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Meslé MMI, Brown J, Mook P, Katz MA, Hagan J, Pastore R, Benka B, Redlberger-Fritz M, Bossuyt N, Stouten V, Vernemmen C, Constantinou E, Maly M, Kynčl J, Sanca O, Krause TG, Vestergaard LS, Leino T, Poukka E, Gkolfinopoulou K, Mellou K, Tsintziloni M, Molnár Z, Aspelund G, Thordardottir M, Domegan L, Kelly E, O'Donell J, Urdiales AM, Riccardo F, Sacco C, Bumšteinas V, Liausediene R, Mossong J, Vergison A, Borg ML, Melillo T, Kocinski D, Pollozhani E, Meijerink H, Costa D, Gomes JP, Leite PP, Druc A, Gutu V, Mita V, Lazar M, Popescu R, Popovici O, Musilová M, Mrzel M, Socan M, Učakar V, Limia A, Mazagatos C, Olmedo C, Dabrera G, Kall M, Sinnathamby M, McGowan G, McMenamin J, Morrison K, Nitzan D, Widdowson MA, Smallwood C, Pebody R. Estimated number of lives directly saved by COVID-19 vaccination programmes in the WHO European Region from December, 2020, to March, 2023: a retrospective surveillance study. THE LANCET. RESPIRATORY MEDICINE 2024; 12:714-727. [PMID: 39127051 DOI: 10.1016/s2213-2600(24)00179-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/14/2024] [Accepted: 05/24/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND By March, 2023, 54 countries, areas, and territories (hereafter CAT) in the WHO European Region had reported more than 2·2 million COVID-19-related deaths to the WHO Regional Office for Europe. Here, we estimated how many lives were directly saved by vaccinating adults in the WHO European Region from December, 2020, to March, 2023. METHODS In this retrospective surveillance study, we estimated the number of lives directly saved by age group, vaccine dose, and circulating variant-of-concern (VOC) period, regionally and nationally, using weekly data on COVID-19 mortality and infection, COVID-19 vaccination uptake, and SARS-CoV-2 virus characterisations by lineage downloaded from The European Surveillance System on June 11, 2023, as well as vaccine effectiveness data from the literature. We included data for six age groups (25-49 years, 50-59 years, ≥60 years, 60-69 years, 70-79 years, and ≥80 years). To be included in the analysis, CAT needed to have reported both COVID-19 vaccination and mortality data for at least one of the four older age groups. Only CAT that reported weekly data for both COVID-19 vaccination and mortality by age group for 90% of study weeks or more in the full study period were included. We calculated the percentage reduction in the number of expected and reported deaths. FINDINGS Between December, 2020, and March, 2023, in 34 of 54 CAT included in the analysis, COVID-19 vaccines reduced deaths by 59% overall (CAT range 17-82%), representing approximately 1·6 million lives saved (range 1·5-1·7 million) in those aged 25 years or older: 96% of lives saved were aged 60 years or older and 52% were aged 80 years or older; first boosters saved 51% of lives, and 60% were saved during the Omicron period. INTERPRETATION Over nearly 2·5 years, most lives saved by COVID-19 vaccination were in older adults by first booster dose and during the Omicron period, reinforcing the importance of up-to-date vaccination among the most at-risk individuals. Further modelling work should evaluate indirect effects of vaccination and public health and social measures. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Margaux M I Meslé
- World Health Organization Regional Office for Europe, Copenhagen, Denmark.
| | - Jeremy Brown
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Piers Mook
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Mark A Katz
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - José Hagan
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Roberta Pastore
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Bernhard Benka
- Österreichische Agentur für Gesundheit und Ernährungssicherheit, Vienna, Austria
| | | | | | | | | | | | - Marek Maly
- National Institute of Public Health, Prague, Czechia
| | - Jan Kynčl
- National Institute of Public Health, Prague, Czechia; Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Ondrej Sanca
- Institute of Health Information and Statistics of the Czech Republic, Nové Město, Czechia
| | | | | | - Tuija Leino
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Eero Poukka
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Kassiani Mellou
- Hellenic National Public Health Organization, Athens, Greece
| | | | - Zsuzsanna Molnár
- National Center for Public Health and Pharmacy, Budapest, Hungary
| | - Gudrun Aspelund
- Centre for Health Security and Communicable Disease Control, Reykjavik, Iceland
| | | | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Eva Kelly
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Joan O'Donell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | | | - Viktoras Bumšteinas
- National Public Health Center under the Ministry of Health, Vilnius, Lithuania
| | - Rasa Liausediene
- National Public Health Center under the Ministry of Health, Vilnius, Lithuania
| | | | | | - Maria-Louise Borg
- Infectious Disease Prevention and Control Unit, Health Promotion and Disease Prevention Directorate, Pietà, Malta
| | - Tanya Melillo
- Infectious Disease Prevention and Control Unit, Health Promotion and Disease Prevention Directorate, Pietà, Malta
| | - Dragan Kocinski
- Institute of Public Health of Republic of North Macedonia, Skopje, North Macedonia
| | - Enkela Pollozhani
- Institute of Public Health of Republic of North Macedonia, Skopje, North Macedonia
| | | | - Diana Costa
- Directorate of Disease Prevention and Health Promotion, Directorate-General of Health, Lisbon, Portugal
| | - João Paulo Gomes
- National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Pedro Pinto Leite
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - Alina Druc
- National Agency for Public Health, Chisinau, Moldova
| | | | - Valentin Mita
- National Agency for Public Health, Chisinau, Moldova
| | - Mihaela Lazar
- Cantacuzino National Military Medical Institute for Research and Development, Bucharest, Romania
| | | | | | | | - Maja Mrzel
- National Institute of Public Health, Ljubljana, Slovenia
| | - Maja Socan
- National Institute of Public Health, Ljubljana, Slovenia
| | | | | | | | | | | | | | | | | | | | | | - Dorit Nitzan
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | | | - Richard Pebody
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Marron L, Mateo-Urdiales A, O'Donnell J, Robinson E, Domegan L. The impact of the COVID-19 vaccination programme on symptomatic and severe SARS-CoV-2 infection during a period of Omicron variant dominance in Ireland, December 2021 to March 2023. Euro Surveill 2024; 29. [PMID: 38994604 PMCID: PMC11241852 DOI: 10.2807/1560-7917.es.2024.29.28.2300697] [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: 07/13/2024] Open
Abstract
BackgroundAs Ireland prepared for an autumn 2023 COVID-19 vaccination booster campaign, there was concern that vaccine fatigue would affect uptake, which has been abating.AimThis study aimed to quantify the direct impact of the COVID-19 vaccination programme in Ireland on averted COVID-19-related outcomes including symptomatic presentations to primary care/community testing centres, emergency department (ED) presentations, hospitalisations, intensive care unit (ICU) admissions and deaths, in individuals aged ≥ 50 years, during Omicron dominance.MethodsWe conducted a retrospective observational COVID-19 vaccine impact study in December 2021-March 2023 in Ireland. We used national data on notified outcomes and vaccine coverage, as well as vaccine effectiveness (VE) estimates, sourced from the World Health Organization's live systematic review of VE, to estimate the count and prevented fraction of outcomes in ≥ 50-year-olds averted by the COVID-19 vaccination programme in this age group.ResultsThe COVID-19 vaccination programme averted 48,551 symptomatic COVID-19 presentations to primary care/community testing centres (36% of cases expected in the absence of vaccination), 9,517 ED presentations (53% of expected), 102,160 hospitalisations (81% of expected), 3,303 ICU admissions (89% of expected) and 15,985 deaths (87% of expected).ConclusionsWhen Omicron predominated, the COVID-19 vaccination programme averted symptomatic and severe COVID-19 cases, including deaths due to COVID-19. In line with other international vaccine impact studies, these findings emphasise the benefits of COVID-19 vaccination for population health and the healthcare system and are relevant for informing COVID-19 booster vaccination programmes, pandemic preparedness and communicating the reason for and importance of COVID-19 vaccination in Ireland and internationally.
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Affiliation(s)
- Louise Marron
- European Centre for Disease Prevention and Control (ECDC) Fellowship Programme, Field Epidemiology path (EPIET), ECDC, Stockholm, Sweden
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Alberto Mateo-Urdiales
- Department of Infectious Diseases, Istituto Superiore di Sanità (Italian National Institute of Health), Rome, Italy
| | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Eve Robinson
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
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Corrao G, Porcu G, Tratsevich A, Cereda D, Pavesi G, Bertolaso G, Franchi M. Estimating All-Cause Deaths Averted in the First Two Years of the COVID-19 Vaccination Campaign in Italy. Vaccines (Basel) 2024; 12:413. [PMID: 38675795 PMCID: PMC11055119 DOI: 10.3390/vaccines12040413] [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: 02/29/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Comparing deaths averted by vaccination campaigns is a crucial public health endeavour. Excess all-cause deaths better reflect the impact of the pandemic than COVID-19 deaths. We used a seasonal autoregressive integrated moving average with exogenous factors model to regress daily all-cause deaths on annual trend, seasonality, and environmental temperature in three Italian regions (Lombardy, Marche and Sicily) from 2015 to 2019. The model was used to forecast excess deaths during the vaccinal period (December 2020-October 2022). We used the prevented fraction to estimate excess deaths observed during the vaccinal campaigns, those which would have occurred without vaccination, and those averted by the campaigns. At the end of the vaccinal period, the Lombardy region proceeded with a more intensive COVID-19 vaccination campaign than other regions (on average, 1.82 doses per resident, versus 1.67 and 1.56 in Marche and Sicily, respectively). A higher prevented fraction of all-cause deaths was consistently found in Lombardy (65% avoided deaths, as opposed to 60% and 58% in Marche and Sicily). Nevertheless, because of a lower excess mortality rate found in Lombardy compared to Marche and Sicily (12, 24 and 23 per 10,000 person-years, respectively), a lower rate of averted deaths was observed (22 avoided deaths per 10,000 person-years, versus 36 and 32 in Marche and Sicily). In Lombardy, early and full implementation of adult COVID-19 vaccination was associated with the largest reduction in all-cause deaths compared to Marche and Sicily.
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Affiliation(s)
- Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (G.C.); (A.T.); (M.F.)
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Gloria Porcu
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (G.C.); (A.T.); (M.F.)
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- Specialization School of Health Statistics and Biometrics, University of Padua, 35131 Padua, Italy
| | - Alina Tratsevich
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (G.C.); (A.T.); (M.F.)
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Danilo Cereda
- Preventive Unit of Welfare Department, Lombardy Region, 20124 Milan, Italy;
| | - Giovanni Pavesi
- General Directorate of Welfare Department, Lombardy Region, 20124 Milan, Italy;
| | | | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, 20126 Milan, Italy; (G.C.); (A.T.); (M.F.)
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
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Monge S, Humphreys J, Nicolay N, Braeye T, Van Evercooren I, Holm Hansen C, Emborg H, Sacco C, Mateo‐Urdiales A, Castilla J, Martínez‐Baz I, de Gier B, Hahné S, Meijerink H, Kristoffersen A, Machado A, Soares P, Nardone A, Bacci S, Kissling E, Nunes B. Effectiveness of XBB.1.5 Monovalent COVID-19 Vaccines During a Period of XBB.1.5 Dominance in EU/EEA Countries, October to November 2023: A VEBIS-EHR Network Study. Influenza Other Respir Viruses 2024; 18:e13292. [PMID: 38654485 PMCID: PMC11040092 DOI: 10.1111/irv.13292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/26/2024] Open
Abstract
Using a common protocol across seven countries in the European Union/European Economic Area, we estimated XBB.1.5 monovalent vaccine effectiveness (VE) against COVID-19 hospitalisation and death in booster-eligible ≥ 65-year-olds, during October-November 2023. We linked electronic records to construct retrospective cohorts and used Cox models to estimate adjusted hazard ratios and derive VE. VE for COVID-19 hospitalisation and death was, respectively, 67% (95%CI: 58-74) and 67% (95%CI: 42-81) in 65- to 79-year-olds and 66% (95%CI: 57-73) and 72% (95%CI: 51-85) in ≥ 80-year-olds. Results indicate that periodic vaccination of individuals ≥ 65 years has an ongoing benefit and support current vaccination strategies in the EU/EEA.
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Affiliation(s)
- Susana Monge
- Department of Communicable Diseases, National Centre of EpidemiologyInstitute of Health Carlos IIIMadridSpain
- CIBER on Infectious DiseasesMadridSpain
| | | | - Nathalie Nicolay
- Vaccine Preventable Diseases and ImmunisationEuropean Centre for Disease Prevention and Control (ECDC)SolnaSweden
| | | | | | - Christian Holm Hansen
- Department of Infectious Disease Epidemiology and PreventionStatens Serum InstitutCopenhagenDenmark
| | - Hanne‐Dorthe Emborg
- Department of Infectious Disease Epidemiology and PreventionStatens Serum InstitutCopenhagenDenmark
| | - Chiara Sacco
- Infectious Diseases DepartmentIstituto Superiore di SanitàRomeItaly
- European Programme on Intervention Epidemiology Training (EPIET)European Centre for Disease Prevention and ControlStockholmSweden
| | | | - Jesús Castilla
- Instituto de Salud Pública de Navarra – IdiSNAPamplonaSpain
- CIBER on Epidemiology and Public HealthMadridSpain
| | - Iván Martínez‐Baz
- Instituto de Salud Pública de Navarra – IdiSNAPamplonaSpain
- CIBER on Epidemiology and Public HealthMadridSpain
| | - Brechje de Gier
- Center for Infectious Disease ControlNational Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - Susan Hahné
- Center for Infectious Disease ControlNational Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | | | | | - Ausenda Machado
- Departamento de EpidemiologiaInstituto Nacional de Saúde Doutor Ricardo JorgeLisboaPortugal
| | - Patricia Soares
- Departamento de EpidemiologiaInstituto Nacional de Saúde Doutor Ricardo JorgeLisboaPortugal
| | | | - Sabrina Bacci
- Vaccine Preventable Diseases and ImmunisationEuropean Centre for Disease Prevention and Control (ECDC)SolnaSweden
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Meah S, Shi X, Fritsche LG, Salvatore M, Wagner A, Martin ET, Mukherjee B. Design and analysis heterogeneity in observational studies of COVID-19 booster effectiveness: A review and case study. SCIENCE ADVANCES 2023; 9:eadj3747. [PMID: 38117882 PMCID: PMC10732535 DOI: 10.1126/sciadv.adj3747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/16/2023] [Indexed: 12/22/2023]
Abstract
We investigated the design and analysis of observational booster vaccine effectiveness (VE) studies by performing a scoping review of booster VE literature with a focus on study design and analytic choices. We then applied 20 different approaches, including those found in the literature, to a single dataset from Michigan Medicine. We identified 80 studies in our review, including over 150 million observations in total. We found that while protection against infection is variable and dependent on several factors including the study population and time period, both monovalent boosters and particularly the bivalent booster offer strong protection against severe COVID-19. In addition, VE analyses with a severe disease outcome (hospitalization, intensive care unit admission, or death) appear to be more robust to design and analytic choices than an infection endpoint. In terms of design choices, we found that test-negative designs and their variants may offer advantages in statistical efficiency compared to cohort designs.
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Affiliation(s)
- Sabir Meah
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
- Department of Urology, Michigan Medicine, Ann Arbor, MI 48109, USA
| | - Xu Shi
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Lars G. Fritsche
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI 48109, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA
- Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Maxwell Salvatore
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Abram Wagner
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Emily T. Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI 48109, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA
- Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
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Xu N, Xu Y, Dai R, Zheng L, Qin P, Wan P, Yang Y, Jiang J, Zhang H, Hu X, Lv H. Study of efficacy and antibody duration to fourth-dose booster of Ad5-nCoV or inactivated SARS-CoV-2 vaccine in Chinese adults: a prospective cohort study. Front Immunol 2023; 14:1244373. [PMID: 37736100 PMCID: PMC10510200 DOI: 10.3389/fimmu.2023.1244373] [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: 06/22/2023] [Accepted: 08/16/2023] [Indexed: 09/23/2023] Open
Abstract
Introduction China experienced a record surge of coronavirus disease 2019 cases in December 2022, during the pandemic. Methods We conducted a randomized, parallel-controlled prospective cohort study to evaluate efficacy and antibody duration after a fourth-dose booster with Ad5-nCoV or inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Results A total of 191 participants aged ≥18 years who had completed a three-dose regimen of the inactivated SARS-CoV-2 vaccine 6 months earlier were recruited to receive the intramuscular Ad5-nCoV booster or the inactivated SARS-CoV-2 vaccine. The Ad5-nCoV group had significantly higher antibody levels compared with the inactivated vaccine group at 6 months after the fourth vaccination dose. After the pandemic, the breakthrough infection rate for the Ad5-nCoV and the inactivated vaccine groups was 77.89% and 78.13%, respectively. Survival curve analysis (p = 0.872) and multivariable logistic regression analysis (p = 0.956) showed no statistically significant differences in breakthrough infection between the two groups. Discussion Compared with a homologous fourth dose, a heterologous fourth dose of Ad5-nCoV elicited a higher immunogenic response in healthy adults who had been immunized with three doses of inactivated vaccine. Nevertheless, the efficacy of the two vaccine types was equivalent after the pandemic.
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Affiliation(s)
- Nani Xu
- Department of Immunization Program, Xihu District Center for Disease Control and Prevention, Hangzhou, China
| | - Yu Xu
- Department of Vaccine, Clinical Trials, CanSino Biologics, Tianjin, China
| | - Rongrong Dai
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Lin Zheng
- Department of Immunization Program, Xihu District Center for Disease Control and Prevention, Hangzhou, China
| | - Pan Qin
- Department of Immunization Program, Xihu District Center for Disease Control and Prevention, Hangzhou, China
| | - Peng Wan
- Department of Vaccine, Clinical Trials, CanSino Biologics, Tianjin, China
| | - Yejing Yang
- Department of Immunization Program, Xihu District Center for Disease Control and Prevention, Hangzhou, China
| | - Jianmin Jiang
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- Key Lab of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Hangjie Zhang
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- Key Lab of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xiaowei Hu
- Department of Immunization Program, Xihu District Center for Disease Control and Prevention, Hangzhou, China
| | - Huakun Lv
- Department of Immunization Program, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- Key Lab of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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7
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Carazo S, Skowronski DM, Brisson M, Sauvageau C, Brousseau N, Fafard J, Gilca R, Talbot D, Ouakki M, Febriani Y, Deceuninck G, De Wals P, De Serres G. Effectiveness of previous infection-induced and vaccine-induced protection against hospitalisation due to omicron BA subvariants in older adults: a test-negative, case-control study in Quebec, Canada. THE LANCET. HEALTHY LONGEVITY 2023; 4:e409-e420. [PMID: 37459879 DOI: 10.1016/s2666-7568(23)00099-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Older adults (aged ≥60 years) were prioritised for COVID-19 booster vaccination due to severe outcome risk, but the risk for this group is also affected by previous SARS-CoV-2 infection and vaccination. We estimated vaccine effectiveness against omicron-associated hospitalisation in older adults by previously documented infection, time since last immunological event, and age group. METHODS This was a population-based test-negative case-control study done in Quebec, Canada, during BA.1 dominant (December, 2021, to March, 2022), BA.2 dominant (April to June, 2022), and BA.4/5 dominant (July to November, 2022) periods using provincial laboratory, immunisation, hospitalisation, and chronic disease surveillance databases. We included older adults (aged ≥60 years) with symptoms associated with COVID-19 who were tested for SARS-CoV-2 in acute-care hospitals. Cases were defined as patients who were hospitalised for COVID-19 within 14 days after testing positive; controls were patients who tested negative. Analyses spanned 3-14 months after last vaccine dose or previous infection. Logistic regression models compared COVID-19 hospitalisation risk by mRNA vaccine dose and previous infection versus unvaccinated and infection-naive participants. FINDINGS Between Dec 26, 2021, and Nov 5, 2022, we included 174 819 specimens (82 870 [47·4%] from men and 91 949 [52·6%] from women; from 8455 cases and 166 364 controls), taken from 2951 cases and 48 724 controls in the BA.1 period; 1897 cases and 41 702 controls in the BA.2 period; and 3607 cases and 75 938 controls in the BA.4/5 period. In participants who were infection naive, vaccine effectiveness against hospitalisation improved with dose number, consistent with a shorter median time since last dose, but decreased with more recent omicron subvariants. Four-dose vaccine effectiveness was 96% (95% CI 93-98) during the BA.1 period, 84% (81-87) during the BA.2 period, and 68% (63-72) during the BA.4/5 period. Regardless of dose number (two to five doses) or timing since previous infection, hybrid protection was more than 90%, persisted for at least 6-8 months, and did not decline with age. INTERPRETATION Older adults with both previous SARS-CoV-2 infection and two or more vaccine doses appear to be well protected for a prolonged period against hospitalisation due to omicron subvariants, including BA.4/5. Ensuring that older adults who are infection naive remain up to date with vaccination might reduce COVID-19 hospitalisations most efficiently. FUNDING Ministère de la Santé et des Services Sociaux du Québec. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Sara Carazo
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada.
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Marc Brisson
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Chantal Sauvageau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Nicholas Brousseau
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Judith Fafard
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Quebec, QC, Canada
| | - Rodica Gilca
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Denis Talbot
- Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Manale Ouakki
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada
| | - Yossi Febriani
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Geneviève Deceuninck
- Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Philippe De Wals
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
| | - Gaston De Serres
- Biological Risks Unit, Institut National de Santé Publique du Québec, Quebec, QC, Canada; Social and Preventive Medicine Department, Faculty of Medicine, Laval University, Quebec, QC, Canada; Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Quebec, QC, Canada
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Meah S, Shi X, Fritsche LG, Salvatore M, Wagner A, Martin ET, Mukherjee B. Design and Analysis Heterogeneity in Observational Studies of COVID-19 Booster Effectiveness: A Review and Case Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.22.23291692. [PMID: 37425863 PMCID: PMC10327238 DOI: 10.1101/2023.06.22.23291692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Background Observational vaccine effectiveness (VE) studies based on real-world data are a crucial supplement to initial randomized clinical trials of Coronavirus Disease 2019 (COVID-19) vaccines. However, there exists substantial heterogeneity in study designs and statistical methods for estimating VE. The impact of such heterogeneity on VE estimates is not clear. Methods We conducted a two-step literature review of booster VE: a literature search for first or second monovalent boosters on January 1, 2023, and a rapid search for bivalent boosters on March 28, 2023. For each study identified, study design, methods, and VE estimates for infection, hospitalization, and/or death were extracted and summarized via forest plots. We then applied methods identified in the literature to a single dataset from Michigan Medicine (MM), providing a comparison of the impact of different statistical methodologies on the same dataset. Results We identified 53 studies estimating VE of the first booster, 16 for the second booster. Of these studies, 2 were case-control, 17 were test-negative, and 50 were cohort studies. Together, they included nearly 130 million people worldwide. VE for all outcomes was very high (around 90%) in earlier studies (i.e., in 2021), but became attenuated and more heterogeneous over time (around 40%-50% for infection, 60%-90% for hospitalization, and 50%-90% for death). VE compared to the previous dose was lower for the second booster (10-30% for infection, 30-60% against hospitalization, and 50-90% against death). We also identified 11 bivalent booster studies including over 20 million people. Early studies of the bivalent booster showed increased effectiveness compared to the monovalent booster (VE around 50-80% for hospitalization and death).Our primary analysis with MM data using a cohort design included 186,495 individuals overall (including 153,811 boosted and 32,684 with only a primary series vaccination), and a secondary test-negative design included 65,992 individuals tested for SARS-CoV-2. When different statistical designs and methods were applied to MM data, VE estimates for hospitalization and death were robust to analytic choices, with test-negative designs leading to narrower confidence intervals. Adjusting either for the propensity of getting boosted or directly adjusting for covariates reduced the heterogeneity across VE estimates for the infection outcome. Conclusion While the advantage of the second monovalent booster is not obvious from the literature review, the first monovalent booster and the bivalent booster appear to offer strong protection against severe COVID-19. Based on both the literature view and data analysis, VE analyses with a severe disease outcome (hospitalization, ICU admission, or death) appear to be more robust to design and analytic choices than an infection endpoint. Test-negative designs can extend to severe disease outcomes and may offer advantages in statistical efficiency when used properly.
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Affiliation(s)
- Sabir Meah
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Xu Shi
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Lars G. Fritsche
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI 48109, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA
- Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Maxwell Salvatore
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Abram Wagner
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Emily T. Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI 48109, USA
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA
- Center for Statistical Genetics, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
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Viskupič F, Wiltse DL, Kayaalp A. Attitudes toward COVID-19 vaccine mandate: The role of psychological characteristics and partisan self-identification. PERSONALITY AND INDIVIDUAL DIFFERENCES 2023; 206:112119. [PMID: 36785728 PMCID: PMC9910023 DOI: 10.1016/j.paid.2023.112119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
Governments around the world are increasingly considering vaccine mandates to curb the spread of COVID-19. In May 2022, we surveyed 394 residents of South Dakota to examine predictors of popular attitudes toward a COVID-19 vaccine mandate. We investigated the role of Big Five personality traits, right-wing authoritarianism, and social dominance orientation, as well as partisan self-identification, evangelical identity, and COVID-19 vaccination status. Results showed that Big Five personality traits (openness and emotional stability), right-wing authoritarianism, social dominance orientation, evangelical identity, and partisan self-identification are linked to attitudes toward a COVID-19 vaccine mandate. Our findings underscore the politicization of the COVID-19 pandemic as well as the impact of dispositional factors on attitudes toward mandatory COVID-19 vaccination.
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Affiliation(s)
| | | | - Alper Kayaalp
- University of Houston Clearlake, United States of America
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Efficacy of the Second COVID-19 Vaccine Booster Dose in the Elderly. Vaccines (Basel) 2023; 11:vaccines11020213. [PMID: 36851092 PMCID: PMC9959889 DOI: 10.3390/vaccines11020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND We analyzed coronavirus disease 2019 (COVID-19) vaccine efficacy in older persons who received the second booster compared to unvaccinated people and those receiving only a single COVID-19 vaccine booster. METHODS We collected information on vaccine efficacy from the ongoing Italian nationwide COVID-19 vaccination campaign in subjects aged 80 years or older from official data published by the Italian National Institute of Health. RESULTS The second vaccine booster maintained high effectiveness against adverse COVID-19 outcomes such as hospitalization, intensive care unit admission and death (i.e., between 77 and 86%), and also showed around 10% higher efficacy than the single booster. Nonetheless, the efficacy of the second vaccine booster declined over time, decreasing by 33-46% when assessed at >120 days from administration. CONCLUSIONS The results of our ad interim analysis of the ongoing Italian nationwide COVID-19 vaccination campaign suggest that regular boosting with COVID-19 vaccines may be advisable in older persons.
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Caetano C, Morgado ML, Patrício P, Leite A, Machado A, Torres A, Pereira JF, Namorado S, Sottomayor A, Peralta-Santos A, Nunes B. Measuring the impact of COVID-19 vaccination and immunity waning: A modelling study for Portugal. Vaccine 2022; 40:7115-7121. [PMID: 36404429 PMCID: PMC9576223 DOI: 10.1016/j.vaccine.2022.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/30/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
Abstract
Vaccination strategies to control COVID-19 have been ongoing worldwide since the end of 2020. Understanding their possible effect is key to prevent future disease spread. Using a modelling approach, this study intends to measure the impact of the COVID-19 Portuguese vaccination strategy on the effective reproduction number and explore three scenarios for vaccine effectiveness waning. Namely, the no-immunity-loss, 1-year and 3-years of immunity duration scenarios. We adapted an age-structured SEIR deterministic model and used Portuguese hospitalisation data for the model calibration. Results show that, although the Portuguese vaccination plan had a substantial impact in reducing overall transmission, it might not be sufficient to control disease spread. A significant vaccination coverage of those above 5 years old, a vaccine effectiveness against disease of at least 80% and softer non-pharmaceutical interventions (NPIs), such as mask usage and social distancing, would be necessary to control disease spread in the worst scenario considered. The immunity duration scenario of 1-year displays a resurgence of COVID-19 hospitalisations by the end of 2021, the same is observed in 3-year scenario although with a lower magnitude. The no-immunity-loss scenario presents a low increase in hospitalisations. In both the 1-year and 3-year scenarios, a vaccination boost of those above 65 years old would result in a 53% and 38% peak reduction of non-ICU hospitalisations, respectively. These results suggest that NPIs should not be fully phased-out but instead be combined with a fast booster vaccination strategy to reduce healthcare burden.
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Affiliation(s)
- Constantino Caetano
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Center for Computational and Stochastic Mathematics, Instituto Superior Técnico, University of Lisbon, Portugal.
| | - Maria Luísa Morgado
- Center for Computational and Stochastic Mathematics, Instituto Superior Técnico, University of Lisbon, Portugal; Department of Mathematics, University of Trás-os-Montes e Alto Doutor (UTAD), Portugal
| | - Paula Patrício
- Center for Mathematics and Applications (NovaMath), FCT NOVA and Department of Mathematics, Nova School of Science and Technology, Universidade NOVA de Lisboa, Quinta da Torre, Caparica, Portugal
| | - Andreia Leite
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Portugal
| | - Ausenda Machado
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Portugal
| | - André Torres
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Portugal
| | - João Freitas Pereira
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Department of Mathematics, University of Trás-os-Montes e Alto Doutor (UTAD), Portugal
| | - Sónia Namorado
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Portugal
| | - Ana Sottomayor
- Direção de Serviços de Informação e Análise, Direção Geral da Saúde, Lisboa, Portugal
| | - André Peralta-Santos
- Direção de Serviços de Informação e Análise, Direção Geral da Saúde, Lisboa, Portugal
| | - Baltazar Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Portugal; Comprehensive Health Research Center, Universidade NOVA de Lisboa, Portugal
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