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Wang X, Zhang Y, Huang C, Yang H, Jiang C, Yu X, Zhao R, Hong J, Zhang Y, Wang Y, Zhao R, An Z, Tong Z. Booster vaccines dose reduced mortality in hospitalized COVID-19 patients requiring oxygen supplementation: Evidence from the Beijing Omicron outbreak. Hum Vaccin Immunother 2024; 20:2361500. [PMID: 38904423 PMCID: PMC11195489 DOI: 10.1080/21645515.2024.2361500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/26/2024] [Indexed: 06/22/2024] Open
Abstract
To assess the impact of vaccines on clinical outcomes among hospitalized COVID-19-infected patients requiring oxygen supplementation during the Beijing Omicron outbreak. We conducted a retrospective cohort study at Beijing Chaoyang Hospital, Capital Medical University, from November 15, 2022, to March 31, 2023. Vaccination statuses were categorized into 3 doses, 2 doses, and unvaccinated (0 dose). The primary outcome was 28-day all-cause mortality. Secondary outcomes included poor outcomes, intensive care unit admission, cardiovascular thromboembolism events, and hospital readmission. Among the included patients, 117 were 2 doses, 285 received booster doses, and 503 were unvaccinated. After propensity score inverse probability weighting, the 3 doses group showed a significantly lower 28-day all-cause mortality compared to the unvaccinated group (inverse probability of treatment weighting-adjusted HR: 0.64, 95% CI: 0.50-0.81). No significant difference was observed in all-cause mortality between the 2 doses and unvaccinated groups. No significant differences were observed in secondary outcome analyses when comparing the 3 doses or 2 doses group to the unvaccinated group. Subgroup analysis revealed significant benefits of booster vaccination in patients with shorter symptom duration, lower Charlson Comorbidity Index, and without immunosuppression status. Our study highlights the significant reduction in all-cause mortality among hospitalized Omicron-infected patients who received a third dose vaccine. These findings underscore the importance of prioritizing booster vaccinations, especially among the elderly. Further research is warranted to confirm and extend these observations.
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Affiliation(s)
- Xinrui Wang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yi Zhang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chong Huang
- School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Hui Yang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chunguo Jiang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaojia Yu
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Rui Zhao
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jun Hong
- School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Yi Zhang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yushu Wang
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Rui Zhao
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhuoling An
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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O'Brien SF, Asamoah-Boaheng M, Grunau B, Krajden M, Buckeridge DL, Goldfarb DM, Anderson M, Germain M, Brown P, Stein DR, Kandola K, Tipples G, Awadalla P, Lang A, Behl L, Fitzpatrick T, Drews SJ. Canada's approach to SARS-CoV-2 sero-surveillance: Lessons learned for routine surveillance and future pandemics. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:558-566. [PMID: 38981961 DOI: 10.17269/s41997-024-00901-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/24/2024] [Indexed: 07/11/2024]
Abstract
SETTING In Canada's federated healthcare system, 13 provincial and territorial jurisdictions have independent responsibility to collect data to inform health policies. During the COVID-19 pandemic (2020-2023), national and regional sero-surveys mostly drew upon existing infrastructure to quickly test specimens and collect data but required cross-jurisdiction coordination and communication. INTERVENTION There were 4 national and 7 regional general population SARS-CoV-2 sero-surveys. Survey methodologies varied by participant selection approaches, assay choices, and reporting structures. We analyzed Canadian pandemic sero-surveillance initiatives to identify key learnings to inform future pandemic planning. OUTCOMES Over a million samples were tested for SARS-CoV-2 antibodies from 2020 to 2023 but siloed in 11 distinct datasets. Most national sero-surveys had insufficient sample size to estimate regional prevalence; differences in methodology hampered cross-regional comparisons of regional sero-surveys. Only four sero-surveys included questionnaires. Sero-surveys were not directly comparable due to different assays, sampling methodologies, and time-frames. Linkage to health records occurred in three provinces only. Dried blood spots permitted sample collection in remote populations and during stay-at-home orders. IMPLICATIONS To provide timely, high-quality information for public health decision-making, routine sero-surveillance systems must be adaptable, flexible, and scalable. National capability planning should include consortiums for assay design and validation, defined mechanisms to improve test capacity, base documents for data linkage and material transfer across jurisdictions, and mechanisms for real-time communication of data. Lessons learned will inform incorporation of a robust sero-survey program into routine surveillance with strategic sampling and capacity to adapt and scale rapidly as a part of a comprehensive national pandemic response plan.
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Affiliation(s)
- Sheila F O'Brien
- Epidemiology & Surveillance, Canadian Blood Services, Ottawa, ON, Canada.
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Michael Asamoah-Boaheng
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, BC, Canada
| | - Brian Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, St. Paul's Hospital, Vancouver, BC, Canada
- British Columbia Emergency Health Services, Vancouver, BC, Canada
| | - Mel Krajden
- Public Health Laboratory, British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - David L Buckeridge
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, BC Children's Hospital, Vancouver, BC, Canada
| | - Maureen Anderson
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
- Ministry of Health, Government of Saskatchewan, Regina, SK, Canada
| | - Marc Germain
- Affaires médicales et innovation, Héma-Québec, Québec, QC, Canada
| | - Patrick Brown
- Department of Statistical Sciences, University of Toronto, Toronto, ON, Canada
| | - Derek R Stein
- Cadham Provincial Laboratory, Winnipeg, MB, Canada
- Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Kami Kandola
- Government of Northwest Territories, Yellowknife, NT, Canada
| | - Graham Tipples
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB, Canada
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB, Canada
- Department of Medical Microbiology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Philip Awadalla
- Ontario Institute for Cancer Research, University of Toronto, Toronto, ON, Canada
| | - Amanda Lang
- Roy Romanow Provincial Laboratory, Saskatchewan Health Authority, Regina, SK, Canada
| | - Lesley Behl
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Tiffany Fitzpatrick
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Steven J Drews
- Medical Microbiology, Canadian Blood Services, Edmonton, AB, Canada
- Division of Diagnostics and Applied Microbiology, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
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3
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Bowdish DME, Chandran V, Hitchon CA, Kaplan GG, Avina-Zubieta JA, Fortin PR, Larché MJ, Boire G, Gingras AC, Dayam RM, Colmegna I, Lukusa L, Lee JLF, Richards DP, Pereira D, Watts TH, Silverberg MS, Bernstein CN, Lacaille D, Benoit J, Kim J, Lalonde N, Gunderson J, Allard-Chamard H, Roux S, Quan J, Hracs L, Turnbull E, Valerio V, Bernatsky S. When Should I Get My Next COVID-19 Vaccine? Data From the Surveillance of Responses to COVID-19 Vaccines in Systemic Immune-Mediated Inflammatory Diseases (SUCCEED) Study. J Rheumatol 2024; 51:721-727. [PMID: 38621797 DOI: 10.3899/jrheum.2023-1214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE To determine how serologic responses to coronavirus disease 2019 (COVID-19) vaccination and infection in immune-mediated inflammatory disease (IMID) are affected by time since last vaccination and other factors. METHODS Post-COVID-19 vaccination, data, and dried blood spots or sera were collected from adults with rheumatoid arthritis, inflammatory bowel disease, systemic lupus erythematosus, ankylosing spondylitis and spondylarthritis, and psoriasis and psoriatic arthritis. The first sample was collected at enrollment, then at 2 to 4 weeks and 3, 6, and 12 months after the latest vaccine dose. Multivariate generalized estimating equation regressions (including medications, demographics, and vaccination history) evaluated serologic response, based on log-transformed anti-receptor-binding domain (RBD) IgG titers; we also measured antinucleocapsid (anti-N) IgG. RESULTS Positive associations for log-transformed anti-RBD titers were seen with female sex, number of doses, and self-reported COVID-19 infections in 2021 to 2023. Negative associations were seen with prednisone, anti-tumor necrosis factor agents, and rituximab. Over the 2021-2023 period, most (94%) of anti-N positivity was associated with a self-reported infection in the 3 months prior to testing. From March 2021 to February 2022, anti-N positivity was present in 5% to 15% of samples and was highest in the post-Omicron era, with antinucleocapsid positivity trending to 30% to 35% or higher as of March 2023. Anti-N positivity in IMID remained lower than Canada's general population seroprevalence (> 50% in 2022 and > 75% in 2023). Time since last vaccination was negatively associated with log-transformed anti-RBD titers, particularly after 210 days. CONCLUSION Ours is the first pan-Canadian IMID assessment of how vaccine history and other factors affect serologic COVID-19 vaccine responses. These findings may help individuals personalize vaccination decisions, including consideration of additional vaccination when > 6 months has elapsed since last COVID-19 vaccination/infection.
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Affiliation(s)
- Dawn M E Bowdish
- D.M.E. Bowdish, PhD, J. Benoit, Department of Medicine, McMaster University, Hamilton, Ontario
| | - Vinod Chandran
- V. Chandran, MD, PhD, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, and Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario
| | - Carol A Hitchon
- C.A. Hitchon, MD, MSc, C.N. Bernstein, MD, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Gilaad G Kaplan
- G.G. Kaplan, MD, MPH, J. Quan, MSc, L. Hracs, PhD, Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta
| | - J Antonio Avina-Zubieta
- J.A. Avina-Zubieta, MD, PhD, D. Lacaille, MD, MHSc, Arthritis Research Canada, and Division of Rheumatology, University of British Columbia, Vancouver, British Columbia
| | - Paul R Fortin
- P.R. Fortin, MD, MPH, Centre de Recherche Arthrite, Division of Rheumatology, Department of Medicine, CHU de Québec - Université Laval, Quebec City, Quebec
| | - Maggie J Larché
- M.J. Larché, MD, PhD, Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario
| | - Gilles Boire
- G. Boire, MD, MSc, H. Allard-Chamard, MD, PhD, S. Roux, MD, PhD, Division of Rheumatology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec
| | - Anne-Claude Gingras
- A.C. Gingras, PhD, R.M. Dayam, PhD, Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario
| | - Roya M Dayam
- A.C. Gingras, PhD, R.M. Dayam, PhD, Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario
| | - Ines Colmegna
- I. Colmegna, MD, S. Bernatsky, MD, PhD, The Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec, and Department of Medicine, Division of Rheumatology, McGill University, Montreal, Quebec
| | - Luck Lukusa
- L. Lukusa, MSc, J.L.F. Lee, BSc, E. Turnbull, RN, V. Valerio, MD, The Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec
| | - Jennifer L F Lee
- L. Lukusa, MSc, J.L.F. Lee, BSc, E. Turnbull, RN, V. Valerio, MD, The Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec
| | - Dawn P Richards
- D.P. Richards, PhD, N. Lalonde, BSc, J. Gunderson, BEd, Canadian Arthritis Patient Alliance, Toronto, Ontario
| | - Daniel Pereira
- D. Pereira, BSc, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario
| | - Tania H Watts
- T.H. Watts, PhD, Department of Immunology, University of Toronto, Toronto, Ontario
| | - Mark S Silverberg
- M.S. Silverberg, MD, PhD, Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, and Zane Cohen Center for Digestive Diseases, Division of Gastroenterology, Mount Sinai Hospital, Sinai Health, Toronto, Ontario
| | - Charles N Bernstein
- C.A. Hitchon, MD, MSc, C.N. Bernstein, MD, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Diane Lacaille
- J.A. Avina-Zubieta, MD, PhD, D. Lacaille, MD, MHSc, Arthritis Research Canada, and Division of Rheumatology, University of British Columbia, Vancouver, British Columbia
| | - Jenna Benoit
- D.M.E. Bowdish, PhD, J. Benoit, Department of Medicine, McMaster University, Hamilton, Ontario
| | - John Kim
- J. Kim, PhD, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Nadine Lalonde
- D.P. Richards, PhD, N. Lalonde, BSc, J. Gunderson, BEd, Canadian Arthritis Patient Alliance, Toronto, Ontario
| | - Janet Gunderson
- D.P. Richards, PhD, N. Lalonde, BSc, J. Gunderson, BEd, Canadian Arthritis Patient Alliance, Toronto, Ontario
| | - Hugues Allard-Chamard
- G. Boire, MD, MSc, H. Allard-Chamard, MD, PhD, S. Roux, MD, PhD, Division of Rheumatology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec
| | - Sophie Roux
- G. Boire, MD, MSc, H. Allard-Chamard, MD, PhD, S. Roux, MD, PhD, Division of Rheumatology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec
| | - Joshua Quan
- G.G. Kaplan, MD, MPH, J. Quan, MSc, L. Hracs, PhD, Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta
| | - Lindsay Hracs
- G.G. Kaplan, MD, MPH, J. Quan, MSc, L. Hracs, PhD, Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta
| | - Elizabeth Turnbull
- L. Lukusa, MSc, J.L.F. Lee, BSc, E. Turnbull, RN, V. Valerio, MD, The Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec
| | - Valeria Valerio
- L. Lukusa, MSc, J.L.F. Lee, BSc, E. Turnbull, RN, V. Valerio, MD, The Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec
| | - Sasha Bernatsky
- I. Colmegna, MD, S. Bernatsky, MD, PhD, The Research Institute of the McGill University Health Center, McGill University, Montreal, Quebec, and Department of Medicine, Division of Rheumatology, McGill University, Montreal, Quebec;
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4
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Brown PE, Fu SH, Newcombe L, Tang X, Nagelkerke N, Birnboim HC, Bansal A, Colwill K, Mailhot G, Delgado-Brand M, Tursun T, Qi F, Gingras AC, Slutsky AS, Pasic MD, Companion J, Bogoch II, Morawski E, Lam T, Reid A, Jha P. Hybrid immunity from severe acute respiratory syndrome coronavirus 2 infection and vaccination in Canadian adults: A cohort study. eLife 2024; 13:e89961. [PMID: 38916134 PMCID: PMC11281784 DOI: 10.7554/elife.89961] [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: 10/23/2023] [Accepted: 06/20/2024] [Indexed: 06/26/2024] Open
Abstract
Background Few national-level studies have evaluated the impact of 'hybrid' immunity (vaccination coupled with recovery from infection) from the Omicron variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods From May 2020 to December 2022, we conducted serial assessments (each of ~4000-9000 adults) examining SARS-CoV-2 antibodies within a mostly representative Canadian cohort drawn from a national online polling platform. Adults, most of whom were vaccinated, reported viral test-confirmed infections and mailed self-collected dried blood spots (DBSs) to a central lab. Samples underwent highly sensitive and specific antibody assays to spike and nucleocapsid protein antigens, the latter triggered only by infection. We estimated cumulative SARS-CoV-2 incidence prior to the Omicron period and during the BA.1/1.1 and BA.2/5 waves. We assessed changes in antibody levels and in age-specific active immunity levels. Results Spike levels were higher in infected than in uninfected adults, regardless of vaccination doses. Among adults vaccinated at least thrice and infected more than 6 months earlier, spike levels fell notably and continuously for the 9-month post-vaccination. In contrast, among adults infected within 6 months, spike levels declined gradually. Declines were similar by sex, age group, and ethnicity. Recent vaccination attenuated declines in spike levels from older infections. In a convenience sample, spike antibody and cellular responses were correlated. Near the end of 2022, about 35% of adults above age 60 had their last vaccine dose more than 6 months ago, and about 25% remained uninfected. The cumulative incidence of SARS-CoV-2 infection rose from 13% (95% confidence interval 11-14%) before omicron to 78% (76-80%) by December 2022, equating to 25 million infected adults cumulatively. However, the coronavirus disease 2019 (COVID-19) weekly death rate during the BA.2/5 waves was less than half of that during the BA.1/1.1 wave, implying a protective role for hybrid immunity. Conclusions Strategies to maintain population-level hybrid immunity require up-to-date vaccination coverage, including among those recovering from infection. Population-based, self-collected DBSs are a practicable biological surveillance platform. Funding Funding was provided by the COVID-19 Immunity Task Force, Canadian Institutes of Health Research, Pfizer Global Medical Grants, and St. Michael's Hospital Foundation. PJ and ACG are funded by the Canada Research Chairs Program.
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Affiliation(s)
- Patrick E Brown
- Centre for Global Health Research, Unity Health Toronto and University of TorontoTorontoCanada
| | - Sze Hang Fu
- Centre for Global Health Research, Unity Health Toronto and University of TorontoTorontoCanada
| | - Leslie Newcombe
- Centre for Global Health Research, Unity Health Toronto and University of TorontoTorontoCanada
| | - Xuyang Tang
- Centre for Global Health Research, Unity Health Toronto and University of TorontoTorontoCanada
| | - Nico Nagelkerke
- Centre for Global Health Research, Unity Health Toronto and University of TorontoTorontoCanada
| | - H Chaim Birnboim
- Centre for Global Health Research, Unity Health Toronto and University of TorontoTorontoCanada
| | - Aiyush Bansal
- Centre for Global Health Research, Unity Health Toronto and University of TorontoTorontoCanada
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute, Sinai HealthTorontoCanada
| | | | | | - Tulunay Tursun
- Lunenfeld-Tanenbaum Research Institute, Sinai HealthTorontoCanada
| | - Freda Qi
- Lunenfeld-Tanenbaum Research Institute, Sinai HealthTorontoCanada
| | | | | | | | | | - Isaac I Bogoch
- Toronto General Hospital, University Hospital NetworkTorontoCanada
| | | | | | | | - Prabhat Jha
- Centre for Global Health Research, Unity Health Toronto and University of TorontoTorontoCanada
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Guan D, Dave S, Ebrahim M, Laroche JA. Factors associated with childhood non-vaccination against COVID-19 in Canada: A national survey analysis. Vaccine X 2024; 18:100478. [PMID: 38572339 PMCID: PMC10988031 DOI: 10.1016/j.jvacx.2024.100478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/01/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
Background COVID-19 vaccination efforts are critical in mitigating the impact of the virus, but despite proven safety and efficacy, vaccination rates among children in Canada are lower than in adults, prompting a need to explore determinants of childhood COVID-19 non-vaccination to improve uptake. Method This study analyzed data from the Canadian COVID-19 Immunization Coverage Survey 2022. Using multivariable logistic regression, it examined the association between COVID-19 non-vaccination among children aged 5-17 and factors such as parental sociodemographic characteristics, vaccine knowledge, attitudes, and beliefs (KAB), and vaccination history. Results The analysis revealed that negative KAB towards vaccines, reflected in higher KAB composite scores, significantly increased the likelihood of non-vaccination. Additionally, factors such as lower household incomes, rural residence, employment in sectors not at risk for vaccine-preventable diseases, and younger parental age were associated with higher non-vaccination. The study also highlighted ethnic disparities in vaccination odds and found that children with incomplete routine vaccinations or inconsistent flu vaccination histories were more likely to be unvaccinated against COVID-19. Surprisingly, children of parents who consistently received flu vaccinations were more likely to be unvaccinated against COVID-19. Furthermore, parental education levels showed a complex relationship with children's COVID-19 vaccination status, indicating nuanced influences on vaccination decisions. Conclusion The findings offer vital insights into the factors influencing COVID-19 vaccination uptake among children in Canada, suggesting avenues for targeted strategies to improve vaccine coverage.
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Affiliation(s)
- David Guan
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Sailly Dave
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Marwa Ebrahim
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Julie A. Laroche
- Centre for Immunization Surveillance, Public Health Agency of Canada, Ottawa, Ontario, Canada
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6
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Naik H, Wilton J, Tran KC, Janjua NZ, Levin A, Zhang W. Long-Term Health-Related Quality of Life in Working-Age COVID-19 Survivors: A Cross-Sectional Study. Am J Med 2024:S0002-9343(24)00338-3. [PMID: 38795939 DOI: 10.1016/j.amjmed.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Most working-age (18-64) adults have been infected with SARS-CoV-2, and some may have developed post-COVID-19 condition (PCC). However, long-term health-related quality of life (HRQOL) following infection remains uncharacterized. METHODS In this cross-sectional study, COVID-19 survivors from throughout British Columbia (BC), Canada, completed a questionnaire >2 years after infection. PCC status was self-reported, and HRQOL was assessed using the EuroQol 5-dimension 5-level (EQ-5D-5L) instrument. We compared HRQOL in those with current PCC, those with recovered PCC, and those without a history of PCC. Multivariable analyses were weighted to be representative of COVID-19 survivors in BC. RESULTS Of the 1,135 analyzed participants, 19.2% had current PCC, and 27.6% had recovered PCC. Compared to those without a history of PCC, participants with recovered PCC had a similar mean EQ-5D health utility (adjusted difference -0.02 [95%CI -0.03, 0.00]), but those with current PCC had a lower health utility (adjusted difference -0.08 [95%CI -0.12, -0.05]). Participants with current PCC were also more likely to report problems with mobility (adjusted odds ratio (aOR) 6.00 [95%CI 2.88-12.52]), self-care (aOR 5.96 [95%CI 1.84-19.32]), usual activities (aOR 8.00 [95%CI 4.27-14.99]), pain/discomfort (aOR 4.28 [95%CI 2.46-7.48]), and anxiety/depression (aOR 3.45 [95%CI 1.90-6.27]). CONCLUSIONS In working-age adults who have survived >2 years following COVID-19, HRQOL is high among those who never had PCC or have recovered from PCC. However, individuals with ongoing symptoms have lower HRQOL and are more likely to have functional deficits. These findings underscore the importance of implementing targeted healthcare interventions to improve HRQOL in adults with long-term PCC.
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Affiliation(s)
- Hiten Naik
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Post-COVID-19 Interdisciplinary Clinical Care Network, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada.
| | - James Wilton
- BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Karen C Tran
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Post-COVID-19 Interdisciplinary Clinical Care Network, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | - Naveed Zafar Janjua
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada; BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada; School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Adeera Levin
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Post-COVID-19 Interdisciplinary Clinical Care Network, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | - Wei Zhang
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
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7
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Walmsley S, Nabipoor M, Qi F, Lovblom LE, Ravindran R, Colwill K, Dayam RM, Tursun TR, Silva A, Gingras AC. Declining Levels of Neutralizing Antibodies to SARS-CoV-2 Omicron Variants Are Enhanced by Hybrid Immunity and Original/Omicron Bivalent Vaccination. Vaccines (Basel) 2024; 12:564. [PMID: 38932293 PMCID: PMC11209254 DOI: 10.3390/vaccines12060564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 06/28/2024] Open
Abstract
We determined neutralizing antibody levels to the ancestral Wuhan SARS-CoV-2 strain and three Omicron variants, namely BA.5, XBB.1.5, and EG.5, in a heavily vaccinated cohort of 178 adults 15-19 months after the initial vaccine series and prospectively after 4 months. Although all participants had detectable neutralizing antibodies to Wuhan, the proportion with detectable neutralizing antibodies to the Omicron variants was decreased, and the levels were lower. Individuals with hybrid immunity at the baseline visit and those receiving the Original/Omicron bivalent vaccine between the two sampling times demonstrated increased neutralizing antibodies to all strains. Both a higher baseline neutralizing antibody titer to Omicron BA.5 and hybrid immunity were associated with protection against a breakthrough SARS-CoV-2 infection during a 4-month period of follow up during the Omicron BA.5 wave. Neither were associated with protection from a breakthrough infection at 10 months follow up. Receipt of an Original/Omicron BA.4/5 vaccine was associated with protection from a breakthrough infection at both 4 and 10 months follow up. This work demonstrates neutralizing antibody escape with the emerging Omicron variants and supports the use of additional vaccine doses with components that match circulating SARS-CoV-2 variants. A threshold value for neutralizing antibodies for protection against reinfection cannot be determined.
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Affiliation(s)
- Sharon Walmsley
- Division of Infectious Diseases, University Health Network, Toronto, ON M5G 2C4, Canada;
- Department of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Majid Nabipoor
- Biostatistics Department, University Health Network, Toronto, ON M5G 2C4, Canada; (M.N.); (L.E.L.)
| | - Freda Qi
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON M5G 1X5, Canada; (F.Q.); (K.C.); (R.M.D.); (T.R.T.); (A.-C.G.)
| | - Leif Erik Lovblom
- Biostatistics Department, University Health Network, Toronto, ON M5G 2C4, Canada; (M.N.); (L.E.L.)
| | - Rizani Ravindran
- Division of Infectious Diseases, University Health Network, Toronto, ON M5G 2C4, Canada;
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON M5G 1X5, Canada; (F.Q.); (K.C.); (R.M.D.); (T.R.T.); (A.-C.G.)
| | - Roya Monica Dayam
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON M5G 1X5, Canada; (F.Q.); (K.C.); (R.M.D.); (T.R.T.); (A.-C.G.)
| | - Tulunay R. Tursun
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON M5G 1X5, Canada; (F.Q.); (K.C.); (R.M.D.); (T.R.T.); (A.-C.G.)
| | - Amanda Silva
- DATA Team, University Health Network, Toronto, ON M5G 2C4, Canada;
| | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON M5G 1X5, Canada; (F.Q.); (K.C.); (R.M.D.); (T.R.T.); (A.-C.G.)
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5S 1A1, Canada
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8
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Datwani S, Kalikawe R, Waterworth R, Mwimanzi FM, Liang R, Sang Y, Lapointe HR, Cheung PK, Omondi FH, Duncan MC, Barad E, Speckmaier S, Moran-Garcia N, DeMarco ML, Hedgcock M, Costiniuk CT, Hull M, Harris M, Romney MG, Montaner JSG, Brumme ZL, Brockman MA. T-Cell Responses to COVID-19 Vaccines and Breakthrough Infection in People Living with HIV Receiving Antiretroviral Therapy. Viruses 2024; 16:661. [PMID: 38793543 PMCID: PMC11125792 DOI: 10.3390/v16050661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
People living with HIV (PLWH) can exhibit impaired immune responses to vaccines. Accumulating evidence indicates that PLWH, particularly those receiving antiretroviral therapy, mount strong antibody responses to COVID-19 vaccines, but fewer studies have examined cellular immune responses to the vaccinations. Here, we used an activation-induced marker (AIM) assay to quantify SARS-CoV-2 spike-specific CD4+ and CD8+ T cells generated by two and three doses of COVID-19 vaccines in 50 PLWH receiving antiretroviral therapy, compared to 87 control participants without HIV. In a subset of PLWH, T-cell responses were also assessed after post-vaccine breakthrough infections and/or receipt of a fourth vaccine dose. All participants remained SARS-CoV-2 infection-naive until at least one month after their third vaccine dose. SARS-CoV-2 infection was determined by seroconversion to a Nucleocapsid (N) antigen, which occurred in 21 PLWH and 38 control participants after the third vaccine dose. Multivariable regression analyses were used to investigate the relationships between sociodemographic, health- and vaccine-related variables, vaccine-induced T-cell responses, and breakthrough infection risk. We observed that a third vaccine dose boosted spike-specific CD4+ and CD8+ T-cell frequencies significantly above those measured after the second dose (all p < 0.0001). Median T-cell frequencies did not differ between PLWH and controls after the second dose (p > 0.1), but CD8+ T-cell responses were modestly lower in PLWH after the third dose (p = 0.02), an observation that remained significant after adjusting for sociodemographic, health- and vaccine-related variables (p = 0.045). In PLWH who experienced a breakthrough infection, median T-cell frequencies increased even higher than those observed after three vaccine doses (p < 0.03), and CD8+ T-cell responses in this group remained higher even after a fourth vaccine dose (p = 0.03). In multivariable analyses, the only factor associated with an increased breakthrough infection risk was younger age, which is consistent with the rapid increase in SARS-CoV-2 seropositivity that was seen among younger adults in Canada after the initial appearance of the Omicron variant. These results indicate that PLWH receiving antiretroviral therapy mount strong T-cell responses to COVID-19 vaccines that can be enhanced by booster doses or breakthrough infection.
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Affiliation(s)
- Sneha Datwani
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V6A 1S6, Canada; (S.D.); (R.K.); (R.W.); (F.M.M.); (Y.S.); (P.K.C.); (F.H.O.); (M.C.D.); (E.B.)
| | - Rebecca Kalikawe
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V6A 1S6, Canada; (S.D.); (R.K.); (R.W.); (F.M.M.); (Y.S.); (P.K.C.); (F.H.O.); (M.C.D.); (E.B.)
| | - Rachel Waterworth
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V6A 1S6, Canada; (S.D.); (R.K.); (R.W.); (F.M.M.); (Y.S.); (P.K.C.); (F.H.O.); (M.C.D.); (E.B.)
| | - Francis M. Mwimanzi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V6A 1S6, Canada; (S.D.); (R.K.); (R.W.); (F.M.M.); (Y.S.); (P.K.C.); (F.H.O.); (M.C.D.); (E.B.)
| | - Richard Liang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (R.L.); (H.R.L.); (N.M.-G.); (M.H.); (M.H.); (J.S.G.M.)
| | - Yurou Sang
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V6A 1S6, Canada; (S.D.); (R.K.); (R.W.); (F.M.M.); (Y.S.); (P.K.C.); (F.H.O.); (M.C.D.); (E.B.)
| | - Hope R. Lapointe
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (R.L.); (H.R.L.); (N.M.-G.); (M.H.); (M.H.); (J.S.G.M.)
| | - Peter K. Cheung
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V6A 1S6, Canada; (S.D.); (R.K.); (R.W.); (F.M.M.); (Y.S.); (P.K.C.); (F.H.O.); (M.C.D.); (E.B.)
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (R.L.); (H.R.L.); (N.M.-G.); (M.H.); (M.H.); (J.S.G.M.)
| | - Fredrick Harrison Omondi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V6A 1S6, Canada; (S.D.); (R.K.); (R.W.); (F.M.M.); (Y.S.); (P.K.C.); (F.H.O.); (M.C.D.); (E.B.)
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (R.L.); (H.R.L.); (N.M.-G.); (M.H.); (M.H.); (J.S.G.M.)
| | - Maggie C. Duncan
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V6A 1S6, Canada; (S.D.); (R.K.); (R.W.); (F.M.M.); (Y.S.); (P.K.C.); (F.H.O.); (M.C.D.); (E.B.)
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (R.L.); (H.R.L.); (N.M.-G.); (M.H.); (M.H.); (J.S.G.M.)
| | - Evan Barad
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V6A 1S6, Canada; (S.D.); (R.K.); (R.W.); (F.M.M.); (Y.S.); (P.K.C.); (F.H.O.); (M.C.D.); (E.B.)
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (R.L.); (H.R.L.); (N.M.-G.); (M.H.); (M.H.); (J.S.G.M.)
| | - Sarah Speckmaier
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (R.L.); (H.R.L.); (N.M.-G.); (M.H.); (M.H.); (J.S.G.M.)
| | - Nadia Moran-Garcia
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (R.L.); (H.R.L.); (N.M.-G.); (M.H.); (M.H.); (J.S.G.M.)
| | - Mari L. DeMarco
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, BC V6Z 1Y6, Canada (M.G.R.)
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | | | - Cecilia T. Costiniuk
- Division of Infectious Diseases Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (R.L.); (H.R.L.); (N.M.-G.); (M.H.); (M.H.); (J.S.G.M.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Marianne Harris
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (R.L.); (H.R.L.); (N.M.-G.); (M.H.); (M.H.); (J.S.G.M.)
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Marc G. Romney
- Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, BC V6Z 1Y6, Canada (M.G.R.)
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (R.L.); (H.R.L.); (N.M.-G.); (M.H.); (M.H.); (J.S.G.M.)
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Zabrina L. Brumme
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V6A 1S6, Canada; (S.D.); (R.K.); (R.W.); (F.M.M.); (Y.S.); (P.K.C.); (F.H.O.); (M.C.D.); (E.B.)
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (R.L.); (H.R.L.); (N.M.-G.); (M.H.); (M.H.); (J.S.G.M.)
| | - Mark A. Brockman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V6A 1S6, Canada; (S.D.); (R.K.); (R.W.); (F.M.M.); (Y.S.); (P.K.C.); (F.H.O.); (M.C.D.); (E.B.)
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada; (R.L.); (H.R.L.); (N.M.-G.); (M.H.); (M.H.); (J.S.G.M.)
- Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V6A 1S6, Canada
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9
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Yu Y, Knight MJ, Gibson D, O’Brien SF, Buckeridge DL, Russell WA. Temporal trends in disparities in COVID-19 seropositivity among Canadian blood donors. Int J Epidemiol 2024; 53:dyae078. [PMID: 38840559 PMCID: PMC11153835 DOI: 10.1093/ije/dyae078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND In Canada's largest COVID-19 serological study, SARS-CoV-2 antibodies in blood donors have been monitored since 2020. No study has analysed changes in the association between anti-N seropositivity (a marker of recent infection) and geographic and sociodemographic characteristics over the pandemic. METHODS Using Bayesian multi-level models with spatial effects at the census division level, we analysed changes in correlates of SARS-CoV-2 anti-N seropositivity across three periods in which different variants predominated (pre-Delta, Delta and Omicron). We analysed disparities by geographic area, individual traits (age, sex, race) and neighbourhood factors (urbanicity, material deprivation and social deprivation). Data were from 420 319 blood donations across four regions (Ontario, British Columbia [BC], the Prairies and the Atlantic region) from December 2020 to November 2022. RESULTS Seropositivity was higher for racialized minorities, males and individuals in more materially deprived neighbourhoods in the pre-Delta and Delta waves. These subgroup differences dissipated in the Omicron wave as large swaths of the population became infected. Across all waves, seropositivity was higher in younger individuals and those with lower neighbourhood social deprivation. Rural residents had high seropositivity in the Prairies, but not other regions. Compared to generalized linear models, multi-level models with spatial effects had better fit and lower error when predicting SARS-CoV-2 anti-N seropositivity by geographic region. CONCLUSIONS Correlates of recent COVID-19 infection have evolved over the pandemic. Many disparities lessened during the Omicron wave, but public health intervention may be warranted to address persistently higher burden among young people and those with less social deprivation.
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Affiliation(s)
- Yuan Yu
- School of Population and Global Health, McGill University, Montreal, Canada
| | - Matthew J Knight
- School of Population and Global Health, McGill University, Montreal, Canada
| | - Diana Gibson
- School of Population and Global Health, McGill University, Montreal, Canada
| | - Sheila F O’Brien
- Canadian Blood Services, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - David L Buckeridge
- School of Population and Global Health, McGill University, Montreal, Canada
- COVID-19 Immunity Task Force, Montreal, Canada
| | - W Alton Russell
- School of Population and Global Health, McGill University, Montreal, Canada
- COVID-19 Immunity Task Force, Montreal, Canada
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10
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O’Brien SF, Deeks SL, Hatchette T, Pambrun C, Drews SJ. SARS-CoV-2 seroprevalence in Nova Scotia blood donors. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2024; 9:32-45. [PMID: 38567363 PMCID: PMC10984316 DOI: 10.3138/jammi-2023-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/20/2023] [Accepted: 11/09/2023] [Indexed: 04/04/2024]
Abstract
Background SARS-CoV-2 seroprevalence monitors cumulative infection rates irrespective of case testing protocols. We aimed to describe Nova Scotia blood donor seroprevalence in relation to public health policy and reported data over the course of the COVID-19 pandemic (May 2020 to August 2022). Methods Monthly random Nova Scotia blood donation samples (24,258 in total) were tested for SARS-CoV-2 infection antibodies (anti-nucleocapsid) from May 2020 to August 2022, and vaccination antibodies (anti-spike) from January 2021 to August 2022. Multivariable logistic regression for infection antibodies and vaccination antibodies separately with month, age, sex, and racialization identified independent predictors. The provincial nucleic acid amplification test (NAAT)-positive case rate over the pandemic was calculated from publicly available data. Results Anti-N seroprevalence was 3.8% in January 2022, increasing to 50.8% in August 2022. The general population COVID-19 case rate was 3.5% in January 2022, increasing to 12.5% in August 2022. The percentage of NAAT-positive samples in public health laboratories increased from 1% in November 2021 to a peak of 30.7% in April 2022 with decreasing numbers of tests performed. Higher proportions of younger donors as well as Black, Indigenous, and racialized blood donors were more likely to have infection antibodies (p < 0.01). Vaccination antibodies increased to 100% over 2021, initially in older donors (60+ years), and followed by progressively younger age groups. Conclusions SARS-CoV-2 infection rates were relatively low in Nova Scotia until the more contagious Omicron variant dominated, after which about half of Nova Scotia donors had been infected despite most adults being vaccinated (although severity was much lower in vaccinated individuals). Most COVID-19 cases were detected by NAAT until Omicron arrived. When NAAT testing priorities focused on high-risk individuals, infection rates were better reflected by seroprevalence.
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Affiliation(s)
- Sheila F O’Brien
- Epidemiology & Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ontario, Canada
| | - Shelley L Deeks
- Department of Health and Wellness, Government of Nova Scotia, Halifax, Nova Scotia, Canada
- Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd Hatchette
- Division of Microbiology, Nova Scotia Health, Central Zone, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Chantale Pambrun
- Medical Affairs & Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Steven J Drews
- Microbiology, Canadian Blood Services, Edmonton, Alberta, Canada
- Department of Pathology & Laboratory Medicine, University of Alberta, Edmonton, Alberta, Canada
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11
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Walmsley S, Nabipoor M, Lovblom LE, Ravindran R, Colwill K, McGeer A, Dayam RM, Manase D, Gingras AC. Predictors of Breakthrough SARS-CoV-2 Infection after Vaccination. Vaccines (Basel) 2023; 12:36. [PMID: 38250849 PMCID: PMC10820583 DOI: 10.3390/vaccines12010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
The initial two-dose vaccine series and subsequent booster vaccine doses have been effective in modulating SARS-CoV-2 disease severity and death but do not completely prevent infection. The correlates of infection despite vaccination continue to be under investigation. In this prospective decentralized study (n = 1286) comparing antibody responses in an older- (≥70 years) to a younger-aged cohort (aged 30-50 years), we explored the correlates of breakthrough infection in 983 eligible subjects. Participants self-reported data on initial vaccine series, subsequent booster doses and COVID-19 infections in an online portal and provided self-collected dried blood spots for antibody testing by ELISA. Multivariable survival analysis explored the correlates of breakthrough infection. An association between higher antibody levels and protection from breakthrough infection observed during the Delta and Omicron BA.1/2 waves of infection no longer existed during the Omicron BA.4/5 wave. The older-aged cohort was less likely to have a breakthrough infection at all time-points. Receipt of an original/Omicron vaccine and the presence of hybrid immunity were associated with protection of infection during the later Omicron BA.4/5 and XBB waves. We were unable to determine a threshold antibody to define protection from infection or to guide vaccine booster schedules.
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Affiliation(s)
- Sharon Walmsley
- Division of Infectious Diseases, Department of Medicine, University Health Network, Toronto, ON M5G1L7, Canada;
- Department of Medicine, University of Toronto, Toronto, ON M5S1A1, Canada
| | - Majid Nabipoor
- Biostatistics Department, University Health Network, Toronto, ON M5G1L7, Canada; (M.N.); (L.E.L.)
| | - Leif Erik Lovblom
- Biostatistics Department, University Health Network, Toronto, ON M5G1L7, Canada; (M.N.); (L.E.L.)
| | - Rizani Ravindran
- Division of Infectious Diseases, Department of Medicine, University Health Network, Toronto, ON M5G1L7, Canada;
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON M5G1X5, Canada; (K.C.); (R.M.D.); (A.-C.G.)
| | - Alison McGeer
- Mount Sinai Hospital, Sinai Health, Toronto, ON M5G1X5, Canada;
| | - Roya Monica Dayam
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON M5G1X5, Canada; (K.C.); (R.M.D.); (A.-C.G.)
| | - Dorin Manase
- DATA Team, University Health Network, Toronto, ON M5G1L7, Canada;
| | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Sinai Health, Toronto, ON M5G1X5, Canada; (K.C.); (R.M.D.); (A.-C.G.)
- Department of Molecular Genetics, University of Toronto, Toronto, ON M5S1A1, Canada
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12
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Skowronski DM, Kaweski SE, Irvine MA, Chuang ESY, Kim S, Sabaiduc S, Reyes RC, Henry B, Sekirov I, Smolina K. Risk of hospital admission and death from first-ever SARS-CoV-2 infection by age group during the Delta and Omicron periods in British Columbia, Canada. CMAJ 2023; 195:E1427-E1439. [PMID: 37903524 PMCID: PMC10615343 DOI: 10.1503/cmaj.230721] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Population-based cross-sectional serosurveys within the Lower Mainland, British Columbia, Canada, showed about 10%, 40% and 60% of residents were infected with SARS-CoV-2 by the sixth (September 2021), seventh (March 2022) and eighth (July 2022) serosurveys. We conducted the ninth (December 2022) and tenth (July 2023) serosurveys and sought to assess risk of severe outcomes from a first-ever SARS-CoV-2 infection during intersurvey periods. METHODS Using increments in cumulative infection-induced seroprevalence, population census, discharge abstract and vital statistics data sets, we estimated infection hospitalization and fatality ratios (IHRs and IFRs) by age and sex for the sixth to seventh (Delta/Omicron-BA.1), seventh to eighth (Omicron-BA.2/BA.5) and eighth to ninth (Omicron-BA.5/BQ.1) intersurvey periods. As derived, IHR and IFR estimates represent the risk of severe outcome from a first-ever SARS-CoV-2 infection acquired during the specified intersurvey period. RESULTS The cumulative infection-induced seroprevalence was 74% by December 2022 and 79% by July 2023, exceeding 80% among adults younger than 50 years but remaining less than 60% among those aged 80 years and older. Period-specific IHR and IFR estimates were consistently less than 0.3% and 0.1% overall. By age group, IHR and IFR estimates were less than 1.0% and up to 0.1%, respectively, except among adults aged 70-79 years during the sixth to seventh intersurvey period (IHR 3.3% and IFR 1.0%) and among those aged 80 years and older during all periods (IHR 4.7%, 2.2% and 3.5%; IFR 3.3%, 0.6% and 1.3% during the sixth to seventh, seventh to eighth and eighth to ninth periods, respectively). The risk of severe outcome followed a J-shaped age pattern. During the eighth to ninth period, we estimated about 1 hospital admission for COVID-19 per 300 newly infected children younger than 5 years versus about 1 per 30 newly infected adults aged 80 years and older, with no deaths from COVID-19 among children but about 1 death per 80 newly infected adults aged 80 years and older during that period. INTERPRETATION By July 2023, we estimated about 80% of residents in the Lower Mainland, BC, had been infected with SARS-CoV-2 overall, with low risk of hospital admission or death; about 40% of the oldest adults, however, remained uninfected and at highest risk of a severe outcome. First infections among older adults may still contribute substantial burden from COVID-19, reinforcing the need to continue to prioritize this age group for vaccination and to consider them in health care system planning.
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Affiliation(s)
- Danuta M Skowronski
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Samantha E Kaweski
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Michael A Irvine
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Erica S Y Chuang
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Shinhye Kim
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Suzana Sabaiduc
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Romina C Reyes
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Bonnie Henry
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Inna Sekirov
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
| | - Kate Smolina
- Immunization Programs and Vaccine Preventable Diseases Service (Skowronski, Kaweski, Chuang, Kim), BC Centre for Disease Control; School of Population and Public Health (Skowronski, Henry, Smolina), University of British Columbia; Data and Analytic Services (Irvine, Smolina), BC Centre for Disease Control, Vancouver, BC; Faculty of Health Sciences (Irvine), Simon Fraser University, Burnaby, BC; Public Health Laboratory (Sabaiduc, Sekirov), BC Centre for Disease Control; Department of Pathology and Laboratory Medicine (Reyes, Sekirov), University of British Columbia, Vancouver, BC; LifeLabs (Reyes), Burnaby, BC; Ministry of Health (Henry), Office of the Provincial Health Officer, Victoria, BC
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