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Porter C, Lyski ZL, Uhrlaub JL, Ellingson KD, Jeddy Z, Gwynn L, Rivers P, Sprissler R, Hegmann KT, Coughlin MM, Fowlkes AL, Hollister J, LeClair L, Mak J, Beitel SC, Fuller S, Zheng PQ, Vaughan M, Rai RP, Grant L, Newes-Adeyi G, Yoo YM, Olsho L, Burgess JL, Caban-Martinez AJ, Yoon SK, Britton A, Gaglani M, Phillips AL, Thiese MS, Hagen MB, Jones JM, Lutrick K. Evaluating Immunologic and Illness Outcomes of SARS-CoV-2 Infection in Vaccinated and Unvaccinated Children Aged ≥ 5 Years, in a Multisite Longitudinal Cohort. Diseases 2024; 12:171. [PMID: 39195170 DOI: 10.3390/diseases12080171] [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: 06/25/2024] [Revised: 07/20/2024] [Accepted: 07/24/2024] [Indexed: 08/29/2024] Open
Abstract
Hybrid immunity, as a result of infection and vaccination to SARS-CoV-2, has been well studied in adults but limited evidence is available in children. We evaluated the antibody responses to primary SARS-CoV-2 infection among vaccinated and unvaccinated children aged ≥ 5 years. METHODS A longitudinal cohort study of children aged ≥ 5 was conducted during August 2021-August 2022, at sites in Arizona, Texas, Utah, and Florida. Children submitted weekly nasal swabs for PCR testing and provided sera 14-59 days after PCR-confirmed SARS-CoV-2 infection. Antibodies were measured by ELISA against the receptor-binding domain (RBD) and S2 domain of ancestral Spike (WA1), in addition to Omicron (BA.2) RBD, following infection in children, with and without prior monovalent ancestral mRNA COVID-19 vaccination. RESULTS Among the 257 participants aged 5 to 18 years, 166 (65%) had received at least two mRNA COVID-19 vaccine doses ≥ 14 days prior to infection. Of these, 53 occurred during Delta predominance, with 37 (70%) unvaccinated at the time of infection. The remaining 204 infections occurred during Omicron predominance, with 53 (26%) participants unvaccinated. After adjusting for weight, age, symptomatic infection, and gender, significantly higher mean RBD AUC values were observed among the vaccinated group compared to the unvaccinated group for both WA1 and Omicron (p < 0.0001). A smaller percentage of vaccinated children reported fever during illness, with 55 (33%) reporting fever compared to 44 (48%) unvaccinated children reporting fever (p = 0.021). CONCLUSIONS Children with vaccine-induced immunity at the time of SARS-CoV-2 infection had higher antibody levels during convalescence and experienced less fever compared to unvaccinated children during infection.
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Affiliation(s)
- Cynthia Porter
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Zoe L Lyski
- Immunobiology, College of Medicine-Tucson, University of Arizona, Health Sciences, Tucson, AZ 85724, USA
| | - Jennifer L Uhrlaub
- Immunobiology, College of Medicine-Tucson, University of Arizona, Health Sciences, Tucson, AZ 85724, USA
| | - Katherine D Ellingson
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | - Zuha Jeddy
- Abt Associates, Rockville, MD 20852, USA
| | - Lisa Gwynn
- Leonard M. Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Patrick Rivers
- Family and Community Medicine, College of Medicine-Tucson, University of Arizona Health Sciences, Tucson, AZ 85711, USA
| | - Ryan Sprissler
- Center for Applied Genetics and Genomic Medicine, University of Arizona, Tucson, AZ 85721, USA
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT 84111, USA
| | - Melissa M Coughlin
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Ashley L Fowlkes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - James Hollister
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | | | - Josephine Mak
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Shawn C Beitel
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | | | | | | | | | - Lauren Grant
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | - Young M Yoo
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | - Jefferey L Burgess
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
| | | | - Sarang K Yoon
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT 84111, USA
| | - Amadea Britton
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, TX 76508, USA
| | - Andrew L Phillips
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT 84111, USA
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT 84111, USA
| | - Melissa Briggs Hagen
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Jefferson M Jones
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Karen Lutrick
- Family and Community Medicine, College of Medicine-Tucson, University of Arizona Health Sciences, Tucson, AZ 85711, USA
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Rivers P, Porter C, LeClair LB, Jeddy Z, Fowlkes AL, Lamberte JM, Herder K, Smith M, Rai R, Grant L, Hegmann KT, Jovel K, Vaughan M, Mathenge C, Phillips AL, Khan S, Britton A, Pilishvili T, Burgess JL, Newes-Adeyi G, Gaglani M, Caban-Martinez A, Yoon S, Lutrick K. Longitudinal parental perception of COVID-19 vaccines for children in a multi-site, cohort study. Vaccine 2024; 42:1512-1520. [PMID: 38307743 DOI: 10.1016/j.vaccine.2024.01.016] [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: 05/24/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVES Pediatric COVID-19 vaccine hesitancy and uptake is not well understood. Among parents of a prospective cohort of children aged 6 months-17 years, we assessed COVID-19 vaccine knowledge, attitudes, and practices (KAP), and uptake over 15 months. METHODS The PROTECT study collected sociodemographic characteristics of children at enrollment and COVID-19 vaccination data and parental KAPs quarterly. Univariable and multivariable logistic regression models were used to test the effect of KAPs on vaccine uptake; McNemar's test for paired samples was used to evaluate KAP change over time. RESULTS A total of 2,837 children were enrolled, with more than half (61 %) vaccinated by October 2022. Positive parental beliefs about vaccine safety and effectiveness strongly predicted vaccine uptake among children aged 5-11 years (aOR 13.1, 95 % CI 8.5-20.4 and aOR 6.4, 95 % CI 4.3-9.6, respectively) and children aged 12+ years (aOR 7.0, 95 % CI 3.8-13.0 and aOR 8.9, 95 % CI 4.4-18.0). Compared to enrollment, at follow-up parents (of vaccinated and unvaccinated children) reported higher self-assessed vaccine knowledge, but more negative beliefs towards vaccine safety, effectiveness, and trust in government. Parents unlikely to vaccinate their children at enrollment reported more positive beliefs on vaccine knowledge, safety, and effectiveness at follow-up. CONCLUSION The PROTECT cohort allows for an examination of factors driving vaccine uptake and how beliefs about COVID-19 and the COVID-19 vaccines change over time. Findings of the current analysis suggest that these beliefs change over time and policies aiming to increase vaccine uptake should focus on vaccine safety and effectiveness.
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Affiliation(s)
| | | | | | - Zuha Jeddy
- Abt Associates, Rockville, MD, United States
| | - Ashley L Fowlkes
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | - Ramona Rai
- Abt Associates, Rockville, MD, United States
| | - Lauren Grant
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | | | | | - Sana Khan
- University of Arizona, Tucson, AZ, United States
| | - Amadea Britton
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tamara Pilishvili
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | | | - Sarang Yoon
- Utah University, Salt Lake City, UT, United States
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Feldstein LR, Britton A, Grant L, Wiegand R, Ruffin J, Babu TM, Briggs Hagen M, Burgess JL, Caban-Martinez AJ, Chu HY, Ellingson KD, Englund JA, Hegmann KT, Jeddy Z, Lauring AS, Lutrick K, Martin ET, Mathenge C, Meece J, Midgley CM, Monto AS, Newes-Adeyi G, Odame-Bamfo L, Olsho LEW, Phillips AL, Rai RP, Saydah S, Smith N, Steinhardt L, Tyner H, Vandermeer M, Vaughan M, Yoon SK, Gaglani M, Naleway AL. Effectiveness of Bivalent mRNA COVID-19 Vaccines in Preventing SARS-CoV-2 Infection in Children and Adolescents Aged 5 to 17 Years. JAMA 2024; 331:408-416. [PMID: 38319331 PMCID: PMC10848053 DOI: 10.1001/jama.2023.27022] [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: 07/19/2023] [Accepted: 12/11/2023] [Indexed: 02/07/2024]
Abstract
Importance Bivalent mRNA COVID-19 vaccines were recommended in the US for children and adolescents aged 12 years or older on September 1, 2022, and for children aged 5 to 11 years on October 12, 2022; however, data demonstrating the effectiveness of bivalent COVID-19 vaccines are limited. Objective To assess the effectiveness of bivalent COVID-19 vaccines against SARS-CoV-2 infection and symptomatic COVID-19 among children and adolescents. Design, Setting, and Participants Data for the period September 4, 2022, to January 31, 2023, were combined from 3 prospective US cohort studies (6 sites total) and used to estimate COVID-19 vaccine effectiveness among children and adolescents aged 5 to 17 years. A total of 2959 participants completed periodic surveys (demographics, household characteristics, chronic medical conditions, and COVID-19 symptoms) and submitted weekly self-collected nasal swabs (irrespective of symptoms); participants submitted additional nasal swabs at the onset of any symptoms. Exposure Vaccination status was captured from the periodic surveys and supplemented with data from state immunization information systems and electronic medical records. Main Outcome and Measures Respiratory swabs were tested for the presence of the SARS-CoV-2 virus using reverse transcriptase-polymerase chain reaction. SARS-CoV-2 infection was defined as a positive test regardless of symptoms. Symptomatic COVID-19 was defined as a positive test and 2 or more COVID-19 symptoms within 7 days of specimen collection. Cox proportional hazards models were used to estimate hazard ratios for SARS-CoV-2 infection and symptomatic COVID-19 among participants who received a bivalent COVID-19 vaccine dose vs participants who received no vaccine or monovalent vaccine doses only. Models were adjusted for age, sex, race, ethnicity, underlying health conditions, prior SARS-CoV-2 infection status, geographic site, proportion of circulating variants by site, and local virus prevalence. Results Of the 2959 participants (47.8% were female; median age, 10.6 years [IQR, 8.0-13.2 years]; 64.6% were non-Hispanic White) included in this analysis, 25.4% received a bivalent COVID-19 vaccine dose. During the study period, 426 participants (14.4%) had laboratory-confirmed SARS-CoV-2 infection. Among these 426 participants, 184 (43.2%) had symptomatic COVID-19, 383 (89.9%) were not vaccinated or had received only monovalent COVID-19 vaccine doses (1.38 SARS-CoV-2 infections per 1000 person-days), and 43 (10.1%) had received a bivalent COVID-19 vaccine dose (0.84 SARS-CoV-2 infections per 1000 person-days). Bivalent vaccine effectiveness against SARS-CoV-2 infection was 54.0% (95% CI, 36.6%-69.1%) and vaccine effectiveness against symptomatic COVID-19 was 49.4% (95% CI, 22.2%-70.7%). The median observation time after vaccination was 276 days (IQR, 142-350 days) for participants who received only monovalent COVID-19 vaccine doses vs 50 days (IQR, 27-74 days) for those who received a bivalent COVID-19 vaccine dose. Conclusion and Relevance The bivalent COVID-19 vaccines protected children and adolescents against SARS-CoV-2 infection and symptomatic COVID-19. These data demonstrate the benefit of COVID-19 vaccine in children and adolescents. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations.
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Affiliation(s)
- Leora R. Feldstein
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amadea Britton
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren Grant
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryan Wiegand
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jasmine Ruffin
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tara M. Babu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle
| | - Melissa Briggs Hagen
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle
| | | | | | | | | | - Adam S. Lauring
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor
| | | | - Emily T. Martin
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | | | - Jennifer Meece
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Claire M. Midgley
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Arnold S. Monto
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | | | | | | | | | | | - Sharon Saydah
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ning Smith
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Laura Steinhardt
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Harmony Tyner
- St Luke’s Regional Health Care System, Duluth, Minnesota
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4
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Lyski ZL, Porter C, Uhrlaub JL, Ellingson KD, Jeddy Z, Gwynn L, Rivers P, Sprissler R, Hegmann KT, Coughlin M, Fowlkes A, Hollister J, LeClair L, Mak J, Beitel SC, Fuller S, Grant L, Newes-Adeyi G, Yoo YM, Olsho L, Burgess JL, Caban-Martinez A, Yoon S, Britton A, Gaglani M, Lutrick K. Humoral Immune Response to Messenger RNA Coronavirus Disease 2019 Vaccination Among Children Aged 5-11 Years in a Multisite Prospective Cohort Study, September 2021-September 2022. Open Forum Infect Dis 2023; 10:ofad431. [PMID: 37663086 PMCID: PMC10468733 DOI: 10.1093/ofid/ofad431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/09/2023] [Indexed: 09/05/2023] Open
Abstract
Background The PROTECT study is a longitudinal cohort study initiated in July 2021 with weekly testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 4 states: Arizona, Florida, exas, and Utah. This study aims to examine vaccine-elicited antibody response against postvaccination SARS-CoV-2 infections. Methods Children aged 5-11 years had serum collected 14-59 days after their second dose of monovalent Pfizer-BioNTech coronavirus disease 2019 messenger RNA vaccine. Vaccine-elicited antibodies were measured using the area under the curve (AUC) and end-point titer using enzyme-linked immunosorbent assay (receptor-binding domain [RBD] and S2) and surrogate neutralization assays against ancestral (WA1) and Omicron (BA.2). Results 79 vaccinated participants (33 [41.7%] female; median age, 8.8 years [standard deviation, 1.9 years]), 48 (60.8%) were from Tucson, Arizona; 64 (81.0%) were non-Hispanic white; 63 (80.8%) attended school in person; 68 (86.1%) did not have any chronic conditions; and 47 (59.5%) were infected after vaccination. Uninfected children had higher AUCs against WA1 (P = .009) and Omicron (P = .02). The geometric mean and surrogate neutralization titer above the limit of detection was 346.0 for WA1 and 39.7 for Omicron, an 8.7-fold decrease (P < .001). After adjustment of covariates in the WA1-specific model, we observed a 47% reduction in the odds of postvaccination infection for every standard deviation increase in RBD AUC (aOR, 0.53 [95% confidence interval, .29-.97) and a 69% reduction in the odds of infection for every 3-fold increase in RBD end titer (0.31 [.06-1.57]). Conclusions Children with higher antibody levels experienced a lower incidence of postvaccination SARS-CoV-2 infection.
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Affiliation(s)
- Zoe L Lyski
- Immunobiology, College of Medicine–Tucson, University of Arizona, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Cynthia Porter
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Jennifer L Uhrlaub
- Immunobiology, College of Medicine–Tucson, University of Arizona, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Katherine D Ellingson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Zuha Jeddy
- Abt Associates, Rockville, Maryland, USA
| | - Lisa Gwynn
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Patrick Rivers
- Family and Community Medicine, College of Medicine–Tucson, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Ryan Sprissler
- University of Arizona Genetics Core—Center for Applied Genetics and Genomic Medicine, University of Arizona, Tucson, Arizona, USA
| | - Kurt T Hegmann
- Department of Family and Preventive Medicine, Rocky Mountain Center for Occupational and Environmental Health, University of Utah Health, Salt Lake City, Utah, USA
| | - Melissa Coughlin
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashley Fowlkes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Hollister
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | - Josephine Mak
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shawn C Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | - Lauren Grant
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Young M Yoo
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | - Sarang Yoon
- Department of Family and Preventive Medicine, Rocky Mountain Center for Occupational and Environmental Health, University of Utah Health, Salt Lake City, Utah, USA
| | - Amadea Britton
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University School of Medicine, Temple, Texas, USA
| | - Karen Lutrick
- Family and Community Medicine, College of Medicine–Tucson, University of Arizona Health Sciences, Tucson, Arizona, USA
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Lutrick K, Fowlkes A, Rivers P, Herder K, Santibanez TA, LeClair L, Groover K, Lamberte JM, Grant L, Odame-Bamfo L, Ferraris MV, Phillips AL, Sokol B, Lowe AA, Mathenge C, Pubillones FA, Cottam B, McLeland-Wieser H, Jovel KS, Ochoa JS, Mckell J, Berry M, Khan S, Solle NS, Rai RP, Nakayima FM, Newes-Adeyi G, Porter C, Baccam Z, Ellingson KD, Burgess JL, Gaglani M, Gwynn L, Caban-Martinez A, Yoon S. Parental Intentions and Perceptions Toward COVID-19 Vaccination Among Children Aged 4 Months to 4 Years — PROTECT Cohort, Four States, July 2021–May 2022. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2022; 71:1109-1114. [PMID: 36048723 PMCID: PMC9472774 DOI: 10.15585/mmwr.mm7135a2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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