1
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Xue R, Liu S, Zhou F. Enhancing the effectiveness of anti-respiratory virus vaccines by bolstering mucosal immunity and cellular defenses. MedComm (Beijing) 2024; 5:e616. [PMID: 39184860 PMCID: PMC11344650 DOI: 10.1002/mco2.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/19/2024] [Accepted: 05/23/2024] [Indexed: 08/27/2024] Open
Abstract
A schematic diagram of intratracheal (IT) boosting, which leads to enhanced mucosal immunity and protective efficacy. IT boosting leads to significant expansion of mucosal neutralizing antibodies, along with robust CD8+ and CD4+ T-cell responses. Notably, IT boosting results in substantial and sustained activation of cytokine, natural killer, T, and B-cell pathways in the lung, contributing to enhanced mucosal immunity and overall protective efficacy.
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Affiliation(s)
- Rubing Xue
- The First Affiliated Hospital, the Institutes of Biology and Medical Sciences, Suzhou Medical CollegeSoochow UniversitySuzhouChina
- MOE Laboratory of Biosystems Homeostasis & Protection and Innovation Center for Cell Signaling NetworkLife Sciences InstituteHangzhouZhejiangChina
| | - Sijia Liu
- International Biomed‐X Research Center, Second Affiliated Hospital of Zhejiang University School of MedicineZhejiang UniversityHangzhouChina
| | - Fangfang Zhou
- The First Affiliated Hospital, the Institutes of Biology and Medical Sciences, Suzhou Medical CollegeSoochow UniversitySuzhouChina
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2
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Poukka E, Perälä J, Nohynek H, Goebeler S, Auranen K, Leino T, Baum U. Relative effectiveness of bivalent boosters against severe COVID-19 outcomes among people aged ≥ 65 years in Finland, September 2022 to August 2023. Euro Surveill 2024; 29. [PMID: 39268649 PMCID: PMC11395282 DOI: 10.2807/1560-7917.es.2024.29.37.2300587] [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] [Indexed: 09/17/2024] Open
Abstract
BackgroundLong-term effectiveness data on bivalent COVID-19 boosters are limited.AimWe evaluated the long-term protection of bivalent boosters against severe COVID-19 among ≥ 65-year-olds in Finland.MethodsIn this register-based cohort analysis, we compared the risk of three severe COVID-19 outcomes among ≥ 65-year-olds who received a bivalent booster (Original/Omicron BA.1 or Original/BA.4-5; exposed group) between 1/9/2022 and 31/8/2023 to those who did not (unexposed). We included individuals vaccinated with at least two monovalent COVID-19 vaccine doses before 1/9/2022 and ≥ 3 months ago. The analysis was divided into two periods: 1/9/2022-28/2/2023 (BA.5 and BQ.1.X predominating) and 1/3/2023-31/8/2023 (XBB predominating). The hazards for the outcomes between exposed and unexposed individuals were compared with Cox regression.ResultsWe included 1,191,871 individuals. From 1/9/2022 to 28/2/2023, bivalent boosters were associated with a reduced risk of hospitalisation due to COVID-19 (hazard ratio (HR): 0.45; 95% confidence interval (CI): 0.37-0.55), death due to COVID-19 (HR: 0.49; 95% CI: 0.38-0.62), and death in which COVID-19 was a contributing factor (HR: 0.40; 95% CI: 0.31-0.51) during 14-60 days since vaccination. From 1/3/2023 to 31/8/2023, bivalent boosters were associated with lower risks of all three severe COVID-19 outcomes during 61-120 days since a bivalent booster (e.g. HR: 0.53; 95% CI: 0.39-0.71 for hospitalisation due to COVID-19); thereafter no notable risk reduction was observed. No difference was found between Original/Omicron BA.1 and Original/BA.4-5 boosters.ConclusionBivalent boosters initially reduced the risk of severe COVID-19 outcomes by ca 50% among ≥ 65-year-olds, but protection waned over time. These findings help guide vaccine development and vaccination programmes.
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Affiliation(s)
- Eero Poukka
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jori Perälä
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sirkka Goebeler
- Forensic Medicine Unit, Department of Government services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kari Auranen
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Tuija Leino
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ulrike Baum
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
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3
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Baden LR, El Sahly HM, Essink B, Follmann D, Hachigian G, Strout C, Overcash JS, Doblecki-Lewis S, Whitaker JA, Anderson EJ, Neuzil K, Corey L, Priddy F, Tomassini JE, Brown M, Girard B, Stolman D, Urdaneta V, Wang X, Deng W, Zhou H, Dixit A, Das R, Miller JM. Long-term safety and effectiveness of mRNA-1273 vaccine in adults: COVE trial open-label and booster phases. Nat Commun 2024; 15:7469. [PMID: 39209823 PMCID: PMC11362294 DOI: 10.1038/s41467-024-50376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024] Open
Abstract
Primary vaccination with mRNA-1273 (100-µg) was safe and efficacious at preventing coronavirus disease 2019 (COVID-19) in the previously reported, blinded Part A of the phase 3 Coronavirus Efficacy (COVE; NCT04470427) trial in adults (≥18 years) across 99 U.S. sites. The open-label (Parts B and C) primary objectives were evaluation of long-term safety and effectiveness of primary vaccination plus a 50-µg booster dose; immunogenicity was a secondary objective. Of 29,035 open-label participants, 19,609 received boosters (mRNA-1273 [n = 9647]; placebo-mRNA-1273 [n = 9952]; placebo [n = 10] groups). Booster safety was consistent with that reported for primary vaccination. Incidences of COVID-19 and severe COVID-19 were higher during the Omicron BA.1 than Delta variant waves and boosting versus non-boosting was associated with a significant, 47.0% (95% CI : 39.0-53.9%) reduction of Omicron BA.1 incidence (24.6 [23.4 - 25.8] vs 46.4 [40.6 - 52.7]/1000 person-months). In an exploratory Cox regression model adjusted for time-varying covariates, a longer median interval between primary vaccination and boosting (mRNA-1273 [13 months] vs placebo-mRNA-1273 [8 months]) was associated with significantly lower, COVID-19 risk (24.0% [16.0% - 32.0%]) during Omicron BA.1 predominance. Boosting elicited greater immune responses against SARS-CoV-2 than primary vaccination, irrespective of prior SARS-CoV-2 infection. Primary vaccination and boosting with mRNA-1273 demonstrated acceptable safety, effectiveness and immunogenicity against COVID-19, including emergent variants.
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Affiliation(s)
| | | | | | - Dean Follmann
- National Institute of Allergy and Infectious Disease, Bethesda, MD, USA
| | | | - Cynthia Strout
- Coastal Carolina Research Center, Mount Pleasant, SC, USA
| | | | | | | | | | | | - Lawrence Corey
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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4
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Chalkias S, McGhee N, Whatley JL, Essink B, Brosz A, Tomassini JE, Girard B, Edwards DK, Wu K, Nasir A, Lee D, Avena LE, Feng J, Deng W, Montefiori DC, Baden LR, Miller JM, Das R. Interim Report of the Reactogenicity and Immunogenicity of Severe Acute Respiratory Syndrome Coronavirus 2 XBB-Containing Vaccines. J Infect Dis 2024; 230:e279-e286. [PMID: 38349280 PMCID: PMC11326827 DOI: 10.1093/infdis/jiae067] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Monovalent Omicron XBB.1.5-containing vaccines were approved for coronavirus disease 2019 (COVID-19) 2023-2024 immunizations. METHODS This ongoing, open-label, phase 2/3 study evaluated messenger RNA (mRNA)-1273.815 monovalent (50-µg Omicron XBB.1.5 spike mRNA) and mRNA-1273.231 bivalent (25-µg each Omicron XBB.1.5 and BA.4/BA.5 spike mRNAs) vaccines, administered as fifth doses to adults who previously received primary series, third doses of an original mRNA COVID-19 vaccine, and fourth doses of an Omicron BA.4/BA.5 bivalent vaccine. Interim safety and immunogenicity 29 days after vaccination are reported. RESULTS Participants (randomized 1:1) received 50-µg of mRNA-1273.815 (n = 50) or mRNA-1273.231 (n = 51); median intervals (interquartile range) from prior BA.4/BA.5 bivalent doses were 8.2 (8.1-8.3) and 8.3 (8.1-8.4) months, respectively. Fold increases in neutralizing antibody (nAb) against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants from prebooster nAb levels were numerically higher against XBB.1.5, XBB.1.16, EG.5.1, BA.2.86, and JN.1 than BA.4/BA.5, BQ.1.1, or D614G on day 29. Monovalent vaccine also cross-neutralized FL.1.5.1, EG.5.1, BA.2.86, HK.3.1, HV.1, and JN.1 variants in a participant subset (n = 20) 15 days after vaccination. Reactogenicity was similar to that of mRNA-1273 vaccines. CONCLUSIONS XBB.1.5-containing mRNA-1273 vaccines elicit robust, diverse nAb responses against more recent SARS-CoV-2 variants, including JN.1, supporting the XBB.1.5-spike update for COVID-19 vaccines.
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Affiliation(s)
- Spyros Chalkias
- Infectious Disease, Research and Development, Moderna, Cambridge, Massachusetts, USA
| | - Nichole McGhee
- Infectious Disease, Research and Development, Moderna, Cambridge, Massachusetts, USA
| | | | | | - Adam Brosz
- Meridian Clinical Research, Grand Island, Nebraska, USA
| | - Joanne E Tomassini
- Infectious Disease, Research and Development, Moderna, Cambridge, Massachusetts, USA
| | - Bethany Girard
- Infectious Disease, Research and Development, Moderna, Cambridge, Massachusetts, USA
| | - Darin K Edwards
- Infectious Disease, Research and Development, Moderna, Cambridge, Massachusetts, USA
| | - Kai Wu
- Infectious Disease, Research and Development, Moderna, Cambridge, Massachusetts, USA
| | - Arshan Nasir
- Infectious Disease, Research and Development, Moderna, Cambridge, Massachusetts, USA
| | - Diana Lee
- Infectious Disease, Research and Development, Moderna, Cambridge, Massachusetts, USA
| | - Laura E Avena
- Infectious Disease, Research and Development, Moderna, Cambridge, Massachusetts, USA
| | - Jing Feng
- Infectious Disease, Research and Development, Moderna, Cambridge, Massachusetts, USA
| | - Weiping Deng
- Infectious Disease, Research and Development, Moderna, Cambridge, Massachusetts, USA
| | - David C Montefiori
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Lindsey R Baden
- Division of Infectious Diseases, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Jacqueline M Miller
- Infectious Disease, Research and Development, Moderna, Cambridge, Massachusetts, USA
| | - Rituparna Das
- Infectious Disease, Research and Development, Moderna, Cambridge, Massachusetts, USA
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5
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Kirsebom FCM, Stowe J, Lopez Bernal J, Allen A, Andrews N. Effectiveness of autumn 2023 COVID-19 vaccination and residual protection of prior doses against hospitalisation in England, estimated using a test-negative case-control study. J Infect 2024; 89:106177. [PMID: 38719110 DOI: 10.1016/j.jinf.2024.106177] [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: 03/28/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION The last COVID-19 vaccine offered to all adults in England became available from November 2021. The most recent booster programme commenced in September 2023. Bivalent BA.4-5 or monovalent XBB.1.5 boosters were given. During the study period, the JN.1 variant became dominant in England. METHODS Vaccine effectiveness against hospitalisation was estimated throughout using the test-negative case-control study design where positive PCR tests from hospitalised individuals are cases and comparable negative PCR tests are controls. Multivariable logistic regression was used to assess vaccine effectiveness against hospitalisation with the test result as the outcome, vaccination status as the primary exposure variable of interest and confounder adjustment. RESULTS There was no evidence of residual protection for boosters given as part of previous campaigns. There were 28,916 eligible tests included to estimate the effectiveness of the autumn 2023 boosters in those aged 65 years and older. VE peaked at 50.6% (95% CI: 44.2-56.3%) after 2-4 weeks, followed by waning to 13.6% (95% CI: -11.7 to 33.2%). Estimates were generally higher for the XBB.1.5 booster than the BA.4-5 booster, but this difference was not statistically significant. Point estimates were highest against XBB sub-lineages. Effectiveness was lower against both JN.1 and EG.5.1 variants with confidence intervals non-overlapping with the effectiveness of the XBB sub-lineages at 2-4 weeks for EG.5.1 where VE was 44.5% (95% CI: 20.2-61.4%) and at 5-9 weeks for JN.1 where VE was 26.4% (95%CI: -3.4 to 47.6%). CONCLUSIONS The recent monovalent XBB.1.5 and bivalent BA.4-5 boosters provided comparable and good protection against hospitalisation, however there was evidence of lower VE against hospitalisation of these boosters against JN.1.
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Affiliation(s)
| | - Julia Stowe
- UK Health Security Agency, London, United Kingdom
| | - Jamie Lopez Bernal
- UK Health Security Agency, London, United Kingdom; NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom; NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, United Kingdom
| | - Alex Allen
- UK Health Security Agency, London, United Kingdom
| | - Nick Andrews
- UK Health Security Agency, London, United Kingdom; NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
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6
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Dixit A, Bennett R, Ali K, Griffin C, Clifford RA, Turner M, Poston R, Hautzinger K, Yeakey A, Girard B, Zhou W, Deng W, Zhou H, Schnyder Ghamloush S, Kuter BJ, Slobod K, Miller JM, Priddy F, Das R. Interim safety and immunogenicity of COVID-19 omicron BA.1 variant-containing vaccine in children in the USA: an open-label non-randomised phase 3 trial. THE LANCET. INFECTIOUS DISEASES 2024; 24:687-697. [PMID: 38518789 DOI: 10.1016/s1473-3099(24)00101-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/17/2024] [Accepted: 02/08/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Variant-containing mRNA vaccines for COVID-19 to broaden protection against SARS-CoV-2 variants are recommended based on findings in adults. We report interim safety and immunogenicity of an omicron BA.1 variant-containing (mRNA-1273.214) primary vaccination series and booster dose in paediatric populations. METHODS This open-label, two-part, non-randomised phase 3 trial enrolled participants aged 6 months to 5 years at 24 US study sites. Eligible participants were generally healthy or had stable chronic conditions, without known SARS-CoV-2 infection in the previous 90 days. Individuals who were acutely ill or febrile 1 day before or at the screening visit or those who previously received other COVID-19 vaccines (except mRNA-1273 for part 2) were excluded. In part 1, SARS-CoV-2-vaccine-naive participants received two-dose mRNA-1273.214 (25 μg; omicron BA.1 and ancestral Wuhan-Hu-1 mRNA) primary series. In part 2, participants who previously completed the two-dose mRNA-1273 (25 μg) primary series in KidCOVE (NCT04796896) received a mRNA-1273.214 (10 μg) booster dose. Primary study outcomes were safety and reactogenicity of the mRNA-1273.214 primary series (part 1) or booster dose (part 2) as well as the inferred effectiveness of mRNA-1273.214 based on immune responses against ancestral SARS-CoV-2 (D614G) and omicron BA.1 variant at 28 days post-primary series (part 1) or post-booster dose (part 2). The safety set included participants who received at least one dose of the study vaccine; the immunogenicity set included those who provided immunogenicity samples. Interim safety and immunogenicity are summarised in this analysis as of the data cutoff date (Dec 5, 2022). This trial is registered with ClinicalTrials.gov, NCT05436834. FINDINGS Between June 21, 2022, and Dec 5, 2022, 179 participants received one or more doses of mRNA-1273.214 primary series (part 1) and 539 received a mRNA-1273.214 booster dose (part 2). The safety profile within 28 days after either dose of the mRNA-1273.214 primary series and the booster dose was consistent with that of the mRNA-1273 primary series in this age group, with no new safety concerns or vaccine-related serious adverse events observed. At 28 days after primary series dose 2 and the booster dose, both mRNA-1273.214 primary series (day 57, including all participants with or without evidence of prior SARS-CoV-2 infection at baseline) and booster (day 29, including participants without evidence of prior SARS-CoV-2 infection at baseline) elicited responses that were superior against omicron-BA.1 (geometric mean ratio part 1: 25·4 [95% CI 20·1-32·1] and part 2: 12·5 [11·0-14·3]) and non-inferior against D614G (part 1: 0·8 [0·7-1·0] and part 2: 3·1 [2·8-3·5]), compared with neutralising antibody responses induced by the mRNA-1273 primary series (in a historical comparator group). INTERPRETATION mRNA-1273.214 was immunogenic against BA.1 and D614G in children aged 6 months to 5 years, with a comparable safety profile to mRNA-1273, when given as a two-dose primary series or a booster dose. These results are aligned with the US Centers for Disease Control and Prevention recommendations for the use of variant-containing vaccines for continued protection against the emerging variants of SARS-CoV-2. FUNDING Moderna.
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Affiliation(s)
| | | | - Kashif Ali
- Texas Center for Drug Development, Houston, TX, USA
| | - Carl Griffin
- Lynn Health Science Institute - ERN - PPDS, Oklahoma City, OK, USA
| | | | - Mark Turner
- Velocity Clinical Research - Boise - ERN - PPDS, Meridian, ID, USA
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7
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DeSilva MB, Knowlton G, Rai NK, Bodurtha P, Essien I, Riddles J, Mehari L, Muscoplat M, Lynfield R, Rowley EA, Chamberlain AM, Patel P, Hughes A, Dickerson M, Thompson MG, Griggs EP, Tenforde M, Winkelman TN, Benitez GV, Drawz PE. Vaccine Effectiveness Against SARS-CoV-2 Related Hospitalizations in People who had Experienced Homelessness or Incarceration - Findings from the Minnesota EHR Consortium. J Community Health 2024; 49:448-457. [PMID: 38066221 PMCID: PMC10981627 DOI: 10.1007/s10900-023-01308-3] [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] [Accepted: 11/03/2023] [Indexed: 04/02/2024]
Abstract
COVID-19 disproportionately affects people experiencing homelessness or incarceration. While homelessness or incarceration alone may not impact vaccine effectiveness, medical comorbidities along with social conditions associated with homelessness or incarceration may impact estimated vaccine effectiveness. COVID-19 vaccines reduce rates of hospitalization and death; vaccine effectiveness (VE) against severe outcomes in people experiencing homelessness or incarceration is unknown. We conducted a retrospective, observational cohort study evaluating COVID-19 vaccine VE against SARS-CoV-2 related hospitalization (positive SARS-CoV-2 molecular test same week or within 3 weeks prior to hospital admission) among patients who had experienced homelessness or incarceration. We utilized data from 8 health systems in the Minnesota Electronic Health Record Consortium linked to data from Minnesota's immunization information system, Homeless Management Information System, and Department of Corrections. We included patients 18 years and older with a history of experiencing homelessness or incarceration. VE and 95% Confidence Intervals (CI) against SARS-CoV-2 hospitalization were estimated for primary series and one booster dose from Cox proportional hazard models as 100*(1-Hazard Ratio) during August 26, 2021, through October 8, 2022 adjusting for patient age, sex, comorbid medical conditions, and race/ethnicity. We included 80,051 individuals who had experienced homelessness or incarceration. Adjusted VE was 52% (95% CI, 41-60%) among those 22 weeks or more since their primary series, 66% (95% CI, 53-75%) among those less than 22 weeks since their primary series, and 69% (95% CI: 60-76%) among those with one booster. VE estimates were consistently lower during the Omicron predominance period compared with the combined Omicron and Delta periods. Despite higher exposure risk, COVID-19 vaccines provided good effectiveness against SARS-CoV-2 related hospitalizations in persons who have experienced homelessness or incarceration.
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Affiliation(s)
- Malini B DeSilva
- Health Partners Institute, 8170 33rd Ave South, Mail stop 21112R, Bloomington, MN, 55440-1524, USA.
| | - Gregory Knowlton
- Health Partners Institute, 8170 33rd Ave South, Mail stop 21112R, Bloomington, MN, 55440-1524, USA
| | - Nayanjot K Rai
- Division of Nephrology & Hypertension, University of Minnesota, Minneapolis, MN, USA
| | - Peter Bodurtha
- Health, Homelessness and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Inih Essien
- Health Partners Institute, 8170 33rd Ave South, Mail stop 21112R, Bloomington, MN, 55440-1524, USA
| | | | | | - Miriam Muscoplat
- Division of Infectious Disease, Epidemiology, Prevention, and Control, Department of Health, St Paul, Minnesota, MN, USA
| | | | | | | | - Palak Patel
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | | | - Monica Dickerson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Eric P Griggs
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Mark Tenforde
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Tyler Na Winkelman
- Health, Homelessness and Criminal Justice Lab, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Gabriela Vazquez Benitez
- Health Partners Institute, 8170 33rd Ave South, Mail stop 21112R, Bloomington, MN, 55440-1524, USA
| | - Paul E Drawz
- Division of Nephrology & Hypertension, University of Minnesota, Minneapolis, MN, USA
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8
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Kirsebom FCM, Andrews N, Stowe J, Dabrera G, Ramsay M, Lopez Bernal J. Effectiveness of the Sanofi/GSK (VidPrevtyn Beta) and Pfizer-BioNTech (Comirnaty Original/Omicron BA.4-5) bivalent vaccines against hospitalisation in England. EClinicalMedicine 2024; 71:102587. [PMID: 38618208 PMCID: PMC11015482 DOI: 10.1016/j.eclinm.2024.102587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/16/2024] Open
Abstract
Background The Sanofi/GSK AS03-adjuvanted (VidPrevtyn Beta) vaccine and the Pfizer-BioNTech mRNA (Comirnaty Original/Omicron BA.4-5) bivalent vaccine were offered to adults aged 75 years and over in England from 3rd April 2023. This is the first time an adjuvanted COVID-19 vaccine has been administered as part of a UK COVID-19 vaccination programme. In clinical trials, antibody levels generated were comparable with mRNA vaccines but there are no real-world data on the effectiveness or duration of protection. Methods We used a test-negative case-control study design to estimate the incremental vaccine effectiveness of the Sanofi/GSK and Pfizer bivalent BA.4-5 boosters against hospitalisation amongst those aged 75 years and older in England. Cases (those testing positive) and controls (those testing negative) were identified from the national COVID-19 PCR testing data undertaken in hospital settings. The study period included tests from 3rd April 2023 to 27th August 2023. Tests were linked to the COVID-19 vaccination register and to the national hospital admission database, restricting to those with an acute respiratory infection coded in the primary diagnosis field. Vaccine effectiveness was estimated using multivariable logistic regression amongst those who had last received an autumn 2022 booster given at least 3 months prior. The test result was the outcome and vaccination status the exposure. Analyses were adjusted for week of test, gender, age, clinical risk group status, care home resident status, region, index of multiple deprivation, ethnicity, influenza vaccination status and recent COVID-19 positivity. Findings There were 14,169 eligible tests from hospitalised individuals aged 75 years and older; 3005 cases (positive tests) and 11,164 controls (negative tests). Effectiveness was highest in the period 9-13 days post vaccination for both manufacturers at about 50%; 43.7% (95% CI, 20.1-60.3%) and 56.1% (95% CI, 25.2-74.2%) for Sanofi/GSK and Pfizer BA.4-5, respectively. There was evidence of waning with a reduction to about 30% for both manufacturers after 5-9 weeks. The longest time interval post vaccination for which we were able to estimate effectiveness was 10+ weeks post vaccination, at which point vaccine effectiveness was 17.6% (95% CI, -3.6 to 34.5%) and 37.9% (95% CI, 13.2-55.5%) for the Sanofi/GSK and Pfizer BA.4-5 boosters, respectively. Interpretation Both boosters provided good protection against hospitalisation amongst older adults. The finding that the adjuvanted vaccine targeting the distant Beta strain had similar effectiveness to the bivalent mRNA vaccine targeting more closely matched Omicron sub-lineages is notable and highlights the need for further real-world studies into the effectiveness of vaccines from different vaccine platforms and formulations in the presence of matched and unmatched strains. Funding No external funding.
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Affiliation(s)
| | - Nick Andrews
- UK Health Security Agency, London, United Kingdom
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Julia Stowe
- UK Health Security Agency, London, United Kingdom
| | | | - Mary Ramsay
- UK Health Security Agency, London, United Kingdom
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jamie Lopez Bernal
- UK Health Security Agency, London, United Kingdom
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
- NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, United Kingdom
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9
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Urschel R, Bronder S, Klemis V, Marx S, Hielscher F, Abu-Omar A, Guckelmus C, Schneitler S, Baum C, Becker SL, Gärtner BC, Sester U, Martinez L, Widera M, Schmidt T, Sester M. SARS-CoV-2-specific cellular and humoral immunity after bivalent BA.4/5 COVID-19-vaccination in previously infected and non-infected individuals. Nat Commun 2024; 15:3077. [PMID: 38594497 PMCID: PMC11004149 DOI: 10.1038/s41467-024-47429-8] [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: 06/12/2023] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
Knowledge is limited as to how prior SARS-CoV-2 infection influences cellular and humoral immunity after booster-vaccination with bivalent BA.4/5-adapted mRNA-vaccines, and whether vaccine-induced immunity may indicate subsequent infection. In this observational study, individuals with prior infection (n = 64) showed higher vaccine-induced anti-spike IgG-antibodies and neutralizing titers, but the relative increase was significantly higher in non-infected individuals (n = 63). In general, both groups showed higher neutralizing activity towards the parental strain than towards Omicron-subvariants BA.1, BA.2 and BA.5. In contrast, CD4 or CD8 T cell levels towards spike from the parental strain and the Omicron-subvariants, and cytokine expression profiles were similar irrespective of prior infection. Breakthrough infections occurred more frequently among previously non-infected individuals, who had significantly lower vaccine-induced spike-specific neutralizing activity and CD4 T cell levels. In summary, we show that immunogenicity after BA.4/5-bivalent vaccination differs between individuals with and without prior infection. Moreover, our results may help to improve prediction of breakthrough infections.
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Affiliation(s)
- Rebecca Urschel
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany
| | - Saskia Bronder
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany
| | - Verena Klemis
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany
| | - Stefanie Marx
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany
| | - Franziska Hielscher
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany
| | - Amina Abu-Omar
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany
| | - Candida Guckelmus
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany
| | - Sophie Schneitler
- Institute of Medical Microbiology and Hygiene, Saarland University, 66421, Homburg, Germany
| | - Christina Baum
- Occupational Health Care Center, Saarland University, 66421, Homburg, Germany
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, 66421, Homburg, Germany
| | - Barbara C Gärtner
- Institute of Medical Microbiology and Hygiene, Saarland University, 66421, Homburg, Germany
| | - Urban Sester
- Department of Nephrology, SHG-Klinikum Völklingen, 66333, Völklingen, Germany
| | - Leonardo Martinez
- Boston University, School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - Marek Widera
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Tina Schmidt
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany
| | - Martina Sester
- Department of Transplant and Infection Immunology, Saarland University, 66421, Homburg, Germany.
- Center for Gender-specific Biology and Medicine (CGBM), Saarland University, 66421, Homburg, Germany.
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10
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Jung SM, Loo SL, Howerton E, Contamin L, Smith CP, Carcelén EC, Yan K, Bents SJ, Levander J, Espino J, Lemaitre JC, Sato K, McKee CD, Hill AL, Chinazzi M, Davis JT, Mu K, Vespignani A, Rosenstrom ET, Rodriguez-Cartes SA, Ivy JS, Mayorga ME, Swann JL, España G, Cavany S, Moore SM, Perkins TA, Chen S, Paul R, Janies D, Thill JC, Srivastava A, Aawar MA, Bi K, Bandekar SR, Bouchnita A, Fox SJ, Meyers LA, Porebski P, Venkatramanan S, Adiga A, Hurt B, Klahn B, Outten J, Chen J, Mortveit H, Wilson A, Hoops S, Bhattacharya P, Machi D, Vullikanti A, Lewis B, Marathe M, Hochheiser H, Runge MC, Shea K, Truelove S, Viboud C, Lessler J. Potential impact of annual vaccination with reformulated COVID-19 vaccines: Lessons from the US COVID-19 scenario modeling hub. PLoS Med 2024; 21:e1004387. [PMID: 38630802 PMCID: PMC11062554 DOI: 10.1371/journal.pmed.1004387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 05/01/2024] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Coronavirus Disease 2019 (COVID-19) continues to cause significant hospitalizations and deaths in the United States. Its continued burden and the impact of annually reformulated vaccines remain unclear. Here, we present projections of COVID-19 hospitalizations and deaths in the United States for the next 2 years under 2 plausible assumptions about immune escape (20% per year and 50% per year) and 3 possible CDC recommendations for the use of annually reformulated vaccines (no recommendation, vaccination for those aged 65 years and over, vaccination for all eligible age groups based on FDA approval). METHODS AND FINDINGS The COVID-19 Scenario Modeling Hub solicited projections of COVID-19 hospitalization and deaths between April 15, 2023 and April 15, 2025 under 6 scenarios representing the intersection of considered levels of immune escape and vaccination. Annually reformulated vaccines are assumed to be 65% effective against symptomatic infection with strains circulating on June 15 of each year and to become available on September 1. Age- and state-specific coverage in recommended groups was assumed to match that seen for the first (fall 2021) COVID-19 booster. State and national projections from 8 modeling teams were ensembled to produce projections for each scenario and expected reductions in disease outcomes due to vaccination over the projection period. From April 15, 2023 to April 15, 2025, COVID-19 is projected to cause annual epidemics peaking November to January. In the most pessimistic scenario (high immune escape, no vaccination recommendation), we project 2.1 million (90% projection interval (PI) [1,438,000, 4,270,000]) hospitalizations and 209,000 (90% PI [139,000, 461,000]) deaths, exceeding pre-pandemic mortality of influenza and pneumonia. In high immune escape scenarios, vaccination of those aged 65+ results in 230,000 (95% confidence interval (CI) [104,000, 355,000]) fewer hospitalizations and 33,000 (95% CI [12,000, 54,000]) fewer deaths, while vaccination of all eligible individuals results in 431,000 (95% CI: 264,000-598,000) fewer hospitalizations and 49,000 (95% CI [29,000, 69,000]) fewer deaths. CONCLUSIONS COVID-19 is projected to be a significant public health threat over the coming 2 years. Broad vaccination has the potential to substantially reduce the burden of this disease, saving tens of thousands of lives each year.
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Affiliation(s)
- Sung-mok Jung
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Sara L. Loo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Emily Howerton
- The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Lucie Contamin
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Claire P. Smith
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Erica C. Carcelén
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Katie Yan
- The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Samantha J. Bents
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - John Levander
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jessi Espino
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Joseph C. Lemaitre
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Koji Sato
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Clifton D. McKee
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Alison L. Hill
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Matteo Chinazzi
- Northeastern University, Boston, Massachusetts, United States of America
| | - Jessica T. Davis
- Northeastern University, Boston, Massachusetts, United States of America
| | - Kunpeng Mu
- Northeastern University, Boston, Massachusetts, United States of America
| | | | - Erik T. Rosenstrom
- North Carolina State University, Raleigh, North Carolina, United States of America
| | | | - Julie S. Ivy
- North Carolina State University, Raleigh, North Carolina, United States of America
| | - Maria E. Mayorga
- North Carolina State University, Raleigh, North Carolina, United States of America
| | - Julie L. Swann
- North Carolina State University, Raleigh, North Carolina, United States of America
| | - Guido España
- University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Sean Cavany
- University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Sean M. Moore
- University of Notre Dame, Notre Dame, Indiana, United States of America
| | - T. Alex Perkins
- University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Shi Chen
- University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Rajib Paul
- University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Daniel Janies
- University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Jean-Claude Thill
- University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
| | - Ajitesh Srivastava
- University of Southern California, Los Angeles, California, United States of America
| | - Majd Al Aawar
- University of Southern California, Los Angeles, California, United States of America
| | - Kaiming Bi
- University of Texas at Austin, Austin, Texas, United States of America
| | | | - Anass Bouchnita
- University of Texas at El Paso, El Paso, Texas, United States of America
| | - Spencer J. Fox
- University of Georgia, Athens, Georgia, United States of America
| | | | | | | | - Aniruddha Adiga
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Benjamin Hurt
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Brian Klahn
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Joseph Outten
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Jiangzhuo Chen
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Henning Mortveit
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Amanda Wilson
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Stefan Hoops
- University of Virginia, Charlottesville, Virginia, United States of America
| | | | - Dustin Machi
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Anil Vullikanti
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Bryan Lewis
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Madhav Marathe
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Harry Hochheiser
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Michael C. Runge
- U.S. Geological Survey, Laurel, Maryland, United States of America
| | - Katriona Shea
- The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Shaun Truelove
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Cécile Viboud
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Justin Lessler
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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11
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Rudolph AE, Khan FL, Shah A, Singh TG, Wiemken TL, Puzniak LA, Jodar L, McLaughlin JM. Effectiveness of BNT162b2 BA.4/5 Bivalent mRNA Vaccine Against Symptomatic COVID-19 Among Immunocompetent Individuals Testing at a Large US Retail Pharmacy. J Infect Dis 2024; 229:648-659. [PMID: 37925630 PMCID: PMC10938215 DOI: 10.1093/infdis/jiad474] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/05/2023] [Accepted: 10/27/2023] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND Data on the effectiveness of BA.4/5 bivalent vaccine stratified by age and prior infection are lacking. METHODS This test-negative study used data from individuals ≥5 years of age testing for SARS-CoV-2 with symptoms (15 September 2022 to 31 January 2023) at a large national retail pharmacy chain. The exposure was receipt of 2-4 wild-type doses and a BNT162b2 BA.4/5 bivalent vaccine (>2 months since last wild-type dose). The outcome was a positive SARS-CoV-2 test. Absolute (vs unvaccinated) and relative (vs 2-4 wild-type doses) vaccine effectiveness (VE) were calculated as (1 - adjusted odds ratio from logistic regression) × 100. VE was stratified by age and self-reported prior infection. RESULTS Overall, 307 885 SARS-CoV-2 tests were included (7916 aged 5-11, 16 329 aged 12-17, and 283 640 aged ≥18 years). SARS-CoV-2 positivity was 39%; 21% were unvaccinated, 70% received 2-4 wild-type doses with no bivalent vaccine, and 9% received a BNT162b2 BA.4/5 bivalent dose. At a median of 1-2 months after BNT162b2 BA.4/5 bivalent vaccination, depending on age group, absolute VE was 22%-60% and was significantly higher among those reporting prior infection (range, 55%-79%) than not (range, no protection to 50%). Relative VE was 31%-64%. CONCLUSIONS BNT162b2 BA.4/5 bivalent showed early additional protection against Omicron-related symptomatic COVID-19, with hybrid immunity offering greater protection.
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Affiliation(s)
| | | | - Amy Shah
- Walgreens Center for Health and Wellbeing Research, Deerfield, Illinois, USA
| | - Tanya G Singh
- Walgreens Center for Health and Wellbeing Research, Deerfield, Illinois, USA
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12
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Takefuji Y. Vaccine effects on COVID-19 infection with bivalent boosting by age group. Drug Resist Updat 2024; 73:101039. [PMID: 38169273 DOI: 10.1016/j.drup.2023.101039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/17/2023] [Accepted: 12/24/2023] [Indexed: 01/05/2024]
Abstract
This paper examines time-series vaccine effectiveness on COVID-19 infection with/without a bivalent booster dose by 6 age groups such as 18-29, 30-49, 50-64, 65-79, 80+, and all_ages respectively. CDC's COVID data on rates of COVID-19 cases and deaths by updated (bivalent) booster status was used in this study. This result concludes that there is no difference between vaccines with or without a bivalent booster dose for preventing COVID-19 infection in 6 age groups 18-29, 30-49, 50-64, 65-79, 80+, and all_ages. Vaccination is effective in two age groups of 65-79 and 80+ for preventing COVID-19 infection. However, vaccine effectiveness against COVID-19 infection has not been confirmed in the 18-29 and 30-49 age groups.
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Affiliation(s)
- Yoshiyasu Takefuji
- Faculty of Data Science, Musashino University, 3-3-3 Ariake Koto-ku, Tokyo 135-8181, Japan.
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13
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Griggs EP, Mitchell PK, Lazariu V, Gaglani M, McEvoy C, Klein NP, Valvi NR, Irving SA, Kojima N, Stenehjem E, Crane B, Rao S, Grannis SJ, Embi PJ, Kharbanda AB, Ong TC, Natarajan K, Dascomb K, Naleway AL, Bassett E, DeSilva MB, Dickerson M, Konatham D, Fireman B, Allen KS, Barron MA, Beaton M, Arndorfer J, Vazquez-Benitez G, Garg S, Murthy K, Goddard K, Dixon BE, Han J, Grisel N, Raiyani C, Lewis N, Fadel WF, Stockwell MS, Mamawala M, Hansen J, Zerbo O, Patel P, Link-Gelles R, Adams K, Tenforde MW. Clinical Epidemiology and Risk Factors for Critical Outcomes Among Vaccinated and Unvaccinated Adults Hospitalized With COVID-19-VISION Network, 10 States, June 2021-March 2023. Clin Infect Dis 2024; 78:338-348. [PMID: 37633258 PMCID: PMC11293024 DOI: 10.1093/cid/ciad505] [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: 07/31/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The epidemiology of coronavirus disease 2019 (COVID-19) continues to develop with emerging variants, expanding population-level immunity, and advances in clinical care. We describe changes in the clinical epidemiology of COVID-19 hospitalizations and risk factors for critical outcomes over time. METHODS We included adults aged ≥18 years from 10 states hospitalized with COVID-19 June 2021-March 2023. We evaluated changes in demographics, clinical characteristics, and critical outcomes (intensive care unit admission and/or death) and evaluated critical outcomes risk factors (risk ratios [RRs]), stratified by COVID-19 vaccination status. RESULTS A total of 60 488 COVID-19-associated hospitalizations were included in the analysis. Among those hospitalized, median age increased from 60 to 75 years, proportion vaccinated increased from 18.2% to 70.1%, and critical outcomes declined from 24.8% to 19.4% (all P < .001) between the Delta (June-December, 2021) and post-BA.4/BA.5 (September 2022-March 2023) periods. Hospitalization events with critical outcomes had a higher proportion of ≥4 categories of medical condition categories assessed (32.8%) compared to all hospitalizations (23.0%). Critical outcome risk factors were similar for unvaccinated and vaccinated populations; presence of ≥4 medical condition categories was most strongly associated with risk of critical outcomes regardless of vaccine status (unvaccinated: adjusted RR, 2.27 [95% confidence interval {CI}, 2.14-2.41]; vaccinated: adjusted RR, 1.73 [95% CI, 1.56-1.92]) across periods. CONCLUSIONS The proportion of adults hospitalized with COVID-19 who experienced critical outcomes decreased with time, and median patient age increased with time. Multimorbidity was most strongly associated with critical outcomes.
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Affiliation(s)
- Eric P Griggs
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Victoria Lazariu
- Department of Clinical Research, Westat, Inc, Rockville, Maryland, USA
| | - Manjusha Gaglani
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Baylor Scott & White Health, Temple, Texas, USA
- Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Charlene McEvoy
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Nimish R Valvi
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Stephanie A Irving
- Department of Science Programs, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Noah Kojima
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Edward Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Bradley Crane
- Department of Science Programs, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Suchitra Rao
- Department of Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Department of Family Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Peter J Embi
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anupam B Kharbanda
- Department of Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Toan C Ong
- Department of Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Karthik Natarajan
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
- Medical Informatics Services, New York-Presbyterian Hospital, New York, New York, USA
| | - Kristin Dascomb
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Allison L Naleway
- Department of Science Programs, Kaiser Permanente Center for Health Research, Portland, Oregon, USA
| | - Elizabeth Bassett
- Department of Clinical Research, Westat, Inc, Rockville, Maryland, USA
| | - Malini B DeSilva
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota, USA
| | - Monica Dickerson
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Deepika Konatham
- Department of Research Analytics and Development, Baylor Scott & White Research Institute, Baylor Scott & White Health, Temple, Texas, USA
| | - Bruce Fireman
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Katie S Allen
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Michelle A Barron
- Department of Biomedical Informatics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Maura Beaton
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - Julie Arndorfer
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | - Shikha Garg
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kempapura Murthy
- Department of Research Analytics and Development, Baylor Scott & White Research Institute, Baylor Scott & White Health, Temple, Texas, USA
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Jungmi Han
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
| | - Nancy Grisel
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Chandni Raiyani
- Department of Research Analytics and Development, Baylor Scott & White Research Institute, Baylor Scott & White Health, Temple, Texas, USA
| | - Ned Lewis
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - William F Fadel
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Melissa S Stockwell
- Division of Child & Adolescent Health, Department of Pediatrics, New York-Presbyterian Hospital, New York, New York, USA
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Mufaddal Mamawala
- Department of Research Analytics and Development, Baylor Scott & White Research Institute, Baylor Scott & White Health, Temple, Texas, USA
| | - John Hansen
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Ousseny Zerbo
- Kaiser Permanente Vaccine Study Center, Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Palak Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ruth Link-Gelles
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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14
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McMahan K, Wegmann F, Aid M, Sciacca M, Liu J, Hachmann NP, Miller J, Jacob-Dolan C, Powers O, Hope D, Wu C, Pereira J, Murdza T, Mazurek CR, Hoyt A, Boon ACM, Davis-Gardner M, Suthar MS, Martinot AJ, Boursiquot M, Cook A, Pessaint L, Lewis MG, Andersen H, Tolboom J, Serroyen J, Solforosi L, Costes LMM, Zahn RC, Barouch DH. Mucosal boosting enhances vaccine protection against SARS-CoV-2 in macaques. Nature 2024; 626:385-391. [PMID: 38096903 PMCID: PMC10849944 DOI: 10.1038/s41586-023-06951-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/07/2023] [Indexed: 01/26/2024]
Abstract
A limitation of current SARS-CoV-2 vaccines is that they provide minimal protection against infection with current Omicron subvariants1,2, although they still provide protection against severe disease. Enhanced mucosal immunity may be required to block infection and onward transmission. Intranasal administration of current vaccines has proven inconsistent3-7, suggesting that alternative immunization strategies may be required. Here we show that intratracheal boosting with a bivalent Ad26-based SARS-CoV-2 vaccine results in substantial induction of mucosal humoral and cellular immunity and near-complete protection against SARS-CoV-2 BQ.1.1 challenge. A total of 40 previously immunized rhesus macaques were boosted with a bivalent Ad26 vaccine by the intramuscular, intranasal and intratracheal routes, or with a bivalent mRNA vaccine by the intranasal route. Ad26 boosting by the intratracheal route led to a substantial expansion of mucosal neutralizing antibodies, IgG and IgA binding antibodies, and CD8+ and CD4+ T cell responses, which exceeded those induced by Ad26 boosting by the intramuscular and intranasal routes. Intratracheal Ad26 boosting also led to robust upregulation of cytokine, natural killer, and T and B cell pathways in the lungs. After challenge with a high dose of SARS-CoV-2 BQ.1.1, intratracheal Ad26 boosting provided near-complete protection, whereas the other boosting strategies proved less effective. Protective efficacy correlated best with mucosal humoral and cellular immune responses. These data demonstrate that these immunization strategies induce robust mucosal immunity, suggesting the feasibility of developing vaccines that block respiratory viral infections.
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Affiliation(s)
- Katherine McMahan
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Frank Wegmann
- Janssen Vaccines and Prevention, Leiden, Netherlands
| | - Malika Aid
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michaela Sciacca
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jinyan Liu
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Nicole P Hachmann
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jessica Miller
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Catherine Jacob-Dolan
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA
| | - Olivia Powers
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - David Hope
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Cindy Wu
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Juliana Pereira
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tetyana Murdza
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Camille R Mazurek
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Amelia Hoyt
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | - Amanda J Martinot
- Tufts University Cummings School of Veterinary Medicine, Grafton, MA, USA
| | | | | | | | | | | | | | - Jan Serroyen
- Janssen Vaccines and Prevention, Leiden, Netherlands
| | | | | | - Roland C Zahn
- Janssen Vaccines and Prevention, Leiden, Netherlands
| | - Dan H Barouch
- Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, USA.
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15
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Kim M, Cheng WA, Congrave-Wilson Z, Marentes Ruiz CJ, Turner L, Mendieta S, Jumarang J, Del Valle J, Lee Y, Fabrizio T, Allen EK, Thomas PG, Webby R, Gordon A, Pannaraj PS. Comparisons of Pediatric and Adult SARS-CoV-2-Specific Antibodies up to 6 Months after Infection, Vaccination, or Hybrid Immunity. J Pediatric Infect Dis Soc 2024; 13:91-99. [PMID: 38016076 PMCID: PMC10824260 DOI: 10.1093/jpids/piad107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Characterization of longitudinal SARS-CoV-2-specific antibody responses in children following infection and vaccination is needed to inform SARS-CoV-2 vaccine policy decisions for children, which may differ from adults. METHODS We enrolled individuals at the time of SARS-CoV-2 infection or vaccination for longitudinal serological testing and compared SARS-CoV-2-spike-specific IgG and neutralization activity in children and adults stratified by infection and vaccination status using enzyme-linked immunosorbent and virus neutralization assays. RESULTS Between June 2020 and December 2022, we collected sera from 669 participants aged 40 days to 55 years, including 330 unvaccinated individuals with laboratory-confirmed SARS-CoV-2 infection, 180 vaccinated SARS-CoV-2-naïve individuals, and 159 vaccinated previously infected individuals. Half (n = 330, 49.3%) were children. SARS-CoV-2-specific IgG and neutralization activity in children < 12 years old in response to infection persisted at higher levels than those of adults through at least 6 months (spike-specific IgG levels, 2.05 [95% CI: 1.4-3.1] times higher than adults; neutralizing activity, median 88.8 vs 75.2%, respectively, p = .04). In addition, all pediatric participants had significantly higher IgG levels compared with adults at 6 months following infection or vaccination, regardless of prior infection status. Vaccine-induced SARS-CoV-2-specific IgG responses in previously infected individuals persisted at higher levels than those from infection alone at 6 months (median AUC, children 5-11 years old, 9115 vs 368; adolescents 3613 vs 475; adults 1956 vs 263, all p < .001). CONCLUSIONS These data demonstrate the robust and persistent immunologic response of SARS-CoV-2 vaccination in children and emphasize the benefit of vaccination after SARS-CoV-2 infection.
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Affiliation(s)
- Minjun Kim
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Wesley A Cheng
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Zion Congrave-Wilson
- Division of Infectious Diseases, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Lauren Turner
- Division of Infectious Diseases, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Shirley Mendieta
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Jaycee Jumarang
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Jennifer Del Valle
- Division of Infectious Diseases, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Yesun Lee
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Thomas Fabrizio
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, TN, USA
| | - E Kaitlynn Allen
- Department of Immunology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Paul G Thomas
- Department of Immunology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Richard Webby
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, TN, USA
| | - Aubree Gordon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Pia S Pannaraj
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, San Diego, CA, USA
- Division of Infectious Diseases, Rady Children’s Hospital, San Diego, CA, USA
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16
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Seppälä E, Dahl J, Veneti L, Rydland KM, Klüwer B, Rohringer A, Meijerink H. Covid-19 and influenza vaccine effectiveness against associated hospital admission and death among individuals over 65 years in Norway: A population-based cohort study, 3 October 2022 to 20 June 2023. Vaccine 2024; 42:620-628. [PMID: 38142215 DOI: 10.1016/j.vaccine.2023.12.050] [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: 08/07/2023] [Revised: 12/04/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Co-circulation of SARS-CoV-2 and influenza virus can lead to double epidemics and increased pressure on health systems. To evaluate the effect of both vaccines, we estimated the adjusted vaccine effectiveness (aVE) of influenza and Covid-19 vaccines against related severe disease in the elderly population in Norway during the 2022/2023 season. METHODS In this population-based cohort study, we included data from the Emergency preparedness register for Covid-19 (Beredt C19) on all individuals ≥ 65 years living in Norway between 3 October 2022 and 20 June 2023. Using Cox-proportional hazard models, we estimated aVE of both influenza and Covid-19 vaccines (bivalent BA.1 and BA.4-5) against associated hospitalisation and death. Vaccine status was included as a time-varying covariate and all models were adjusted for potential confounders, including the other vaccine. RESULTS We identified 2,437 influenza-associated hospitalisations and 178 deaths, alongside 5,824 Covid-19-associated hospitalisations and 621 deaths. The aVE was highest in the first three months after receiving either vaccine. Against influenza-associated hospitalisation the aVE was 34 % (26 %-42 %) among 65-79-year-olds and 40 % (30 %-48 %) among ≥ 80-year-olds, and 6.6 % (-64 %-47 %) and 37 % (0.5 %-61 %) against influenza-associated death, respectively. The aVE against Covid-19-associated hospitalisation was 65 % (61 %-69 %) among 65-79-year-olds and 55 % (49 %-60 %) among ≥ 80-year-olds (compared to having received the vaccine ≥ 180 days ago). Similarly, the aVE against Covid-19-associated death was 68 % (48 %-80 %) and 78 % (65 %-86 %), respectively. For Covid-19 we show a reduction in aVE with time since dose. CONCLUSION Covid-19 and influenza vaccines reduced the risk of severe disease in the same high-risk population. Ensuring high uptake of both vaccines could thus limit the overall health care burden.
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Affiliation(s)
- Elina Seppälä
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Jesper Dahl
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Lamprini Veneti
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Birgitte Klüwer
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway
| | - Andreas Rohringer
- Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
| | - Hinta Meijerink
- Department of Infection Control and Vaccines, Norwegian Institute of Public Health, Oslo, Norway.
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17
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Yoon JG, Sohn JW, Choi WS, Wie SH, Lee J, Lee JS, Jeong HW, Eom JS, Seong H, Nham E, Choi YJ, Noh JY, Song JY, Cheong HJ, Kim WJ. Effectiveness of Bivalent mRNA Booster Vaccine Against COVID-19 in Korea. J Korean Med Sci 2024; 39:e15. [PMID: 38258360 PMCID: PMC10803207 DOI: 10.3346/jkms.2024.39.e15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/26/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Bivalent booster mRNA vaccines containing the omicron-variant strains have been introduced worldwide in the autumn of 2022. Nevertheless, the omicron subvariants evoked another large coronavirus disease 2019 (COVID-19) pandemic wave in late 2022 and early 2023. METHODS A retrospective, test-negative, case-control study was conducted to estimate the vaccine effectiveness (VE) of bivalent COVID-19 vaccines in 8 university hospitals between January and February 2023. The case and control groups were divided based on nasopharyngeal COVID-19 real-time polymerase chain reaction results and matched based on age, sex, hospital, and date (week) of the test performed. The VE of the BA.1- or BA.4/BA.5-based mRNA vaccines were estimated. VE was calculated using the 1-adjusted odds ratio from multivariable logistic regression. RESULTS In total, 949 patients and 947 controls were enrolled in this study. VE for the BA.4/BA.5-based bivalent mRNA vaccine was 43% (95% confidence interval [CI], 17, 61%). In subgroup analysis based on age and underlying medical conditions, BA.4/BA.5-based bivalent mRNA vaccine was effective against old adults aged ≥ 65-years (VE, 55%; 95% CI, 23, 73%) and individuals with comorbidities (VE, 54%; 95% CI, 23, 73%). In comparison, the BA.1-based bivalent mRNA vaccine did not demonstrate statistically significant effectiveness (VE, 25%; 95% CI, -8, 49%). CONCLUSION The BA.4/BA.5-based bivalent mRNA booster vaccine provided significant protection against COVID-19 in the Korean adults, especially in the older adults aged ≥ 65 years and in individuals with underlying medical conditions.
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Affiliation(s)
- Jin Gu Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seong-Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hye Won Jeong
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Joong Sik Eom
- Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Hye Seong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Korea
| | - Eliel Nham
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Korea
| | - Yu Jung Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Korea
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Korea
| | - Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Vaccine Innovation Center-KU Medicine (VIC-K), Seoul, Korea.
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18
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Kopel H, Bogdanov A, Winer-Jones JP, Adams C, Winer IH, Bonafede M, Nguyen VH, Mansi JA. Comparison of COVID-19 and Influenza-Related Outcomes in the United States during Fall-Winter 2022-2023: A Cross-Sectional Retrospective Study. Diseases 2024; 12:16. [PMID: 38248367 PMCID: PMC10814040 DOI: 10.3390/diseases12010016] [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: 11/20/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Influenza and COVID-19 contribute significantly to the infectious disease burden during the respiratory season, but their relative burden remains unknown. This study characterizes the frequency and severity of medically attended COVID-19 and influenza during the peak of the 2022-2023 influenza season in the pediatric, adult, and older adult populations and characterizes the prevalence of underlying conditions among patients hospitalized with COVID-19. This cross-sectional analysis included individuals in the Veradigm EHR Database linked to Komodo claims data with a medical encounter between 1 October 2022 and 31 March 2023 (study period). Patients with medical encounters were identified with a diagnosis of COVID-19 or influenza during the study period and stratified based on the highest level of care received with that diagnosis. Among 23,526,196 individuals, there were more COVID-19-related medical encounters than influenza-related encounters, overall and by outcome. Hospitalizations with COVID-19 were more common than hospitalizations with influenza overall (incidence ratio = 4.6) and in all age groups. Nearly all adults hospitalized with COVID-19 had at least one underlying medical condition, but 37.1% of 0-5-year-olds and 25.0% of 6-17-year-olds had no underlying medical conditions. COVID-19 was associated greater burden than influenza during the peak of the 2022-2023 influenza season.
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19
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Priddy F, Chalkias S, Essink B, Whatley J, Brosz A, Lee IT, Feng J, Tracy L, Deng W, Zhou W, Zhou H, Dixit A, Schnyder-Ghamloush S, Girard B, de Windt E, Yeakey A, Miller J, Das R, Kuter BJ. A review of the immunogenicity and safety of booster doses of omicron variant-containing mRNA-1273 COVID-19 vaccines in adults and children. Expert Rev Vaccines 2024; 23:862-878. [PMID: 39234779 DOI: 10.1080/14760584.2024.2397026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 08/05/2024] [Accepted: 08/22/2024] [Indexed: 09/06/2024]
Abstract
INTRODUCTION Vaccination against SARS-CoV-2 is an integral pillar of the public health approach to COVID-19. With the emergence of variants of concern that increase transmissibility and escape from vaccine- or infection-induced protection, vaccines have been developed to more closely match the newly circulating SARS-CoV-2 strains to improve protection. The safety and immunogenicity of multiple authorized messenger RNA (mRNA)-based COVID-19 vaccines targeting the omicron sublineage (BA.1, BA.4/BA.5, and XBB.1.5) have been demonstrated in several clinical trials among adults and children. AREAS COVERED This review will comprehensively detail the available evidence (published through July 2024) from ongoing clinical trials on omicron variant-containing mRNA-1273 vaccines administered as additional doses in previously vaccinated target demographics. EXPERT OPINION Across three clinical trials, omicron variant-containing mRNA-1273 vaccines induced immune responses to vaccine-matched omicron strains as well as ancestral SARS-CoV-2, with a safety and reactogenicity profile comparable to the original mRNA-1273 vaccine. Combined with pivotal data demonstrating the safety, efficacy, and effectiveness of the original mRNA-1273 vaccine, these findings support the use of variant-containing mRNA-1273 vaccines and provide confidence that expeditious development of updated vaccines using this established mRNA platform can maintain protection against COVID-19.
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Affiliation(s)
| | | | | | | | - Adam Brosz
- Meridian Clinical Research, Savannah, GA, USA
| | | | | | | | | | - Wen Zhou
- Moderna, Inc, Cambridge, MA, USA
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20
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Payne AB, Ciesla AA, Rowley EAK, Weber ZA, Reese SE, Ong TC, Vazquez-Benitez G, Naleway AL, Klein NP, Embi PJ, Grannis SJ, Kharbanda AB, Gaglani M, Tenforde MW, Link-Gelles R. Impact of accounting for correlation between COVID-19 and influenza vaccination in a COVID-19 vaccine effectiveness evaluation using a test-negative design. Vaccine 2023; 41:7581-7586. [PMID: 38000964 DOI: 10.1016/j.vaccine.2023.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023]
Abstract
Test-negative-design COVID-19 vaccine effectiveness (VE) studies use symptomatic SARS-CoV-2-positive individuals as cases and symptomatic SARS-CoV-2-negative individuals as controls to evaluate COVID-19 VE. To evaluate the potential bias introduced by the correlation of COVID-19 and influenza vaccination behaviors, we assessed changes in estimates of VE of bivalent vaccines against COVID-19-associated hospitalizations and emergency department/urgent care (ED/UC) encounters when considering influenza vaccination status or including or excluding influenza-positive controls using data from the multi-state VISION vaccine effectiveness network. Analyses included encounters during October 2022 - February 2023, a period of SARS-CoV-2 and influenza cocirculation. When considering influenza vaccination status or including or excluding influenza-positive controls, COVID-19 VE estimates were robust, with most VE estimates against COVID-19-associated hospitalization and ED/UC encounters changing less than 5 percentage points. Higher proportions of influenza-positive patients among controls, influenza vaccination coverage, or VE could impact these findings; the potential bias should continue to be assessed.
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Affiliation(s)
- Amanda B Payne
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Allison Avrich Ciesla
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Eagle Health Analytics, San Antonio, TX, USA
| | | | | | | | - Toan C Ong
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Allison L Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - Peter J Embi
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shaun J Grannis
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Manjusha Gaglani
- Section of Pediatric Infectious Diseases, Center for Research in Vaccines and Infections, Baylor Scott & White Health and Baylor College of Medicine, Temple, TX, USA; Texas A&M University College of Medicine, Temple, TX, USA
| | - Mark W Tenforde
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ruth Link-Gelles
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; United States Public Health Service Commissioned Corps, Rockville, MD, USA
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21
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Antonelli M, Penfold RS, Canas LDS, Sudre C, Rjoob K, Murray B, Molteni E, Kerfoot E, Cheetham N, Pujol JC, Polidori L, May A, Wolf J, Modat M, Spector T, Hammers A, Ourselin S, Steves C. SARS-CoV-2 infection following booster vaccination: Illness and symptom profile in a prospective, observational community-based case-control study. J Infect 2023; 87:506-515. [PMID: 37777159 DOI: 10.1016/j.jinf.2023.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/02/2023] [Accepted: 08/22/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Booster COVID-19 vaccines have shown efficacy in clinical trials and effectiveness in real-world data against symptomatic and severe illness. However, some people still become infected with SARS-CoV-2 following a third (booster) vaccination. This study describes the characteristics of SARS-CoV-2 illness following a third vaccination and assesses the risk of progression to symptomatic disease in SARS-CoV-2 infected individuals with time since vaccination. METHODS This prospective, community-based, case-control study used data from UK-based, adult (≥18 years) users of the COVID Symptom Study mobile application, self-reporting a first positive COVID-19 test between June 1, 2021 and April 1, 2022. To describe the characteristics of SARS-CoV-2 illness following a third vaccination, we selected cases and controls who had received a third and second dose of monovalent vaccination against COVID-19, respectively, and reported a first positive SARS-CoV-2 test at least 7 days after most recent vaccination. Cases and controls were matched (1:1) based on age, sex, BMI, time between first vaccination and infection, and week of testing. We used logistic regression models (adjusted for age, sex, BMI, level of social deprivation and frailty) to analyse associations of disease severity, overall disease duration, and individual symptoms with booster vaccination status. To assess for potential waning of vaccine effectiveness, we compared disease severity, duration, and symptom profiles of individuals testing positive within 3 months of most recent vaccination (reference group) to profiles of individuals infected between 3 and 4, 4-5, and 5-6 months, for both third and second dose. All analyses were stratified by time period, based on the predominant SARS-CoV-2 variant at time of infection (Delta: June 1, 2021-27 Nov, 2021; Omicron: 20 Dec, 2021-Apr 1, 2022). FINDINGS During the study period, 50,162 (Delta period) and 162,041 (Omicron) participants reported a positive SARS-CoV-2 test. During the Delta period, infection following three vaccination doses was associated with lower odds of long COVID (symptoms≥ 4 weeks) (OR=0.83, CI[0.50-1.36], p < 0.0001), hospitalisation (OR=0.55, CI[0.39-0.75], p < 0.0001) and severe symptoms (OR=0.36, CI[0.27-0.49], p < 0.0001), and higher odds of asymptomatic infection (OR=3.45, CI[2.86-4.16], p < 0.0001), compared to infection following only two vaccination doses. During the Omicron period, infection following three vaccination doses was associated with lower odds of severe symptoms (OR=0.48, CI[0.42-0.55], p < 0.0001). During the Delta period, infected individuals were less likely to report almost all individual symptoms after a third vaccination. During the Omicron period, individuals were less likely to report most symptoms after a third vaccination, except for upper respiratory symptoms e.g. sneezing (OR=1.40, CI[1.18-1.35], p < 0.0001), runny nose (OR=1.26, CI[1.18-1.35], p < 0.0001), sore throat (OR=1.17, CI[1.10-1.25], p < 0.0001), and hoarse voice (OR=1.13, CI[1.06-1.21], p < 0.0001), which were more likely to be reported. There was evidence of reduced vaccine effectiveness during both Delta and Omicron periods in those infected more than 3 months after their most recent vaccination, with increased reporting of severe symptoms, long duration illness, and most individual symptoms. INTERPRETATION This study suggests that a third dose of monovalent vaccine may reduce symptoms, severity and duration of SARS-CoV-2 infection following vaccination. For Omicron variants, the third vaccination appears to reduce overall symptom burden but may increase upper respiratory symptoms, potentially due to immunological priming. There is evidence of waning vaccine effectiveness against progression to symptomatic and severe disease and long COVID after three months. Our findings support ongoing booster vaccination promotion amongst individuals at high risk from COVID-19, to reduce severe symptoms and duration of illness, and health system burden. Disseminating knowledge on expected symptoms following booster vaccination may encourage vaccine uptake.
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Affiliation(s)
- Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Rose S Penfold
- Ageing and Health Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK; Department of Twin Research and Genetic Epidemiology, King's College London, UK
| | | | - Carole Sudre
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK; Centre for Medical Image Computing, University College London, London, UK
| | - Khaled Rjoob
- Centre for Medical Image Computing, University College London, London, UK
| | - Ben Murray
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Eric Kerfoot
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Nathan Cheetham
- Department of Twin Research and Genetic Epidemiology, King's College London, UK
| | | | | | | | | | - Marc Modat
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Tim Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, UK
| | - Alexander Hammers
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK; King's College London & Guy's and St Thomas' PET Centre, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Claire Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, UK; Department of Ageing and Health, Guys and St Thomas' NHS Foundation Trust, London, UK.
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22
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Tartof SY, Slezak JM, Puzniak L, Hong V, Frankland TB, Ackerson BK, Xie F, Takhar H, Ogun OA, Simmons S, Zamparo JM, Valluri SR, Jodar L, McLaughlin JM. Effectiveness of BNT162b2 BA.4/5 bivalent mRNA vaccine against a range of COVID-19 outcomes in a large health system in the USA: a test-negative case-control study. THE LANCET. RESPIRATORY MEDICINE 2023; 11:1089-1100. [PMID: 37898148 DOI: 10.1016/s2213-2600(23)00306-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND XBB-related omicron sublineages have recently replaced BA.4/5 as the predominant omicron sublineages in the USA and other regions globally. Despite preliminary signs of immune evasion of XBB sublineages, few data exist describing the real-world effectiveness of bivalent COVID-19 vaccines, especially against XBB-related illness. We aimed to investigate the effectiveness of the Pfizer--BioNTech BNT162b2 BA.4/5 bivalent vaccine against both BA.4/5-related and XBB-related disease in adults aged 18 years or older. METHODS In this test-negative case-control study, we estimated the effectiveness of the BNT162b2 BA.4/5 bivalent vaccine using data from electronic health records of Kaiser Permanente Southern California health system members aged 18 years or older who received at least two doses of the wild-type COVID-19 mRNA vaccines. Participants sought care for acute respiratory infection between Aug 31, 2022, and April 15, 2023, and were tested for SARS-CoV-2 via PCR tests. Relative vaccine effectiveness (≥2 doses of wild-type mRNA vaccine plus a BNT162b2 BA.4/5 bivalent booster vs ≥2 doses of a wild-type mRNA vaccine alone) and absolute vaccine effectiveness (vs unvaccinated individuals) was estimated against critical illness related to acute respiratory infection (intensive care unit [ICU] admission, mechanical ventilation, or inpatient death), hospital admission, emergency department or urgent care visits, and in-person outpatient encounters with odds ratios from logistic regression models adjusted for demographic and clinical factors. We stratified vaccine effectiveness estimates for hospital admission, emergency department or urgent care visits, and outpatient encounters by omicron sublineage (ie, likely BA.4/5-related vs likely XBB-related), time since bivalent booster receipt, age group, number of wild-type doses received, and immunocompromised status. This study is registered with ClinicalTrials.gov (NCT04848584). FINDINGS Analyses were conducted for 123 419 encounters (24 246 COVID-19 cases and 99 173 test-negative controls), including 4131 episode of critical illness (a subset of hospital admissions), 14 529 hospital admissions, 63 566 emergency department or urgent care visits, and 45 324 outpatient visits. 20 555 infections were BA.4/5 related and 3691 were XBB related. In adjusted analyses, relative vaccine effectiveness for those who received the BNT162b2 BA.4/5 bivalent booster compared with those who received at least two doses of a wild-type mRNA vaccine alone was an additional 50% (95% CI 23-68) against critical illness, an additional 39% (28-49) against hospital admission, an additional 35% (30-40) against emergency department or urgent care visits, and an additional 28% (22-33) against outpatient encounters. Waning of the bivalent booster from 0-3 months to 4-7 months after vaccination was evident for outpatient outcomes but was not detected for critical illness, hospital admission, and emergency department or urgent care outcomes. The relative effectiveness of the BNT162b2 BA.4/5 bivalent booster for XBB-related infections compared with BA.4/5-related infections was 56% (95% CI 12-78) versus 40% (27-50) for hospital admission; 34% (21-45) versus 36% (30-41) against emergency department or urgent care visits; and 29% (19-38) versus 27% (20-33) for outpatient encounters. INTERPRETATION By mid-April, 2023, individuals previously vaccinated only with wild-type vaccines had little protection against COVID-19-including hospital admission. A BNT162b2 BA.4/5 bivalent booster restored protection against a range of COVID-19 outcomes, including against XBB-related sublineages, with the most substantial protection observed against hospital admission and critical illness. FUNDING Pfizer.
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Affiliation(s)
- Sara Y Tartof
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA; Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA USA.
| | - Jeff M Slezak
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | - Vennis Hong
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Timothy B Frankland
- Kaiser Permanente Hawaii Center for Integrated Health Care Research, Honolulu, HI, Hawaii
| | | | - Fagen Xie
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Harpreet Takhar
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Oluwaseye A Ogun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Sarah Simmons
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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23
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Tan CY, Chiew CJ, Pang D, Lee VJ, Ong B, Wang LF, Ren EC, Lye DC, Tan KB. Effectiveness of bivalent mRNA vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals: a retrospective cohort study. THE LANCET. INFECTIOUS DISEASES 2023; 23:1343-1348. [PMID: 37543042 DOI: 10.1016/s1473-3099(23)00373-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/22/2023] [Accepted: 06/08/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Emergence of the SARS-CoV-2 omicron (B.1.1.529) variant with high immune evasion has led to the development and roll-out of bivalent mRNA vaccines targeting original and omicron strains. However, real-world observational data on effectiveness of bivalent vaccines are scarce. We aimed to assess the relative effectiveness of a fourth vaccine dose with the BA.1-adapted or BA.4/BA.5-adapted bivalent vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals in Singapore. METHODS We conducted a retrospective cohort study among Singapore residents aged 18 years and older who had received three monovalent mRNA vaccine doses and were eligible for a fourth dose. Data were collected from official databases on COVID-19 cases and vaccinations maintained by the Singapore Ministry of Health. We analysed the incidence of medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission between Oct 14, 2022, and Jan 31, 2023, by previous infection status and type of fourth vaccine dose received. Inverse probability-weighted Cox regressions were used to estimate hazard ratios (HRs). FINDINGS 2 749 819 individuals were included in the analysis. For the SARS-CoV-2-naive group, a fourth monovalent vaccine dose did not confer additional protection over three monovalent doses against symptomatic infection (HR 1·09 [95% CI 1·07-1·11]), whereas the bivalent vaccine did provide additional protection (0·18 [0·17-0·19]). Among individuals with previous infection, the HR was 0·87 (95% CI 0·84-0·91) and 0·14 (0·13-0·15) with receipt of the fourth monovalent and bivalent doses, respectively. Against COVID-19-related hospital admission, the bivalent vaccine (HR 0·12 [95% CI 0·08-0·18] in SARS-CoV-2-naive participants and 0·04 [0·01-0·15] in previously infected participants) conferred greater benefit compared with the fourth monovalent dose (0·84 [0·77-0·91] in SARS-CoV-2-naive participants and 0·85 [0·69-1·04] in previously infected participants). INTERPRETATION A fourth dose with the bivalent vaccine was substantially more effective against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission than four monovalent doses among both SARS-CoV-2-naive and previously infected individuals. Boosters with the bivalent vaccine might be preferred in this omicron-predominant pandemic, regardless of previous infection history. FUNDING None.
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Affiliation(s)
- Celine Y Tan
- Communicable Diseases Division, Ministry of Health, Singapore.
| | - Calvin J Chiew
- Communicable Diseases Division, Ministry of Health, Singapore; National Centre for Infectious Diseases, Singapore
| | - Deanette Pang
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Vernon J Lee
- Communicable Diseases Division, Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Benjamin Ong
- Communicable Diseases Division, Ministry of Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lin-Fa Wang
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Ee Chee Ren
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Immunology Network, Agency for Science Technology and Research, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kelvin Bryan Tan
- Communicable Diseases Division, Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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24
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Lafleur BJ, White L, Dake MD, Nikolich JZ, Sprissler R, Bhattacharya D. No Evidence That Analgesic Use after COVID-19 Vaccination Negatively Impacts Antibody Responses. Immunohorizons 2023; 7:834-841. [PMID: 38085168 PMCID: PMC10759157 DOI: 10.4049/immunohorizons.2300090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
Uptake of mRNA vaccines, especially booster immunizations, against COVID-19 has been lower than hoped, perhaps in part due to their reactogenicity. Analgesics might alleviate symptoms associated with vaccination, but they might also impact immune responses. We semiquantitatively measured Ab responses following COVID-19 vaccination in 2354 human participants surveyed about analgesic use after vaccination. Participants who used nonsteroidal anti-inflammatory drugs or acetaminophen after vaccination showed elevated Ab levels against the receptor-binding domain of Spike protein relative to those who did not use analgesics. This pattern was observed for both mRNA-1273 and BNT162b2 and across age groups. Participants who used analgesics more frequently reported fatigue, muscle aches, and headaches than did those who did not use painkillers. Among participants who reported these symptoms, we observed no statistically significant differences in Ab levels irrespective of analgesic use. These data suggest that elevated Ab levels are associated with symptoms and inflammatory processes rather than painkiller use per se. Taken together, we find no evidence that analgesic use reduces Ab responses after COVID-19 vaccination. Recommendation of their use to alleviate symptoms might improve uptake of booster immunizations.
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Affiliation(s)
- Bonnie J. Lafleur
- BIO5 Institute, University of Arizona, Tucson, AZ
- Department of Pharmacy Practice and Science, R. Ken Coit College of Pharmacy, University of Arizona, Tucson, AZ
| | - Lisa White
- BIO5 Institute, University of Arizona, Tucson, AZ
| | - Michael D. Dake
- Office of the Senior Vice-President for Health Sciences, University of Arizona, Tucson, AZ
| | - Janko Z. Nikolich
- BIO5 Institute, University of Arizona, Tucson, AZ
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ
- University of Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ
| | - Ryan Sprissler
- BIO5 Institute, University of Arizona, Tucson, AZ
- University of Arizona Genomics Core and the Arizona Research Labs, University of Arizona Genetics Core, University of Arizona, Tucson, AZ
| | - Deepta Bhattacharya
- BIO5 Institute, University of Arizona, Tucson, AZ
- Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ
- Department of Surgery, University of Arizona College of Medicine, Tucson, AZ
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25
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Mateo-Urdiales A, Sacco C, Fotakis EA, Del Manso M, Bella A, Riccardo F, Bressi M, Rota MC, Petrone D, Siddu A, Fedele G, Stefanelli P, Palamara AT, Brusaferro S, Rezza G, Pezzotti P, Fabiani M. Relative effectiveness of monovalent and bivalent mRNA boosters in preventing severe COVID-19 due to omicron BA.5 infection up to 4 months post-administration in people aged 60 years or older in Italy: a retrospective matched cohort study. THE LANCET. INFECTIOUS DISEASES 2023; 23:1349-1359. [PMID: 37478877 DOI: 10.1016/s1473-3099(23)00374-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/30/2023] [Accepted: 06/08/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Limited evidence is available on the additional protection conferred by second mRNA vaccine boosters against severe COVID-19 caused by omicron BA.5 infection, and whether the adapted bivalent boosters provide additional protection compared with the monovalent ones. In this study, we aimed to estimate the relative effectiveness of a second booster with monovalent or bivalent mRNA vaccines against severe COVID-19 in Italy. METHODS Linking data from the Italian vaccination registry and the SARS-CoV-2 surveillance system, between Sept 12, 2022, and Jan 7, 2023, we matched 1:1 each person aged 60 years or older receiving a second booster with a person who had received the first booster only at least 120 days earlier. We used hazard ratios, estimated through Cox proportional hazard models, to compare the hazard of severe COVID-19 between the first booster group and each type of second booster (monovalent mRNA vaccine targeting the original strain of SARS-CoV-2, bivalent mRNA vaccine targeting the original strain plus omicron BA.1 [bivalent original/BA.1], and bivalent mRNA vaccine targeting the original strain plus omicron BA.4 and BA.5 [bivalent original/BA.4-5]). Relative vaccine effectiveness (rVE) was calculated as (1-hazard ratio) × 100. FINDINGS We analysed a total of 2 129 559 matched pairs. The estimated rVE against severe COVID-19 with the bivalent original/BA.4-5 booster was 50·6% (95% CI 46·0-54·8) in the overall time interval 14-118 days post-administration. Overall, rVE was 49·3% (43·6-54·4) for the bivalent original/BA.1 booster and 26·9% (11·8-39·3) for the monovalent booster. For the bivalent original/BA.4-5 booster, we did not observe relevant differences in rVE between the 60-79-year age group (overall, 53·6%; 46·8-59·5) and those aged 80 years or older (overall, 48·3%; 41·9-54·0). INTERPRETATION These findings suggest that a second booster with mRNA vaccines provides additional protection against severe COVID-19 due to omicron BA.5 (the predominant circulating subvariant in Italy during the study period) in people aged 60 years or older. Although rVE decreased over time, a second booster with the original/BA.4-5 mRNA vaccine, currently the most used in Italy, was found to be still providing protection 4 months post-administration. FUNDING NextGenerationEU-MUR-PNRR Extended Partnership initiative on Emerging Infectious Diseases (project number PE00000007, INF-ACT). TRANSLATION For the Italian translation of the abstract see Supplementary Materials section.
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Affiliation(s)
| | - Chiara Sacco
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; European Programme on Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Emmanouil Alexandros Fotakis
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; European Programme on Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Martina Del Manso
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Flavia Riccardo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Bressi
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Cristina Rota
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Daniele Petrone
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy; Department of Statistics, Sapienza University, Rome, Italy
| | - Andrea Siddu
- General Directorate of Prevention, Ministry of Health, Rome, Italy
| | - Giorgio Fedele
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Giovanni Rezza
- General Directorate of Prevention, Ministry of Health, Rome, Italy
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Massimo Fabiani
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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26
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Chen K, Zhang L, Fang Z, Li J, Li C, Song W, Huang Z, Chen R, Zhang Y, Li J. Analysis of the protective efficacy of approved COVID-19 vaccines against Omicron variants and the prospects for universal vaccines. Front Immunol 2023; 14:1294288. [PMID: 38090587 PMCID: PMC10711607 DOI: 10.3389/fimmu.2023.1294288] [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: 09/14/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
By the end of 2022, different variants of Omicron had rapidly spread worldwide, causing a significant impact on the Coronavirus disease 2019 (COVID-19) pandemic situation. Compared with previous variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), these new variants of Omicron exhibited a noticeable degree of mutation. The currently developed platforms to design COVID-19 vaccines include inactivated vaccines, mRNA vaccines, DNA vaccines, recombinant protein vaccines, virus-like particle vaccines, and viral vector vaccines. Many of these platforms have obtained approval from the US Food and Drug Administration (FDA) or the WHO. However, the Omicron variants have spread in countries where vaccination has taken place; therefore, the number of cases has rapidly increased, causing concerns about the effectiveness of these vaccines. This article first discusses the epidemiological trends of the Omicron variant and reviews the latest research progress on available vaccines. Additionally, we discuss progress in the development progress and practical significance of universal vaccines. Next, we analyze the neutralizing antibody effectiveness of approved vaccines against different variants of Omicron, heterologous vaccination, and the effectiveness of multivalent vaccines in preclinical trials. We hope that this review will provide a theoretical basis for the design, development, production, and vaccination strategies of novel coronavirus vaccines, thus helping to end the SARS-CoV-2 pandemic.
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Affiliation(s)
- Keda Chen
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Ling Zhang
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Zhongbiao Fang
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Jiaxuan Li
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Chaonan Li
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Wancheng Song
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhiwei Huang
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ruyi Chen
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Yanjun Zhang
- Department of Virus Inspection, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jianhua Li
- Department of Virus Inspection, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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27
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Pulvirenti F, Garzi G, Milito C, Sculco E, Sciannamea M, Napoli A, Cinti L, Roberto P, Punziano A, Carrabba M, Piano Mortari E, Carsetti R, Antonelli G, Quinti I. SARS-CoV-2 pre-exposure prophylaxis with tixagevimab/cilgavimab (AZD7442) provides protection in inborn errors of immunity with antibody defects: a real-world experience. Front Immunol 2023; 14:1249462. [PMID: 37954618 PMCID: PMC10639167 DOI: 10.3389/fimmu.2023.1249462] [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: 06/28/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023] Open
Abstract
Background Preventive strategies against severe COVID-19 in Inborn Errors of Immunity (IEI) include bivalent vaccines, treatment with SARS-CoV-2 monoclonal antibodies (mAbs), early antiviral therapies, and pre-exposure prophylaxis (PrEP). Objective To assess the effectiveness of the PrEP with tixagevimab/cilgavimab (AZD7442) in IEI with primary antibody defects during the COVID-19 Omicron wave. Methods A six-month prospective study evaluated the SARS-CoV-2 infection rate and the COVID-19 severity in the AZD7442 group, in the no-AZD7442 group, and in a group of patients with a recent SARS-CoV-2 infection (< three months). Spike-specific IgG levels were measured at regular intervals. Results Six out of thirty-three patients (18%) and 54/170 patients (32%) became infected in the AZD7442 group and in the no-AZD7442 group, respectively. Within 90 days post-administration, the AZD7442 group was 85% less likely to be infected and 82% less likely to have a symptomatic disease than the no-AZD7442 group. This effect was lost thereafter. In the entire cohort, no mortality/hospitalisation was observed. The control group of 35 recently infected patients was 88% and 92% less likely to be infected than the AZD7442 and no-AZD7442 groups. Serum anti-Spike IgG reached the highest peak seven days post-AZD7442 PrEP then decreased, remaining over 1000 BAU/mL 180 days thereafter. Conclusion In patients with IEI and antibody defects, AZD7442 prophylaxis had a transient protective effect, possibly lost possibly because of the appearance of new variants. However, PrEP with newer mAbs might still represent a feasible preventive strategy in the future in this population.
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Affiliation(s)
- Federica Pulvirenti
- Reference Centre for Primary Immune Deficiencies, Sapienza University Hospital “Policlinico Umberto I”, Rome, Italy
| | - Giulia Garzi
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Eleonora Sculco
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | | | - Anna Napoli
- Department of Molecular Medicine, Sapienza University, Rome, Italy
- Microbiology and Virology Unit, Sapienza University Hospital “Policlinico Umberto I”, Rome, Italy
| | - Lilia Cinti
- Department of Molecular Medicine, Sapienza University, Rome, Italy
- Microbiology and Virology Unit, Sapienza University Hospital “Policlinico Umberto I”, Rome, Italy
| | - Piergiorgio Roberto
- Microbiology and Virology Unit, Sapienza University Hospital “Policlinico Umberto I”, Rome, Italy
| | - Alessandra Punziano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Maria Carrabba
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eva Piano Mortari
- Department of Molecular Medicine, Sapienza University, Rome, Italy
- B Cell Unit, Immunology Research Area, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Rita Carsetti
- B Cell Unit, Immunology Research Area, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Guido Antonelli
- Department of Molecular Medicine, Sapienza University, Rome, Italy
- Microbiology and Virology Unit, Sapienza University Hospital “Policlinico Umberto I”, Rome, Italy
| | - Isabella Quinti
- Reference Centre for Primary Immune Deficiencies, Sapienza University Hospital “Policlinico Umberto I”, Rome, Italy
- Department of Molecular Medicine, Sapienza University, Rome, Italy
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28
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Chen SY, Lin CY, Chi H, Weng SL, Li ST, Tai YL, Huang YN, Huang H, Lin CH, Chiu NC. The Effectiveness of Bivalent COVID-19 Vaccination: A Preliminary Report. Life (Basel) 2023; 13:2094. [PMID: 37895475 PMCID: PMC10608313 DOI: 10.3390/life13102094] [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: 08/22/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Vaccination has been a game-changer in the long battle against COVID-19. However, waning vaccine-induced immunity and the immune evasion of emerging variants create challenges. The rapid-fire development of bivalent vaccines (BVs), comprising ancestral strains and a new variant, was authorized to prevent COVID-19, but the effectiveness of the updated vaccines remains largely unclear. Electronic databases were searched to investigate the immunogenicity and reactogenicity of BVs in humans. As of March 2023, 20 trials were identified. Compared with monovalent vaccination, the induced immunogenicity against ancestral strains was similar. The BVs demonstrated approximately 33-50% higher immunogenicity values against additional variant strains. An observational cohort study showed the additional clinical effectiveness of the BVs. The adverse events were similar. In conclusion, our systematic review found that the BVs had equal immunogenicity against ancestral strains without safety concerns. Approximately 33-50% increased additional antibody titers and clinical effectiveness against additional variant strains were observed in subjects with a BV vaccine with moderate heterogeneity, especially for BA.1-containing BVs.
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Affiliation(s)
- Ssu-Yu Chen
- Hsinchu MacKay Memorial Hospital, Hsinchu City 300, Taiwan
- Hsinchu Municipal MacKay Children’s Hospital, Hsinchu City 300, Taiwan
| | - Chien-Yu Lin
- Hsinchu MacKay Memorial Hospital, Hsinchu City 300, Taiwan
- Hsinchu Municipal MacKay Children’s Hospital, Hsinchu City 300, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 251, Taiwan
| | - Hsin Chi
- Department of Medicine, MacKay Medical College, New Taipei City 251, Taiwan
- MacKay Children’s Hospital, Taipei 104, Taiwan
| | - Shun-Long Weng
- Hsinchu MacKay Memorial Hospital, Hsinchu City 300, Taiwan
- Hsinchu Municipal MacKay Children’s Hospital, Hsinchu City 300, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 251, Taiwan
| | - Sung-Tse Li
- Hsinchu MacKay Memorial Hospital, Hsinchu City 300, Taiwan
- Hsinchu Municipal MacKay Children’s Hospital, Hsinchu City 300, Taiwan
| | - Yu-Lin Tai
- Hsinchu MacKay Memorial Hospital, Hsinchu City 300, Taiwan
- Hsinchu Municipal MacKay Children’s Hospital, Hsinchu City 300, Taiwan
| | - Ya-Ning Huang
- Hsinchu MacKay Memorial Hospital, Hsinchu City 300, Taiwan
- Hsinchu Municipal MacKay Children’s Hospital, Hsinchu City 300, Taiwan
| | - Hsiang Huang
- Hsinchu MacKay Memorial Hospital, Hsinchu City 300, Taiwan
- Hsinchu Municipal MacKay Children’s Hospital, Hsinchu City 300, Taiwan
| | - Chao-Hsu Lin
- Hsinchu MacKay Memorial Hospital, Hsinchu City 300, Taiwan
- Hsinchu Municipal MacKay Children’s Hospital, Hsinchu City 300, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City 251, Taiwan
| | - Nan-Chang Chiu
- Department of Medicine, MacKay Medical College, New Taipei City 251, Taiwan
- MacKay Children’s Hospital, Taipei 104, Taiwan
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29
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Katzman C, Morgan T, de Roche A, Harris J, Mauro C, Zimet G, Rosenthal S. Longitudinal assessment of COVID-19 vaccine uptake: A two-wave survey of a nationally representative U.S. sample. PLoS One 2023; 18:e0289541. [PMID: 37796981 PMCID: PMC10553259 DOI: 10.1371/journal.pone.0289541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/20/2023] [Indexed: 10/07/2023] Open
Abstract
Understanding factors that influence those who are initially COVID-19 vaccine hesitant to accept vaccination is valuable for the development of vaccine promotion strategies. Using Ipsos KnowledgePanel®, we conducted a national survey of adults aged 18 and older in the United States. We created a questionnaire to examine factors associated with COVID-19 vaccine uptake over a longitudinal period ("Wave 1" in April 2021 and "Wave 2" in February 2022), and utilized weighted data provided by Ipsos to make the data nationally representative. Overall, 1189 individuals participated in the Wave 1 survey, and 843 participants completed the Wave 2 survey (71.6% retention rate). Those who intended to be vaccinated as soon as possible ("ASAP") were overwhelmingly vaccinated by Wave 2 (96%, 95% CI: 92% to 100%). Of those who initially wished to delay vaccination until there was more experience with it ("Wait and See"), 57% (95% CI: 47% to 67%) were vaccinated at Wave 2. Within the "Wait and See" cohort, those with income <$50,000 and those who had never received the influenza vaccine were significantly less likely to be vaccinated at Wave 2. Among those who initially indicated that they would not receive a COVID-19 vaccine ("Non-Acceptors"), 28% (95% CI: 21% to 36%) were vaccinated at Wave 2. Those who believed COVID-19 was not a major problem in their community were significantly less likely to be vaccinated, while those with more favorable attitudes toward vaccines in general and public health strategies to decrease the impact of COVID-19 were significantly more likely to be vaccinated. Overall, barriers to vaccine uptake for the "Wait and See" cohort appear to be more practical, whereas barriers for the "Non-Acceptor" cohort seem to be more ideological. These findings will help target interventions to improve uptake of COVID-19 boosters and future novel vaccines.
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Affiliation(s)
- Caroline Katzman
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
- NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Tucker Morgan
- Department of Biostatistics at the Mailman School of Public Health at Columbia University Irving Medical Center, New York, NY, United States of America
| | - Ariel de Roche
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Julen Harris
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
- NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Christine Mauro
- Department of Biostatistics at the Mailman School of Public Health at Columbia University Irving Medical Center, New York, NY, United States of America
| | - Gregory Zimet
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Susan Rosenthal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
- Department of Psychiatry at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center, New York, NY, United States of America
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Fernández-Ruiz M, Almendro-Vázquez P, Redondo N, Ruiz-Merlo T, Abella S, Somoza A, López-Medrano F, San Juan R, Loinaz C, Andrés A, Paz-Artal E, Aguado JM. Cell-mediated and Neutralizing Antibody Responses to the SARS-CoV-2 Omicron BA.4/BA.5-adapted Bivalent Vaccine Booster in Kidney and Liver Transplant Recipients. Transplant Direct 2023; 9:e1536. [PMID: 37745949 PMCID: PMC10513127 DOI: 10.1097/txd.0000000000001536] [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: 07/06/2023] [Accepted: 07/21/2023] [Indexed: 09/26/2023] Open
Abstract
Background The immunogenicity elicited by the Omicron BA.4/BA.5-adapted bivalent booster vaccine after solid organ transplantation (SOT) has not been characterized. Methods We assessed cell-mediated and neutralizing IgG antibody responses against the BA.4/BA.5 spike receptor-binding domain at baseline and 2 wk after the administration of an mRNA-based bivalent (ancestral strain and BA.4/BA.5 subvariants) vaccine among 30 SOT recipients who had received ≥3 monovalent vaccine doses. Previous coronavirus disease 2019 history was present in 46.7% of them. We also recruited a control group of 19 nontransplant healthy individuals. Cell-mediated immunity was measured by fluorescent ELISpot assay for interferon (IFN)-γ secretion, whereas the neutralizing IgG antibody response against the BA.4/BA.5 spike receptor-binding domain was quantified with a competitive ELISA. Results The median number of BA.4/BA.5 spike-specific IFN-γ-producing spot-forming units (SFUs) increased from baseline to 2 wk postbooster (83.8 versus 133.0 SFUs/106 peripheral blood mononuclear cells; P = 0.0017). Seropositivity rate also increased (46.7%-83.3%; P = 0.001), as well as serum neutralizing activity (4.2%-78.3%; P < 0.0001). Patients with no prior coronavirus disease 2019 history experienced higher improvements in cell-mediated and neutralizing responses after booster vaccination. There was no correlation between BA.4/BA.5 spike-specific IFN-γ-producing SFUs and neutralizing activity. Nontransplant controls showed more robust postbooster cell-mediated immunity than SOT recipients (591.1 versus 133.0 IFN-γ-producing SFUs/106 peripheral blood mononuclear cells; P < 0.0001), although no differences were observed for antibody responses in terms of postbooster seropositivity rates or neutralizing activity. Conclusions Booster with the BA.4/BA.5-adapted bivalent vaccine generated strong subvariant-specific responses among SOT recipients. Booster-induced cell-mediated immunity, however, remained lower than in immunocompetent individuals.
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Affiliation(s)
- Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre,” Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Patricia Almendro-Vázquez
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Immunology, Hospital Universitario “12 de Octubre,” Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Natalia Redondo
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre,” Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Tamara Ruiz-Merlo
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre,” Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Sandra Abella
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre,” Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Adán Somoza
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre,” Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Francisco López-Medrano
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre,” Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Rafael San Juan
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre,” Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Carmelo Loinaz
- Department of General and Digestive Tract Surgery and Abdominal Organ Transplantation, Hospital Universitario “12 de Octubre,” Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
- Department of Surgery, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Amado Andrés
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
- Department of Nephrology, Hospital Universitario “12 de Octubre,” Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Estela Paz-Artal
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Immunology, Hospital Universitario “12 de Octubre,” Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
- Department of Immunology, Ophthalmology and Ear, Nose and Throat (ENT), School of Medicine, University Complutense, Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre,” Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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Mimura W, Ishiguro C, Terada-Hirashima J, Matsunaga N, Maeda M, Murata F, Fukuda H. Bivalent Vaccine Effectiveness Among Adults Aged ≥65 Years During the BA.5-Predominant Period in Japan: The VENUS Study. Open Forum Infect Dis 2023; 10:ofad475. [PMID: 37869405 PMCID: PMC10588616 DOI: 10.1093/ofid/ofad475] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Indexed: 10/24/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron BA.5 became prevalent in July 2022 in Japan. Bivalent messenger RNA (mRNA) vaccines were approved as booster doses for individuals who received the primary series or booster dose by monovalent vaccines. We aimed to assess the effectiveness of bivalent vaccines in Japanese adults aged ≥65 years. Methods We conducted a population-based cohort study using data collected from January 2019 to February 2023 in Japan. We included individuals aged ≥65 years in a municipality who received the first or second booster dose of monovalent mRNA vaccines. We estimated the effectiveness of the second or third booster dose of bivalent mRNA vaccines during the Omicron BA.5-predominant period (July-December 2022), compared with ≥90 days after the booster dose of monovalent vaccines. We used a Cox proportional hazard regression model with vaccination status as a time-dependent covariate. Results A total of 81 977 individuals aged ≥65 years (mean [standard deviation] age, 78.3 [7.4] years; 33 487 male [40.8%]) were included in the study cohort. Among them, 57 396 were vaccinated with the second or third dose of bivalent vaccines (BA.1 or BA.4/5). The effectiveness against coronavirus disease 2019 (COVID-19) was estimated to be 57.9% (95% confidence interval, 52.7%-62.5%) for ≥14 days after the second or third bivalent booster dose, compared with 90 days after the first or second monovalent booster dose. Conclusions The study showed that the bivalent mRNA vaccines as the second and third doses would provide protection against COVID-19 among adults ≥65 years in Japan.
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Affiliation(s)
- Wataru Mimura
- Section of Clinical Epidemiology, Department of Data Science, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Chieko Ishiguro
- Section of Clinical Epidemiology, Department of Data Science, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Junko Terada-Hirashima
- Department of Respiratory Medicine, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobuaki Matsunaga
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Megumi Maeda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Fumiko Murata
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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Föhse K, Geckin B, Zoodsma M, Kilic G, Liu Z, Röring RJ, Overheul GJ, van de Maat J, Bulut O, Hoogerwerf JJ, Ten Oever J, Simonetti E, Schaal H, Adams O, Müller L, Ostermann PN, van de Veerdonk FL, Joosten LAB, Haagmans BL, van Crevel R, van Rij RP, GeurtsvanKessel C, de Jonge MI, Li Y, Domínguez-Andrés J, Netea MG. The impact of BNT162b2 mRNA vaccine on adaptive and innate immune responses. Clin Immunol 2023; 255:109762. [PMID: 37673225 DOI: 10.1016/j.clim.2023.109762] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/04/2023] [Accepted: 09/02/2023] [Indexed: 09/08/2023]
Abstract
The mRNA-based BNT162b2 protects against severe disease and mortality caused by SARS-CoV-2 via induction of specific antibody and T-cell responses. Much less is known about its broad effects on immune responses against other pathogens. Here, we investigated the adaptive immune responses induced by BNT162b2 vaccination against various SARS-CoV-2 variants and its effects on the responsiveness of immune cells upon stimulation with heterologous stimuli. BNT162b2 vaccination induced effective humoral and cellular immunity against SARS-CoV-2 that started to wane after six months. We also observed long-term transcriptional changes in immune cells after vaccination. Additionally, vaccination with BNT162b2 modulated innate immune responses as measured by inflammatory cytokine production after stimulation - higher IL-1/IL-6 release and decreased IFN-α production. Altogether, these data expand our knowledge regarding the overall immunological effects of this new class of vaccines and underline the need for additional studies to elucidate their effects on both innate and adaptive immune responses.
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Affiliation(s)
- Konstantin Föhse
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Büsra Geckin
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Martijn Zoodsma
- Department of Computational Biology for Individualised Medicine, Centre for Individualised Infection Medicine (CiiM), A Joint Venture Between the Helmholtz-Centre for Infection Research (HZI) and the Hannover Medical School (MHH), Hannover, Germany; TWINCORE, A Joint Venture Between the Helmholtz-Centre for Infection Research (HZI) and the Hannover Medical School (MHH), Hannover, Germany
| | - Gizem Kilic
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Zhaoli Liu
- Department of Computational Biology for Individualised Medicine, Centre for Individualised Infection Medicine (CiiM), A Joint Venture Between the Helmholtz-Centre for Infection Research (HZI) and the Hannover Medical School (MHH), Hannover, Germany; TWINCORE, A Joint Venture Between the Helmholtz-Centre for Infection Research (HZI) and the Hannover Medical School (MHH), Hannover, Germany
| | - Rutger J Röring
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gijs J Overheul
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Josephine van de Maat
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ozlem Bulut
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jacobien J Hoogerwerf
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jaap Ten Oever
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elles Simonetti
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands
| | - Heiner Schaal
- Institute of Virology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Ortwin Adams
- Institute of Virology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Lisa Müller
- Institute of Virology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Philipp Niklas Ostermann
- Institute of Virology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Frank L van de Veerdonk
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Leo A B Joosten
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bart L Haagmans
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ronald P van Rij
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Marien I de Jonge
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands
| | - Yang Li
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Computational Biology for Individualised Medicine, Centre for Individualised Infection Medicine (CiiM), A Joint Venture Between the Helmholtz-Centre for Infection Research (HZI) and the Hannover Medical School (MHH), Hannover, Germany; TWINCORE, A Joint Venture Between the Helmholtz-Centre for Infection Research (HZI) and the Hannover Medical School (MHH), Hannover, Germany
| | - Jorge Domínguez-Andrés
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
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Tseng HF, Ackerson BK, Sy LS, Tubert JE, Luo Y, Qiu S, Lee GS, Bruxvoort KJ, Ku JH, Florea A, Takhar HS, Bathala R, Zhou CK, Esposito DB, Marks MA, Anderson EJ, Talarico CA, Qian L. mRNA-1273 bivalent (original and Omicron) COVID-19 vaccine effectiveness against COVID-19 outcomes in the United States. Nat Commun 2023; 14:5851. [PMID: 37730701 PMCID: PMC10511551 DOI: 10.1038/s41467-023-41537-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/07/2023] [Indexed: 09/22/2023] Open
Abstract
The bivalent (original and Omicron BA.4/BA.5) mRNA-1273 COVID-19 vaccine was authorized to offer broader protection against COVID-19. We conducted a matched cohort study to evaluate the effectiveness of the bivalent vaccine in preventing hospitalization for COVID-19 (primary outcome) and medically attended SARS-CoV-2 infection and hospital death (secondary outcomes). Compared to individuals who did not receive bivalent mRNA vaccination but received ≥2 doses of any monovalent mRNA vaccine, the relative vaccine effectiveness (rVE) against hospitalization for COVID-19 was 70.3% (95% confidence interval, 64.0%-75.4%). rVE was consistent across subgroups and not modified by time since last monovalent dose or number of monovalent doses received. Protection was durable ≥3 months after the bivalent booster. rVE against SARS-CoV-2 infection requiring emergency department/urgent care and against COVID-19 hospital death was 55.0% (50.8%-58.8%) and 82.7% (63.7%-91.7%), respectively. The mRNA-1273 bivalent booster provides additional protection against hospitalization for COVID-19, medically attended SARS-CoV-2 infection, and COVID-19 hospital death.
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Affiliation(s)
- Hung Fu Tseng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA.
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, 91101, USA.
| | - Bradley K Ackerson
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - Julia E Tubert
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - Yi Luo
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - Sijia Qiu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - Gina S Lee
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - Katia J Bruxvoort
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Jennifer H Ku
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - Ana Florea
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - Harpreet S Takhar
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - Radha Bathala
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | | | | | | | | | - Carla A Talarico
- Moderna Inc., Cambridge, MA, 02139, USA
- AstraZeneca, Gaithersburg, MD, 20878, USA
| | - Lei Qian
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
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Park HJ, Tan ST, León TM, Jain S, Schechter R, Lo NC. Predicting the Public Health Impact of Bivalent Vaccines and Nirmatrelvir-Ritonavir Against Coronavirus Disease 2019. Open Forum Infect Dis 2023; 10:ofad415. [PMID: 37674629 PMCID: PMC10478155 DOI: 10.1093/ofid/ofad415] [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: 05/11/2023] [Accepted: 07/28/2023] [Indexed: 09/08/2023] Open
Abstract
Background Uptake of coronavirus disease 2019 (COVID-19) bivalent vaccines and the oral medication nirmatrelvir-ritonavir (Paxlovid) has remained low across the United States. Assessing the public health impact of increasing uptake of these interventions in key risk groups can guide further public health resources and policy and determine what proportion of severe COVID-19 is avertable with these interventions. Methods This modeling study used person-level data from the California Department of Public Health on COVID-19 cases, hospitalizations, deaths, and vaccine administration from 23 July 2022 to 23 January 2023. We used a quasi-Poisson regression model calibrated to recent historical data to predict future COVID-19 outcomes and modeled the impact of increasing uptake (up to 70% coverage) of bivalent COVID-19 vaccines and nirmatrelvir-ritonavir during acute illness in different risk groups. Risk groups were defined by age (≥50, ≥65, ≥75 years) and vaccination status (everyone, primary series only, previously vaccinated). We predicted the number of averted COVID-19 cases, hospitalizations, and deaths and number needed to treat (NNT). Results The model predicted that increased uptake of bivalent COVID-19 boosters and nirmatrelvir-ritonavir (up to 70% coverage) in all eligible persons could avert an estimated 15.7% (95% uncertainty interval [UI], 11.2%-20.7%; NNT: 17 310) and 23.5% (95% UI, 13.1%-30.0%; NNT: 67) of total COVID-19-related deaths, respectively. In the high-risk group of persons ≥65 years old alone, increased uptake of bivalent boosters and nirmatrelvir-ritonavir could avert an estimated 11.9% (95% UI, 8.4%-15.1%; NNT: 2757) and 22.8% (95% UI, 12.7%-29.2%; NNT: 50) of total COVID-19-related deaths, respectively. Conclusions These findings suggest that prioritizing uptake of bivalent boosters and nirmatrelvir-ritonavir among older age groups (≥65 years) would be most effective (based on NNT) but would not address the entire burden of severe COVID-19.
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Affiliation(s)
- Hailey J Park
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Sophia T Tan
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Tomás M León
- California Department of Public Health, Richmond, California, USA
| | - Seema Jain
- California Department of Public Health, Richmond, California, USA
| | - Robert Schechter
- California Department of Public Health, Richmond, California, USA
| | - Nathan C Lo
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
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35
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Şimşek-Yavuz S. COVID-19: An Update on Epidemiology, Prevention and Treatment, September-2023. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:165-187. [PMID: 38633552 PMCID: PMC10986731 DOI: 10.36519/idcm.2023.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/19/2023] [Indexed: 04/19/2024]
Abstract
After a downward trend for more than 12 months, the incidence of COVID-19 has increased in the last months. Although COVID-19 is not as frequent as in the first years of the pandemic, case numbers are still very high, and it causes a significant number of deaths. COVID-19 is not seen with a predictable frequency, at least two times more deadly than the flu, continues as an epidemic, and has not reached the endemic level yet. Currently, the Omicron strains EG.5 and XBB.1.16 are dominant worldwide. Although BA.2.86 and FLip variants, including FL.1.5.1 are not widespread at the moment, both were shown to be highly immune-evasive and require close monitoring. Prevention of COVID-19 relies on vaccinations, surveillance, proper ventilation of enclosed spaces, isolation of patients, and mask usage. Currently, monovalent COVID-19 vaccines, including XBB.1.5 Omicron SARS-CoV-2, are recommended for both primary and booster vaccinations against COVID-19. Monovalent vaccines, including only original SARS-CoV-2 strain, and bivalent vaccines, including original virus plus BA4/5 variant, are no longer recommended against COVID-19. Booster vaccination with XBB.1.5 containing vaccine should be prioritized for patients at high risk for severe COVID-19. Bacillus Calmette-Guérin (BCG) vaccination does not seem to be effective in preventing COVID-19. At the current phase of the pandemic, nirmatrelvir/ritonavir, remdesivir, molnupiravir, sotrovimab (for patients from XBB.1.5 variant dominant settings), and convalescent plasma can be considered for the treatment of high-risk early-stage outpatients with COVID-19, while hospitalized patients with more severe disease can be treated with dexamethasone, anti cytokines including tocilizumab, sarilumab, baricitinib, and tofacitinib and antithrombotic agents including enoxaparin. Remdesivir oral analogues and ensitrelvir fumarate are promising agents for treating acute COVID-19, which are in phase trials now; however, ivermectin, fluvoxamine, and metformin were shown to be ineffective.
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Affiliation(s)
- Serap Şimşek-Yavuz
- Department of Infectious Diseases and Clinical Microbiology, İstanbul University School of Medicine, İstanbul, Türkiye
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36
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Ko L, Malet G, Chang LL, Nguyen H, Mayes R. COVID-19 Infection Rates in Vaccinated and Unvaccinated Inmates: A Retrospective Cohort Study. Cureus 2023; 15:e44684. [PMID: 37680261 PMCID: PMC10482361 DOI: 10.7759/cureus.44684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 09/09/2023] Open
Abstract
Background In 2023, breakthrough COVID-19 infections among vaccinated individuals and reinfections in previously infected people have become common. Additionally, infections are due to Omicron subvariants of the virus that behave differently from those at the onset of the pandemic. Understanding how vaccination and natural immunity influence COVID-19 infection rates is crucial, especially in high-density congregate settings such as prisons, to inform public health strategies. Methods We analyzed COVID-19 surveillance data from January to July 2023 across 33 California state prisons, primarily a male population of 96,201 individuals. We computed the incidence rate of new COVID-19 infections among COVID-bivalent-vaccinated and entirely unvaccinated groups (those not having received either the bivalent or monovalent vaccine). Results Our results indicate that the infection rates in the bivalent-vaccinated and entirely unvaccinated groups are 3.24% (95% confidence interval (CI): 3.06-3.42%) and 2.72% (CI: 2.50-2.94%), respectively, with an absolute risk difference of only 0.52%. When the data were filtered for those aged 50 and above, the infection rates were 4.07% (CI: 3.77-4.37%) and 3.1% (CI: 2.46-3.74%), respectively, revealing a mere 0.97% absolute risk difference. Among those aged 65 and above, the infection rates were 6.45% (CI: 5.74-7.16%) and 4.5% (CI: 2.57-6.43%), respectively, with an absolute risk difference of 1.95%. Conclusion We note low infection rates in both the vaccinated and unvaccinated groups, with a small absolute difference between the two across age groups. A combination of monovalent and bivalent vaccines and natural infections likely contributed to immunity and a lower level of infection rates compared to the height of the pandemic. It is possible that a degree of 'herd immunity' has been achieved. Yet, using p<0.05 as the threshold for statistical significance, the bivalent-vaccinated group had a slightly but statistically significantly higher infection rate than the unvaccinated group in the statewide category and the age ≥50 years category. However, in the older age category (≥65 years), there was no significant difference in infection rates between the two groups. This suggests that while the bivalent vaccine might offer protection against severe outcomes, it may not significantly reduce the risk of infections entirely. Further research is needed to understand the reasons behind these findings and to consider other factors, such as underlying health conditions. This study underscores the importance of developing vaccines that target residual COVID-19 infections, especially in regard to evolving COVID-19 variants.
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Affiliation(s)
- Luke Ko
- Biomedical Sciences Pathway Program, California High School, San Ramon, USA
| | - Gary Malet
- Internal Medicine, California Correctional Healthcare Services, Stockton, USA
| | - Lisa L Chang
- College of Education, Governors State University, University Park, USA
| | - Huu Nguyen
- Internal Medicine, California Correctional Healthcare Services, Stockton, USA
| | - Robert Mayes
- Internal Medicine, California Correctional Healthcare Services, Stockton, USA
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Murdoch L, Quan K, Baber JA, Ho AWY, Zhang Y, Xu X, Lu C, Cooper D, Koury K, Lockhart SP, Anderson AS, Türeci Ö, Şahin U, Swanson KA, Gruber WC, Kitchin N. Safety and Immunogenicity of the BNT162b2 Vaccine Coadministered with Seasonal Inactivated Influenza Vaccine in Adults. Infect Dis Ther 2023; 12:2241-2258. [PMID: 37698774 PMCID: PMC10581992 DOI: 10.1007/s40121-023-00863-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023] Open
Abstract
INTRODUCTION Vaccination is a critical tool for preventing coronavirus disease 2019 (COVID-19) and influenza illnesses. Coadministration of the COVID-19 vaccine, BNT162b2, with seasonal inactivated influenza vaccine (SIIV) can provide substantial benefits, including streamlining vaccine delivery. METHODS In this phase 3 study, healthy 18- to 64-year-olds who had received three previous doses of BNT162b2 were randomized (1:1) to the coadministration group (month 0, BNT162b2 + SIIV; month 1, placebo) or the separate-administration group (month 0, placebo + SIIV; month 1, BNT162b2). The primary immunogenicity objective was to demonstrate that the immune responses elicited by BNT162b2 and SIIV [measured by full-length S-binding immunoglobulin G (IgG) levels and strain-specific hemagglutination inhibition assay (HAI) titers against four influenza strains 1 month post-vaccination, respectively] when coadministered were noninferior to those elicited by either vaccine administered alone, based on a prespecified 1.5-fold noninferiority margin [lower bound 95% CI for geometric mean ratio (GMR) > 0.67]. Reactogenicity and adverse event (AE) rates were evaluated. RESULTS Randomized participants who received study vaccination (N = 1128; coadministration group, n = 564; separate-administration group, n = 564) had a median age of 39 years. Model-adjusted GMRs for coadministration to separate administration were 0.83 (95% CI 0.77, 0.89) for full-length S-binding IgG levels and 0.89-1.00 (lower bound of all 95% CIs > 0.67) for the four influenza strain-specific HAI titers, with all endpoints achieving the prespecified noninferiority criterion. Reactogenicity events were mostly mild or moderate when BNT162b2 was coadministered with SIIV. Serious AEs were reported in < 1% of participants within 1 month after any vaccination; none were considered vaccine-related. CONCLUSIONS BNT162b2 coadministered with SIIV elicited immune responses that were noninferior to those elicited by BNT162b2 alone and SIIV alone, and BNT162b2 had an acceptable safety profile when coadministered with SIIV. The results of this study support the coadministration of BNT162b2 and SIIV in adults. TRIAL REGISTRATION ClinicalTrials.gov registration: NCT05310084.
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Affiliation(s)
| | - Karen Quan
- Vaccine Clinical Research and Development, Pfizer Australia Pty Ltd, Sydney, NSW, Australia.
| | - James A Baber
- Vaccine Clinical Research and Development, Pfizer Australia Pty Ltd, Sydney, NSW, Australia
| | - Agnes W Y Ho
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Ying Zhang
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Xia Xu
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Claire Lu
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - David Cooper
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Kenneth Koury
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | | | | | | | | | - Kena A Swanson
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - William C Gruber
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
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Lee IT, Cosgrove CA, Moore P, Bethune C, Nally R, Bula M, Kalra PA, Clark R, Dargan PI, Boffito M, Sheridan R, Moran E, Darton TC, Burns F, Saralaya D, Duncan CJA, Lillie PJ, San Francisco Ramos A, Galiza EP, Heath PT, Girard B, Parker C, Rust D, Mehta S, de Windt E, Sutherland A, Tomassini JE, Dutko FJ, Chalkias S, Deng W, Chen X, Feng J, Tracy L, Zhou H, Miller JM, Das R. Omicron BA.1-containing mRNA-1273 boosters compared with the original COVID-19 vaccine in the UK: a randomised, observer-blind, active-controlled trial. THE LANCET. INFECTIOUS DISEASES 2023; 23:1007-1019. [PMID: 37348519 DOI: 10.1016/s1473-3099(23)00295-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/07/2023] [Accepted: 04/27/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND The omicron BA.1 bivalent booster is used globally. Previous open-label studies of the omicron BA.1 (Moderna mRNA-1273.214) booster showed superior neutralising antibody responses against omicron BA.1 and other variants compared with the original mRNA-1273 booster. We aimed to compare the safety and immunogenicity of omicron BA.1 monovalent and bivalent boosters with the original mRNA-1273 vaccine in a large, randomised controlled trial. METHODS In this large, randomised, observer-blind, active-controlled, phase 3 trial in the UK (28 hospital and vaccination clinic sites), individuals aged 16 years or older who had previously received two injections of any authorised or approved COVID-19 vaccine, with or without an mRNA vaccine booster (third dose), were randomly allocated (1:1) using interactive response technology to receive 50 μg omicron BA.1 monovalent or bivalent vaccines or 50 μg mRNA-1273 administered as boosters via deltoid intramuscular injection. The primary outcomes were safety and immunogenicity at day 29, including prespecified non-inferiority and superiority of booster immune responses, based on the neutralising antibody geometric mean concentration (GMC) ratios of the monovalent and bivalent boosters compared with mRNA-1273. Safety was assessed in all participants who received first or second boosters, and primary immunogenicity outcomes were assessed in all participants who received the planned booster dose, had pre-booster and day 29 antibody data, had no major protocol deviations, and who were SARS-CoV-2-negative. The study is registered with EudraCT (2022-000063-51) and ClinicalTrials.gov (NCT05249829) and is ongoing. FINDINGS Between Feb 16 and March 24, 2022, 724 participants were randomly allocated to receive omicron BA.1 monovalent (n=366) or mRNA-1273 (n=357), and between April 2 and June 17, 2022, 2824 participants were randomly allocated to receive omicron BA.1 bivalent (n=1418) or mRNA-1273 (n=1395) vaccines as second boosters. Median durations (months) between the most recent COVID-19 vaccine and study boosters were similar for omicron BA.1 monovalent (4·0 months [IQR 3·6-4·7]) and mRNA-1273 (4·1 [3·5-4·7]), and for the omicron BA.1 bivalent (5·5 [4·8-6·2]) and mRNA-1273 (5·4 [4·8-6·2]) boosters. The omicron BA.1 monovalent and bivalent boosters elicited superior neutralising GMCs against the omicron BA.1 variant compared with mRNA-1273, with GMC ratios of 1·68 (99% CI 1·45-1·95) and 1·53 (1·41-1·67) at day 29 post-booster doses in participants without previous SARS-CoV-2 infection. Both boosters induced non-inferior ancestral SARS-CoV-2 (Asp614Gly) immune responses with GMCs that were similar for the bivalent (2987·2 [95% CI 2814·9-3169·9]) versus mRNA-1273 (2911·3 [2750·9-3081·0]) and lower for the monovalent (2699·7 [2431·3-2997·7] vs 3020·6 [2776·5-3286·2]) boosters, with respective GMC ratios of 1·05 (99% CI 0·96-1·15) and 0·82 (95% CI 0·74-0·91). Results were comparable regardless of previous SARS-CoV-2 infection status. Incidences of solicited adverse reactions with the omicron BA.1 monovalent (335 [91·3%] of 367 participants) and omicron BA.1 bivalent (1285 [90·4%] of 1421 participants) boosters were similar to those observed previously for mRNA-1273, with no new safety concerns identified and no occurrences of fatal adverse events. INTERPRETATION Omicron-containing booster vaccines generated superior immunogenicity against omicron BA.1 and comparable immunogenicity against the original strain with no new safety concerns. It remains important to continuously monitor the immune responses and real-world vaccine effectiveness as divergent SARS-CoV-2 variants emerge. FUNDING Moderna.
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Affiliation(s)
| | - Catherine A Cosgrove
- Vaccine Institute, Centre for Neonatal and Paediatric Infection, St George's University of London, London, UK
| | - Patrick Moore
- Adam Practice, Poole, UK; University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Marcin Bula
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Philip A Kalra
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | | | - Paul I Dargan
- Guy's & St Thomas' NHS Foundation Trust, King's College London, London, UK
| | - Marta Boffito
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; Department of Infectious Disease, Imperial College London, London, UK
| | | | | | - Thomas C Darton
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Fiona Burns
- Royal Free London NHS Foundation Trust University and University College London, London, UK
| | - Dinesh Saralaya
- National Institute for Health Research Patient Recruitment Centre, Bradford, UK; Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher J A Duncan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Patrick J Lillie
- Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, UK
| | - Alberto San Francisco Ramos
- Vaccine Institute, Centre for Neonatal and Paediatric Infection, St George's University of London, London, UK
| | - Eva P Galiza
- Vaccine Institute, Centre for Neonatal and Paediatric Infection, St George's University of London, London, UK
| | - Paul T Heath
- Vaccine Institute, Centre for Neonatal and Paediatric Infection, St George's University of London, London, UK
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Chalkias S, Whatley JL, Eder F, Essink B, Khetan S, Bradley P, Brosz A, McGhee N, Tomassini JE, Chen X, Zhao X, Sutherland A, Shen X, Girard B, Edwards DK, Feng J, Zhou H, Walsh S, Montefiori DC, Baden LR, Miller JM, Das R. Original SARS-CoV-2 monovalent and Omicron BA.4/BA.5 bivalent COVID-19 mRNA vaccines: phase 2/3 trial interim results. Nat Med 2023; 29:2325-2333. [PMID: 37653342 PMCID: PMC10504066 DOI: 10.1038/s41591-023-02517-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023]
Abstract
This ongoing, open-label, phase 2/3 trial compared the safety and immunogenicity of the Omicron BA.4/BA.5-containing bivalent mRNA-1273.222 vaccine with the ancestral Wuhan-Hu-1 mRNA-1273 as booster doses. Two groups of adults who previously received mRNA-1273 as primary vaccination series and booster doses were enrolled in a sequential, nonrandomized manner and received single-second boosters of mRNA-1273 (n = 376) or bivalent mRNA-1273.222 (n = 511). Primary objectives were safety and the noninferiority or superiority of neutralizing antibody (nAb) responses against Omicron BA.4/BA.5 and ancestral SARS-CoV-2 with the D614G mutation (ancestral SARS-CoV-2 (D614G)), 28 days post boost. Superiority and noninferiority were based on prespecified success criteria (lower bounds of 95% CI > 1 and < 0.677, respectively) of the mRNA-1273.222:mRNA-1273 geometric mean ratios. Bivalent Omicron BA.4/BA.5-containing mRNA-1273.222 elicited superior nAb responses against BA.4/BA.5 versus mRNA-1273 and noninferior responses against ancestral SARS-CoV-2 (D614G) at day 29 post boost in participants without detectable prior SARS-CoV-2 infection. Day 29 seroresponses against Omicron BA.4/BA.5 were higher for mRNA-1273.222 than for mRNA-1273 and similar against ancestral SARS-CoV-2 (D614G), both meeting noninferiority criterion. The safety profile of mRNA-1273.222 was similar to that previously reported for mRNA-1273 with no new safety concerns identified. Continued monitoring of neutralization and real-world vaccine effectiveness are needed as additional divergent-virus variants emerge. ClinicalTrials.gov registration: NCT04927065.
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Affiliation(s)
| | | | - Frank Eder
- Meridian Clinical Research, LLC, Binghamton, NY, USA
| | | | | | | | - Adam Brosz
- Meridian Clinical Research, Grand Island, NE, USA
| | | | | | | | | | | | - Xiaoying Shen
- Department of Surgery and Duke Human Vaccine Institute, Durham, NC, USA
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Wang W, Goguet E, Paz S, Vassell R, Pollett S, Mitre E, Weiss CD. Bivalent Coronavirus Disease 2019 Vaccine Antibody Responses to Omicron Variants Suggest That Responses to Divergent Variants Would Be Improved With Matched Vaccine Antigens. J Infect Dis 2023; 228:439-443. [PMID: 37279924 PMCID: PMC10428200 DOI: 10.1093/infdis/jiad111] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/07/2023] [Accepted: 04/20/2023] [Indexed: 06/08/2023] Open
Abstract
We compared neutralizing antibody responses to BA.4/5, BQ.1.1, XBB, and XBB.1.5 Omicron severe acute respiratory syndrome coronavirus 2 variants after a bivalent or ancestral coronavirus disease 2019 (COVID-19) messenger RNA booster vaccine or postvaccination infection. We found that the bivalent booster elicited moderately high antibody titers against BA.4/5 that were approximately 2-fold higher against all Omicron variants than titers elicited by the monovalent booster. The bivalent booster elicited low but similar titers against both XBB and XBB.1.5 variants. These findings inform risk assessments for future COVID-19 vaccine recommendations and suggest that updated COVID-19 vaccines containing matched vaccine antigens to circulating divergent variants may be needed.
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Affiliation(s)
- Wei Wang
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Emilie Goguet
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
| | - Stephanie Paz
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Russell Vassell
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Simon Pollett
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland
- Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Edward Mitre
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Carol D Weiss
- Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
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Chang TY, Jacobson M, Shah M, Kopetsky M, Pramanik R, Shah SB. Reminders, but not monetary incentives, increase COVID-19 booster uptake. Proc Natl Acad Sci U S A 2023; 120:e2302725120. [PMID: 37487101 PMCID: PMC10400997 DOI: 10.1073/pnas.2302725120] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/07/2023] [Indexed: 07/26/2023] Open
Abstract
Despite substantially decreasing the risk of hospitalization and death from COVID-19, COVID-19 booster vaccination rates remain low around the world. A key question for public health agencies is how to increase booster vaccination rates, particularly among high-risk groups. We conducted a large preregistered randomized controlled trial (with 57,893 study subjects) in a county health system in northern California to test the impact of personal reminder messages and small financial incentives of $25 on booster vaccination rates. We found that reminders increased booster vaccination rates within 2 wk by 0.86 percentage points (P = 0.000) or nearly 33% off the control mean of 2.65%. Monetary incentives had no additional impact on vaccination rates. The results highlight the potential of low-cost targeted messages, but not small financial incentives, to increase booster vaccination rates.
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Affiliation(s)
- Tom Y. Chang
- Department of Finance and Business Economics, University of Southern California, Los Angeles, CA90089
| | - Mireille Jacobson
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA90089
- Schaeffer Center for Health Policy & Economic, University of Southern California, Los Angeles, CA90089
| | - Manisha Shah
- Goldman School of Public Policy, University of California, Berkeley94720
| | - Matthew Kopetsky
- Goldman School of Public Policy, University of California, Berkeley94720
- Contra Costa Regional Medical Center Health Centers, Contra Costa Health Services, Martinez, CA94553
| | - Rajiv Pramanik
- Goldman School of Public Policy, University of California, Berkeley94720
- Contra Costa Regional Medical Center Health Centers, Contra Costa Health Services, Martinez, CA94553
| | - Samir B. Shah
- Goldman School of Public Policy, University of California, Berkeley94720
- Contra Costa Regional Medical Center Health Centers, Contra Costa Health Services, Martinez, CA94553
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Park HJ, Tan ST, León TM, Jain S, Schechter R, Lo NC. Predicting the public health impact of bivalent vaccines and nirmatrelvir-ritonavir against COVID-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.18.23289533. [PMID: 37292707 PMCID: PMC10246024 DOI: 10.1101/2023.05.18.23289533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Uptake of COVID-19 bivalent vaccines and oral medication nirmatrelvir-ritonavir (Paxlovid) has remained low across the United States. Assessing the public health impact of increasing uptake of these interventions in key risk groups can guide further public health resources and policy. Methods This modeling study used person-level data from the California Department of Public Health on COVID-19 cases, hospitalizations, deaths, and vaccine administration from July 23, 2022 to January 23, 2023. We modeled the impact of additional uptake of bivalent COVID-19 vaccines and nirmatrelvir-ritonavir during acute illness in different risk groups defined by age (50+, 65+, 75+ years) and vaccination status (everyone, primary series only, previously vaccinated). We predicted the number of averted COVID-19 cases, hospitalizations, and deaths and number needed to treat (NNT). Results For both bivalent vaccines and nirmatrelvir-ritonavir, the most efficient strategy (based on NNT) for averting severe COVID-19 was targeting the 75+ years group. We predicted that perfect coverage of bivalent boosters in the 75+ years group would avert 3,920 hospitalizations (95%UI: 2,491-4,882; 7.8% total averted; NNT 387) and 1,074 deaths (95%UI: 774-1,355; 16.2% total averted; NNT 1,410). Perfect uptake of nirmatrelvir-ritonavir in the 75+ years group would avert 5,644 hospitalizations (95%UI: 3,947-6,826; 11.2% total averted; NNT 11) and 1,669 deaths (95%UI: 1,053-2,038; 25.2% total averted; NNT 35). Conclusions These findings suggest prioritizing uptake of bivalent boosters and nirmatrelvir-ritonavir among the oldest age groups would be efficient and have substantial public health impact in reducing the burden of severe COVID-19, but would not address the entire burden of severe COVID-19.
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Affiliation(s)
- Hailey J. Park
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sophia T. Tan
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Tomás M. León
- California Department of Public Health, Richmond, CA, USA
| | - Seema Jain
- California Department of Public Health, Richmond, CA, USA
| | | | - Nathan C. Lo
- Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Silk BJ, Scobie HM, Duck WM, Palmer T, Ahmad FB, Binder AM, Cisewski JA, Kroop S, Soetebier K, Park M, Kite-Powell A, Cool A, Connelly E, Dietz S, Kirby AE, Hartnett K, Johnston J, Khan D, Stokley S, Paden CR, Sheppard M, Sutton P, Razzaghi H, Anderson RN, Thornburg N, Meyer S, Womack C, Weakland AP, McMorrow M, Broeker LR, Winn A, Hall AJ, Jackson B, Mahon BE, Ritchey MD. COVID-19 Surveillance After Expiration of the Public Health Emergency Declaration - United States, May 11, 2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:523-528. [PMID: 37167154 DOI: 10.15585/mmwr.mm7219e1] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
On January 31, 2020, the U.S. Department of Health and Human Services (HHS) declared, under Section 319 of the Public Health Service Act, a U.S. public health emergency because of the emergence of a novel virus, SARS-CoV-2.* After 13 renewals, the public health emergency will expire on May 11, 2023. Authorizations to collect certain public health data will expire on that date as well. Monitoring the impact of COVID-19 and the effectiveness of prevention and control strategies remains a public health priority, and a number of surveillance indicators have been identified to facilitate ongoing monitoring. After expiration of the public health emergency, COVID-19-associated hospital admission levels will be the primary indicator of COVID-19 trends to help guide community and personal decisions related to risk and prevention behaviors; the percentage of COVID-19-associated deaths among all reported deaths, based on provisional death certificate data, will be the primary indicator used to monitor COVID-19 mortality. Emergency department (ED) visits with a COVID-19 diagnosis and the percentage of positive SARS-CoV-2 test results, derived from an established sentinel network, will help detect early changes in trends. National genomic surveillance will continue to be used to estimate SARS-CoV-2 variant proportions; wastewater surveillance and traveler-based genomic surveillance will also continue to be used to monitor SARS-CoV-2 variants. Disease severity and hospitalization-related outcomes are monitored via sentinel surveillance and large health care databases. Monitoring of COVID-19 vaccination coverage, vaccine effectiveness (VE), and vaccine safety will also continue. Integrated strategies for surveillance of COVID-19 and other respiratory viruses can further guide prevention efforts. COVID-19-associated hospitalizations and deaths are largely preventable through receipt of updated vaccines and timely administration of therapeutics (1-4).
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Ying B, Darling TL, Desai P, Liang CY, Dmitriev IP, Soudani N, Bricker T, Kashentseva EA, Harastani H, Schmidt AG, Curiel DT, Boon AC, Diamond MS. A bivalent ChAd nasal vaccine protects against SARS-CoV-2 BQ.1.1 and XBB.1.5 infection and disease in mice and hamsters. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.05.04.539332. [PMID: 37205450 PMCID: PMC10187308 DOI: 10.1101/2023.05.04.539332] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
We previously described a nasally delivered monovalent adenoviral-vectored SARS-CoV-2 vaccine (ChAd-SARS-CoV-2-S, targeting Wuhan-1 spike [S]; iNCOVACC®) that is currently used in India as a primary or booster immunization. Here, we updated the mucosal vaccine for Omicron variants by creating ChAd-SARS-CoV-2-BA.5-S, which encodes for a pre-fusion and surface-stabilized S protein of the BA.5 strain, and then tested monovalent and bivalent vaccines for efficacy against circulating variants including BQ.1.1 and XBB.1.5. Whereas monovalent ChAd-vectored vaccines effectively induced systemic and mucosal antibody responses against matched strains, the bivalent ChAd-vectored vaccine elicited greater breadth. However, serum neutralizing antibody responses induced by both monovalent and bivalent vaccines were poor against the antigenically distant XBB.1.5 Omicron strain and did not protect in passive transfer experiments. Nonetheless, nasally delivered bivalent ChAd-vectored vaccines induced robust antibody and spike-specific memory T cell responses in the respiratory mucosa, and conferred protection against WA1/2020 D614G and Omicron variants BQ.1.1 and XBB.1.5 in the upper and lower respiratory tracts of both mice and hamsters. Our data suggest that a nasally delivered bivalent adenoviral-vectored vaccine induces protective mucosal and systemic immunity against historical and emerging SARS-CoV-2 strains without requiring high levels of serum neutralizing antibody.
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Affiliation(s)
- Baoling Ying
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Tamarand L. Darling
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Pritesh Desai
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Chieh-Yu Liang
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO
| | - Igor P. Dmitriev
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Nadia Soudani
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO
| | - Traci Bricker
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Elena A. Kashentseva
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Houda Harastani
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Aaron G. Schmidt
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA; Department of Microbiology, Harvard Medical School, Boston, MA
- Department of Microbiology, Harvard Medical School, Boston, MA
| | - David T. Curiel
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - Adrianus C.M. Boon
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO
- Andrew M. and Jane M. Bursky the Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO
| | - Michael S. Diamond
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO
- Andrew M. and Jane M. Bursky the Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO
- Center for Vaccines and Immunity to Microbial Pathogens, Washington University School of Medicine, St. Louis, MO
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Virk A, Johnson MG, Roellinger DL, Scott CG, Sampathkumar P, Breeher LE, Swift M. Hybrid Immunity Provides Protective Advantage Over Vaccination or Prior Remote Coronavirus Disease 2019 Alone. Open Forum Infect Dis 2023; 10:ofad161. [PMID: 37180597 PMCID: PMC10167982 DOI: 10.1093/ofid/ofad161] [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: 12/13/2022] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Background The protective efficacy of prior coronavirus disease 2019 (COVID-19) with or without vaccination remains unknown. This study sought to understand if 2 or more messenger RNA (mRNA) vaccine doses provide additional protection in patients with prior infection, or if infection alone provides comparable protection. Methods We conducted a retrospective cohort study of the risk of COVID-19 from 16 December 2020 through 15 March 2022, among vaccinated and unvaccinated patients of all ages with and without prior infection. A Simon-Makuch hazard plot illustrated the incidence of COVID-19 between groups. Multivariable Cox proportional hazards regression was used to examine the association of demographics, prior infection, and vaccination status with new infection. Results Among 101 941 individuals with at least 1 COVID-19 polymerase chain reaction test prior to 15 March 2022, 72 361 (71.0%) received mRNA vaccination and 5957 (5.8%) were previously infected. The cumulative incidence of COVID-19 was substantially higher throughout the study period for those previously uninfected and unvaccinated, and lowest for those previously infected and vaccinated. After accounting for age, sex, and the interaction between vaccination and prior infection, a reduction in reinfection risk was noted during the Omicron and pre-Omicron phases of 26% (95% confidence interval [CI], 8%-41%; P = .0065) to 36% (95% CI, 10%-54%; P = .0108), respectively, among previously infected and vaccinated individuals, compared to previously infected subjects without vaccination. Conclusions Vaccination was associated with lower risk of COVID-19, including in those with prior infection. Vaccination should be encouraged for all including those with prior infection, especially as new variants emerge and variant-specific booster vaccines become available.
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Affiliation(s)
- Abinash Virk
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Christopher G Scott
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Priya Sampathkumar
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Laura E Breeher
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Melanie Swift
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Ciesla AA, Wiegand RE, Smith ZR, Britton A, Fleming-Dutra KE, Miller J, Accorsi EK, Verani JR, Shang N, Derado G, Pilishvili T, Link-Gelles R. Effectiveness of Booster Doses of Monovalent mRNA COVID-19 Vaccine Against Symptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Children, Adolescents, and Adults During Omicron Subvariant BA.2/BA.2.12.1 and BA.4/BA.5 Predominant Periods. Open Forum Infect Dis 2023; 10:ofad187. [PMID: 37213428 PMCID: PMC10199126 DOI: 10.1093/ofid/ofad187] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/11/2023] [Indexed: 05/23/2023] Open
Abstract
Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) BA.2/BA.2.12.1 and BA.4/BA.5 subvariants have mutations associated with increased capacity to evade immunity when compared with prior variants. We evaluated mRNA monovalent booster dose effectiveness among persons ≥5 years old during BA.2/BA.2.12.1 and BA.4/BA.5 predominance. Methods A test-negative, case-control analysis included data from 12 148 pharmacy SARS-CoV-2 testing sites nationwide for persons aged ≥5 years with ≥1 coronavirus disease-2019 (COVID-19)-like symptoms and a SARS-CoV-2 nucleic acid amplification test from April 2 to August 31, 2022. Relative vaccine effectiveness (rVE) was estimated comparing 3 doses of COVID-19 mRNA monovalent vaccine to 2 doses; for tests among persons ≥50 years, rVE estimates also compared 4 doses to 3 doses (≥4 months since third dose). Results A total of 760 986 test-positive cases and 817 876 test-negative controls were included. Among individuals ≥12 years, rVE of 3 versus 2 doses ranged by age group from 45% to 74% at 1-month post vaccination and waned to 0% by 5-7 months post vaccination during the BA.4/BA.5 period.Adults aged ≥50 years (fourth dose eligible) who received 4 doses were less likely to have symptomatic SARS-CoV-2 infection compared with those with 3 doses; this rVE remained >0% through at least 3 months since last dose. For those aged ≥65 years, rVE of 4 versus 3 doses 1-month post vaccination was higher during BA.2/BA.2.12.1 (rVE = 49%; 95% confidence interval [CI], 43%-53%) than BA.4/BA.5 (rVE = 40%; 95% CI, 36%-44%). In 50- to 64-year-olds, rVE estimates were similar. Conclusions Monovalent mRNA booster doses provided additional protection against symptomatic SARS-CoV-2 infection during BA.2/BA.2.12.1 and BA.4/BA.5 subvariant circulation, but protection waned over time.
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Affiliation(s)
- Allison Avrich Ciesla
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Eagle Health Analytics, San Antonio, Texas, USA
| | - Ryan E Wiegand
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zachary R Smith
- Division of Research and Methodology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, USA
| | - Amadea Britton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine E Fleming-Dutra
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joseph Miller
- Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emma K Accorsi
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer R Verani
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- US Public Health Service Commissioned Corps, Rockville, Maryland, USA
| | - Nong Shang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gordana Derado
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tamara Pilishvili
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ruth Link-Gelles
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- US Public Health Service Commissioned Corps, Rockville, Maryland, USA
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Arbel R, Peretz A, Sergienko R, Friger M, Beckenstein T, Duskin-Bitan H, Yaron S, Hammerman A, Bilenko N, Netzer D. Effectiveness of a bivalent mRNA vaccine booster dose to prevent severe COVID-19 outcomes: a retrospective cohort study. THE LANCET. INFECTIOUS DISEASES 2023:S1473-3099(23)00122-6. [PMID: 37062302 PMCID: PMC10156150 DOI: 10.1016/s1473-3099(23)00122-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND In late 2022, the SARS-CoV-2 omicron (B.1.1.529) BA.5 sublineage accounted for most of the sequenced viral genomes worldwide. Bivalent mRNA vaccines contain an ancestral SARS-CoV-2 strain component plus an updated component of the omicron BA.4 and BA.5 sublineages. Since September, 2022, a single bivalent mRNA vaccine booster dose has been recommended for adults who have completed a primary SARS-CoV-2 vaccination series and are at high risk of severe COVID-19. We aimed to evaluate the effectiveness of a bivalent mRNA vaccine booster dose to reduce hospitalisations and deaths due to COVID-19. METHODS We did a retrospective, population-based, cohort study in Israel, using data from electronic medical records in Clalit Health Services (CHS). We included all members of CHS who were aged 65 years or older and eligible for a bivalent mRNA COVID-19 booster vaccination. We used hospital records to identify COVID-19-related hospitalisations and deaths. The primary endpoint was hospitalisation due to COVID-19, which we compared between participants who received a bivalent mRNA booster vaccination and those who did not. A Cox proportional hazards regression model with time-dependent covariates was used to estimate the association between the bivalent vaccine and hospitalisation due to COVID-19 while adjusting for demographic factors and coexisting illnesses. FINDINGS Between Sept 27, 2022, and Jan 25, 2023, 569 519 eligible participants were identified. Of those, 134 215 (24%) participants received a bivalent mRNA booster vaccination during the study period. Hospitalisation due to COVID-19 occurred in 32 participants who received a bivalent mRNA booster vaccination and 541 who did not receive a bivalent booster vaccination (adjusted hazard ratio 0·28, 95% CI 0·19-0·40). The absolute risk reduction for hospitalisations due to COVID-19 in bivalent mRNA booster recipients versus non-recipients was 0·089% (95% CI 0·075-0·101), and the number needed to vaccinate to prevent one hospitalisation due to COVID-19 was 1118 people (95% CI 993-1341). INTERPRETATION Participants who received a bivalent mRNA booster vaccine dose had lower rates of hospitalisation due to COVID-19 than participants who did not receive a bivalent booster vaccination, for up to 120 days after vaccination. These findings highlight the importance of bivalent mRNA booster vaccination in populations at high risk of severe COVID-19. Further studies with longer observation times are warranted. FUNDING None.
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Affiliation(s)
- Ronen Arbel
- Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel; Maximizing Health Outcomes Research Lab, Sapir College, Sderot, Israel.
| | - Alon Peretz
- Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel; School of Public Health, University of Haifa, Haifa, Israel
| | - Ruslan Sergienko
- Department of Health Policy and Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Michael Friger
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Tanya Beckenstein
- Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel
| | - Hadar Duskin-Bitan
- Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Endocrinology Rabin Medical Center, Petach Tikva, Israel
| | - Shlomit Yaron
- Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel
| | - Ariel Hammerman
- Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel
| | - Natalya Bilenko
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Doron Netzer
- Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel
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Correction and Republication: Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19-Associated Emergency Department or Urgent Care Encounters and Hospitalizations Among Immunocompetent Adults - VISION Network, Nine States, September-November 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2023; 72:292. [PMID: 36927730 PMCID: PMC10027410 DOI: 10.15585/mmwr.mm7211a6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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Why Some People Are Hesitant to Receive COVID-19 Boosters: A Systematic Review. Trop Med Infect Dis 2023; 8:tropicalmed8030159. [PMID: 36977160 PMCID: PMC10054177 DOI: 10.3390/tropicalmed8030159] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/25/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
As the COVID-19 pandemic continues and transitions to an endemic stage, booster vaccines will play an important role in personal and public health. However, convincing people to take boosters continues to be a key obstacle. This study systematically analyzed research that examined the predictors of COVID-19 booster vaccine hesitancy. A search of PubMed, Medline, CINAHL, Web of Science, and Scopus uncovered 42 eligible studies. Globally, the average COVID-19 booster vaccination hesitancy rate was 30.72%. Thirteen key factors influencing booster hesitancy emerged from the literature: demographics (gender, age, education, income, occupation, employment status, ethnicity, and marital status), geographical influences (country, region, and residency), adverse events, perceived benefit/efficacy, perceived susceptibility, perceived severity, prior history of COVID-19 infection, vaccination status, vaccination recommendations, health status, knowledge and information, skepticism/distrust/conspiracy theories, and vaccine type. Vaccine communication campaigns and interventions for COVID boosters should focus on factors influencing booster confidence, complacency, and convenience.
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