high efficacy of multiple vaccines against SARS-CoV-2 disease (COVID-19), and recent studies have shown the vaccines are also effective against infection. Evidence for the effect of each of these vaccines on ability to transmit the virus is also beginning to emerge. We describe an approach to estimate these vaccines' effects on viral positivity, a prevalence measure which under the reasonable assumption that vaccinated individuals who become infected are no more infectious than unvaccinated individuals forms a lower bound on efficacy against transmission. Specifically, we recommend separate analysis of positive tests triggered by symptoms (usually the primary RCT outcome) and cross-sectional prevalence of positive tests obtained regardless of symptoms. The odds ratio of carriage for vaccine vs. placebo provides an unbiased estimate of vaccine effectiveness against viral positivity, under certain assumptions, and we show through simulations that likely departures from these assumptions will only modestly bias this estimate. Applying this approach to published data from the RCT of the Moderna vaccine, we estimate that one dose of vaccine reduces the potential for transmission by at least 61%, possibly considerably more. We describe how these approaches can be translated into observational studies of vaccine effectiveness.
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Affiliation(s)
- Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Rebecca Kahn
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Lipsitch M, Kahn R. Interpreting vaccine efficacy trial results for infection and transmission. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.02.25.21252415. [PMID: 33655276 PMCID: PMC7924301 DOI: 10.1101/2021.02.25.21252415] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Randomized controlled trials (RCTs) have shown high efficacy of multiple vaccines against SARS-CoV-2 disease (COVID-19), and recent studies have shown the vaccines are also effective against infection. Evidence for the effect of each of these vaccines on ability to transmit the virus is also beginning to emerge. We describe an approach to estimate these vaccines' effects on viral positivity, a prevalence measure which under the reasonable assumption that vaccinated individuals who become infected are no more infectious than unvaccinated individuals forms a lower bound on efficacy against transmission. Specifically, we recommend separate analysis of positive tests triggered by symptoms (usually the primary outcome) and cross-sectional prevalence of positive tests obtained regardless of symptoms. The odds ratio of carriage for vaccine vs. placebo provides an unbiased estimate of vaccine effectiveness against viral positivity, under certain assumptions, and we show through simulations that likely departures from these assumptions will only modestly bias this estimate. Applying this approach to published data from the RCT of the Moderna vaccine, we estimate that one dose of vaccine reduces the potential for transmission by at least 61%, possibly considerably more. We describe how these approaches can be translated into observational studies of vaccine effectiveness.
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Affiliation(s)
- Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rebecca Kahn
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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De Salazar PM, Link N, Lamarca K, Santillana M. High coverage COVID-19 mRNA vaccination rapidly controls SARS-CoV-2 transmission in Long-Term Care Facilities. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.04.08.21255108. [PMID: 33880479 PMCID: PMC8057247 DOI: 10.1101/2021.04.08.21255108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Residents of Long-Term Care Facilities (LTCFs) represent a major share of COVID-19 deaths worldwide. Measuring the vaccine effectiveness among the most vulnerable in these settings is essential to monitor and improve mitigation strategies. We evaluated the early effect of the administration of BNT162b2 mRNA vaccines to individuals older than 64 years residing in LTCFs in Catalonia, a region of Spain. We monitored all the SARS-CoV-2 documented infections and deaths among LTCFs residents from February 6th to March 28th, 2021, the subsequent time period after which 70% of them were fully vaccinated. We developed a modeling framework based on the relation between community and LTFCs transmission during the pre-vaccination period (July -December 2020) and compared the true observations with the counterfactual model predictions. As a measure of vaccine effectiveness, we computed the total reduction in SARS-CoV-2 documented infections and deaths among residents of LTCFs over time, as well as the reduction on the detected transmission for all the LTCFs. We estimated that once more than 70% of the LTCFs population were fully vaccinated, 74% (58%-81%, 90% CI) of COVID-19 deaths and 75% (36%-86%, 90% CI) of all expected documented infections among LTCFs residents were prevented. Further, detectable transmission among LTCFs residents was reduced up to 90% (76-93%, 90%CI) relative to that expected given transmission in the community. Our findings provide evidence that high-coverage vaccination is the most effective intervention to prevent SARS-CoV-2 transmission and death among LTCFs residents. Conditional on key factors such as vaccine roll out, escape and coverage --across age groups--, widespread vaccination could be a feasible avenue to control the COVID-19 pandemic.
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Affiliation(s)
- Pablo M De Salazar
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, United States
| | - Nicholas Link
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA
- Machine Intelligence Lab, Boston Children's Hospital, Boston, United States
- Computational Health Informatics Program, Boston Children's Hospital, Boston, United States
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, United States
| | - Karuna Lamarca
- Home Hospitalization Unit, Department of Infectious Diseases, Dos de Maig Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mauricio Santillana
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, United States
- Machine Intelligence Lab, Boston Children's Hospital, Boston, United States
- Computational Health Informatics Program, Boston Children's Hospital, Boston, United States
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, United States
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