1
|
Hashan MR, Smoll N, Chapman G, King C, Walker J, Kirk M, Akbar D, Booy R, Khandaker G. Epidemiology of COVID-19 outbreaks in aged care facilities during postvaccine period: a systematic review and meta-analysis. BMJ Open 2024; 14:e073555. [PMID: 38485480 PMCID: PMC10941149 DOI: 10.1136/bmjopen-2023-073555] [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: 03/13/2023] [Accepted: 01/31/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE We aimed to define the epidemiology of COVID-19 outbreaks in aged care facilities (ACFs) during the postvaccine period, including vaccine effectiveness (VE) for this high-risk group. DESIGN Systematic review and meta-analysis. DATA SOURCES Ovid Medline, Ovid Embase, Scopus, Web of Science and Cochrane databases were searched through 1 September 2023. ELIGIBILITY CRITERIA Any original observational studies and trials reporting data on COVID-19 outbreaks among the partially/fully vaccinated residents from ACFs during or after the worldwide implementation of vaccine roll-out. DATA EXTRACTION AND SYNTHESIS We estimated the attack rate, case fatality rate, mortality rate and VE during postvaccine period. Random effect model was adopted for meta-analysis. Quality assessment on all included studies was performed using the Meta Quality Appraisal Tool. RESULTS 38 articles were included from 12 countries reporting 79 outbreaks with 1708 confirmed cases of COVID-19 from 78 ACFs. The pooled attack rate was 28% (95% CI 20% to 37%) among the fully vaccinated residents. Two-thirds (62.5%) of the index cases were unvaccinated healthcare professionals (eg, physicians, nurses) and caregivers. Unvaccinated residents had a significantly higher rates (12%) (95% CI 7% to 19%) of mortality compared with the vaccinated residents (2%) (95% CI% 1 to 4%) and the post-COVID-19 vaccine estimates for case fatality rate (13% vs 23%) and hospitalisation rate (17% vs 37%) were substantially lower. VE in preventing disease among residents in ACFs was 73% (95% CI 49% to 86). Overall, the included studies were heterogeneous in nature, however, the risk of bias was low to moderate. CONCLUSIONS Our study reaffirmed the impact of vaccination as a key public health measure to minimise the burden of COVID-19 in ACFs. Facilities with higher crowding indexes should be prioritised for vaccination and should advocate for higher vaccination targets among staff and residents as a critical intervention strategy to minimise disease burden in this vulnerable population.
Collapse
Affiliation(s)
- Mohammad Rashidul Hashan
- Central Queensland University, Rockhampton, Queensland, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Nicolas Smoll
- Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Gwenda Chapman
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Catherine King
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Jacina Walker
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Michael Kirk
- Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Delwar Akbar
- School of Business and Law, Central Queensland University, Rockhampton, Queensland, Australia
| | - Robert Booy
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, New South Wales, Australia
| | - Gulam Khandaker
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
- Research Division, Central Queensland University, Rockhampton, Queensland, Australia
| |
Collapse
|
2
|
Chuang ST, Lin MH, Hsu H, Chi CM, Lee YR, Yen YH. Epidemic-Prevention Measures and Health Management in a Nursing Home during the Coronavirus Disease 2019 Pandemic. Healthcare (Basel) 2023; 11:2535. [PMID: 37761732 PMCID: PMC10531124 DOI: 10.3390/healthcare11182535] [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: 07/27/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
This study aimed to investigate the impact of epidemic prevention and isolation policies on residents' health and well-being and assess the effectiveness of implementing intervention measures to maintain their quality of life. This mixed-methods research study involved a retrospective record review of residents' daily life diaries and descriptive statistical analysis. Data were collected between March 2021 and June 2022, and epidemic-prevention measures were implemented using Taiwan's Centers for Disease Control guidelines. Three interventions were developed to address residents' health, social, and rehabilitation needs. Despite an overall infection rate of 10% at various times between 2021 and 2022, there were no reported outbreaks of nosocomial infections. The concept of reablement proved effective in helping residents maintain their independence and physical function, with a maintenance rate of 66.6%, thereby improving their quality of life. By implementing epidemic-prevention measures, we found that proper hand washing and the use of surgical masks were effective in controlling infections. Furthermore, the decline in physical function is a continuous and gradual process for older adults. Even under the restriction of social interaction, it is essential to incorporate rehabilitation plans into residents' daily activities and encourage their active participation, as this promotes improved physical function and enhances their overall quality of life.
Collapse
Affiliation(s)
- Shu-Ting Chuang
- Department of Nursing, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427213, Taiwan;
- Department of Nursing, Tzu Chi University of Science and Technology, Hualien 970046, Taiwan
- Taichung Tzu Chi Nursing Home, Buddhist Tzu Chi Medical Foundation, Taichung City 427213, Taiwan; (C.-M.C.); (Y.-R.L.)
| | - Mei-Hui Lin
- Department of Accounting Information, Da-Yeh University, Changhua 515006, Taiwan;
| | - Honda Hsu
- Division of Plastic Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi City 622007, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Chia-Ming Chi
- Taichung Tzu Chi Nursing Home, Buddhist Tzu Chi Medical Foundation, Taichung City 427213, Taiwan; (C.-M.C.); (Y.-R.L.)
- Ph.D. Program in Healthcare Science, China Medical University, Taichung City 406040, Taiwan
| | - Yu-Ru Lee
- Taichung Tzu Chi Nursing Home, Buddhist Tzu Chi Medical Foundation, Taichung City 427213, Taiwan; (C.-M.C.); (Y.-R.L.)
| | - Ya-Hui Yen
- Department of Nursing, National Chi Nan University, Puli Township 545301, Taiwan
| |
Collapse
|
3
|
Nahum S, Kushnir T. The Relationship between Socio-Demographic Factors, Preventive Health Behaviors and Acceptance of COVID-19 Vaccine among Israeli Pregnant Women during the Coronavirus Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6526. [PMID: 37569066 PMCID: PMC10418854 DOI: 10.3390/ijerph20156526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND The outbreak of the Coronavirus disease led the World Health Organization to publish recommendations regarding preventive health behaviors (PHB). Pregnant women are at a higher risk of severe COVID-19 infection and adherence to these recommendations is critical. There are little data regarding PHB among pregnant women. The current study aims to evaluate the contribution of socio-demographic factors and COVID-19 vaccinations in predicting PHB among pregnant women. METHOD 202 pregnant Israeli women (mean age = 30.8 years) participated in an online survey in 2021. RESULTS 88% of the women were vaccinated and few had been infected. Of the women, 75.2% reported wearing face masks in closed spaces, while 12.4% reported wearing masks outdoors; 63.9% of the women did not travel abroad for fear of infection by the virus and 51% avoided crowded events. A simultaneous regression analysis to predict PHB indicated that pregnancy week and Coronavirus vaccination significantly and positively predicted PHB, but religious status was a negative predictor. Age, number of children, and level of education were not associated with PHB. CONCLUSIONS These findings can be helpful as a preliminary evidence base for policy-making at present and for future epidemics regarding guidelines on PHB adjusted for pregnant women.
Collapse
Affiliation(s)
- Shir Nahum
- Department of Psychology, Ariel University, Ariel 40700, Israel;
| | - Talma Kushnir
- Department of Psychology, Ariel University, Ariel 40700, Israel;
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| |
Collapse
|
4
|
Li T, Wang Z, He S, Chen Y. Investigating the Marginal and Herd Effects of COVID-19 Vaccination for Reducing Case Fatality Rate: Evidence from the United States between March 2021 to January 2022. Vaccines (Basel) 2023; 11:1078. [PMID: 37376467 DOI: 10.3390/vaccines11061078] [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: 02/13/2023] [Revised: 04/19/2023] [Accepted: 04/29/2023] [Indexed: 06/29/2023] Open
Abstract
Vaccination campaigns have been rolled out in most countries to increase vaccination coverage and protect against case mortality during the ongoing pandemic. To evaluate the effectiveness of COVID-19 vaccination, it is vital to disentangle the herd effect from the marginal effect and parameterize them separately in a model. To demonstrate this, we study the relationship between the COVID-19 vaccination coverage and case fatality rate (CFR) based on U.S. vaccination coverage at county level, with daily records from 11 March 2021 to 26 January 2022 for 3109 U.S. counties. Using segmented regression, we discovered three breakpoints of the vaccination coverage, at which herd effects could potentially exist. Controlling for county heterogeneity, we found the size of the marginal effect was not constant but actually increased as the vaccination coverage increased, and only the herd effect at the first breakpoint to be statistically significant, which implied an indirect benefit of vaccination may exist at the early stage of a vaccination campaign. Our results demonstrated that public-health researchers should carefully differentiate and quantify the herd and marginal effects when analyzing vaccination data, to better inform vaccination-campaign strategies as well as evaluate vaccination effectiveness.
Collapse
Affiliation(s)
- Tenglong Li
- Wisdom Lake Academy of Pharmacy, Xi'an Jiaotong-Liverpool University, Suzhou 215123, China
| | - Zilong Wang
- Department of Financial and Actuarial Mathematics, Xi'an Jiaotong-Liverpool University, Suzhou 215123, China
| | - Shuyue He
- Wisdom Lake Academy of Pharmacy, Xi'an Jiaotong-Liverpool University, Suzhou 215123, China
| | - Ying Chen
- Wisdom Lake Academy of Pharmacy, Xi'an Jiaotong-Liverpool University, Suzhou 215123, China
| |
Collapse
|
5
|
Madruga Flores M, Corrales López M, Gómez-Pavón J. [The impact of the first pandemic waves of COVID-19 in older people with dementia]. Aten Primaria 2023; 55:102622. [PMID: 37058882 PMCID: PMC10040343 DOI: 10.1016/j.aprim.2023.102622] [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: 11/22/2022] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
Patients with dementia are in themselves more vulnerable, and have been especially affected by the effect of the COVID-19 pandemic, both directly due to the disease itself, and indirectly due to the deprivation of cognitive stimulation due to isolation social due to confinement. SARS-CoV-2 virus infection has given rise to a wide variety of symptoms, including neurological symptoms and especially delirium in the elderly with dementia. The virus has affected the central nervous system, both directly due to the neurotropism of the virus, and indirectly due to inflammation and tissue hypoxia of vascular origin. The different causes that have been able to lead, in the different waves prior to the omicron variant, to the significant increase in morbidity and mortality in patients with dementia, especially the elderly, are analyzed.
Collapse
Affiliation(s)
- María Madruga Flores
- Servicio de Geriatría, Hospital Universitario Central de la Cruz Roja San José y Santa Adela, Madrid, España.
| | | | - Javier Gómez-Pavón
- Servicio de Geriatría, Hospital Universitario Central de la Cruz Roja San José y Santa Adela, Madrid, España
| |
Collapse
|
6
|
Vicentini C, Zotti CM, Cornio AR, Garlasco J, Marengo N, Meddis D, Ditommaso S, Giacomuzzi M, Memoli G, Bordino V, Gianino MM. Antibody responses to BNT162b2 SARS-CoV-2 mRNA vaccine among healthcare workers and residents of long-term care facilities: A cohort study in Northern Italy. Health Sci Rep 2023; 6:e1087. [PMID: 36789400 PMCID: PMC9922049 DOI: 10.1002/hsr2.1087] [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: 10/20/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 02/13/2023] Open
Abstract
Background and Aims Long-term care facilities (LTCFs) have been severely impacted by COVID-19, with a disproportionate amount of SARS-CoV-2 infections and related deaths occurring among residents. Methods This study is part of an ongoing multicenter, prospective cohort study conducted among healthcare workers (HCWs) and residents of 13 LTCFs in Northern Italy designed to evaluate SARS-CoV-2 specific immunoglobulin class G (IgG) titers before and following vaccination with Pfizer/BNT162b2 SARS-CoV-2 mRNA vaccine (two doses of vaccine, 21 days apart). Serum samples were obtained from participants (t0) before vaccination, and (t1) 2 weeks after and analyzed to determine anti-S1 IgG antibodies. Results Five hundred and thirty-four participants were enrolled (404 subjects participated in both blood draws). Seropositivity was 50.19% at t0 and 99% at t1, with a significant difference in IgG titers. A higher proportion of residents were seropositive at t0 compared with HCWs, with significantly higher IgG titers among residents at both t0 and t1. Pre-existing immunity also had a significant effect on postvaccination IgG titers. However, a significant difference in titers at t1 between HCWs and residents considering only participants seropositive at t0 was found, with higher median titers among previously seropositive residents. Conclusion Findings of this study provide scientific evidence endorsing the policy of universal vaccination in LTCFs.
Collapse
Affiliation(s)
- Costanza Vicentini
- Department of Public Health and PaediatricsUniversity of TurinTurinItaly
| | - Carla Maria Zotti
- Department of Public Health and PaediatricsUniversity of TurinTurinItaly
| | | | - Jacopo Garlasco
- Department of Public Health and PaediatricsUniversity of TurinTurinItaly
| | - Noemi Marengo
- Department of Public Health and PaediatricsUniversity of TurinTurinItaly
| | - Davide Meddis
- Department of Public Health and PaediatricsUniversity of TurinTurinItaly
| | - Savina Ditommaso
- Department of Public Health and PaediatricsUniversity of TurinTurinItaly
| | - Monica Giacomuzzi
- Department of Public Health and PaediatricsUniversity of TurinTurinItaly
| | - Gabriele Memoli
- Department of Public Health and PaediatricsUniversity of TurinTurinItaly
| | - Valerio Bordino
- Department of Public Health and PaediatricsUniversity of TurinTurinItaly
| | | | | |
Collapse
|
7
|
Santos CVBD, Noronha TGD, Werneck GL, Struchiner CJ, Villela DAM. Estimated COVID-19 severe cases and deaths averted in the first year of the vaccination campaign in Brazil: A retrospective observational study. LANCET REGIONAL HEALTH. AMERICAS 2023; 17:100418. [PMID: 36575682 PMCID: PMC9779315 DOI: 10.1016/j.lana.2022.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/25/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
Background A nationwide Severe Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination campaign was initiated in Brazil in January 2021 with CoronaVac (Sinovac Biotech) and ChAdOx1 nCoV-19 (AstraZeneca) followed by BNT162b2 mRNA (Pfizer-BioNTech) and Ad26.COV2.S (Johnson & Johnson-Janssen) vaccines. Here we provide estimates of the number of severe cases and deaths due to coronavirus disease (COVID-19) averted during the first year of the mass vaccination campaign in Brazil. Methods Data on COVID-19 vaccination and COVID-19-related illness and death were obtained from the Brazilian Ministry of Health and used to estimate the direct effects of the vaccination campaign on the number of severe cases and deaths due to COVID-19 occurring between January 17, 2021 and January 31, 2022. To this end, we compared the daily age-specific rates between the unvaccinated population and the "at least partly vaccinated" population (received at least one dose of a two-dose vaccine), as well as other two vaccination subgroups, "fully vaccinated" (completed the one- or two-dose vaccine schedule), and "boosted-vaccinated" (fully vaccinated and recipients of booster dose) populations. Findings We estimated that 74% (n = 875,846; 95% confidence interval, CI 843,383-915,709) of total expected cases of severe COVID-19 and 82% (n = 303,129; 95% CI 284,019-321,681) of total expected deaths due to COVID-19 were averted in the first year of the national vaccination campaign. The averted burden was heterogeneous between age groups and higher in the more populous states. However, outcome rate differences between vaccinated and unvaccinated groups were higher in the less populated states. Interpretation The first year of the COVID-19 vaccination program in Brazil saved the lives of at least 303,129 adults. The results highlight the need for future vaccination campaigns, including those required in the current pandemic, to rapidly achieve high uptake, particularly among the elderly and residents of the least populous regions. Funding Ministry of Health (Brazil).
Collapse
Affiliation(s)
- Cleber Vinicius Brito dos Santos
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), RJ, Brazil,Corresponding author. R. São Francisco Xavier 524, Maracanã, Rio de Janeiro, RJ, Brazil Zipcode: 20550-013
| | - Tatiana Guimarães de Noronha
- Instituto de Tecnologia em Imunobiológicos Bio-Manguinhos, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil,Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal Fluminense (UFF), Niteroi, RJ, Brazil
| | - Guilherme Loureiro Werneck
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), RJ, Brazil,Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Claudio José Struchiner
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), RJ, Brazil,Escola de Matemática Aplicada, Fundação Getúlio Vargas (FGV), Rio de Janeiro, RJ, Brazil
| | | |
Collapse
|
8
|
Ferreira LS, Darcie Marquitti FM, Paixão da Silva RL, Borges ME, Ferreira da Costa Gomes M, Cruz OG, Kraenkel RA, Coutinho RM, Prado PI, Bastos LS. Estimating the impact of implementation and timing of the COVID-19 vaccination programme in Brazil: a counterfactual analysis. LANCET REGIONAL HEALTH. AMERICAS 2023; 17:100397. [PMID: 36439909 PMCID: PMC9676113 DOI: 10.1016/j.lana.2022.100397] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/30/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022]
Abstract
Background Vaccines developed between 2020 and 2021 against the SARS-CoV-2 virus were designed to diminish the severity and prevent deaths due to COVID-19. However, estimates of the effectiveness of vaccination campaigns in achieving these goals remain a methodological challenge. In this work, we developed a Bayesian statistical model to estimate the number of deaths and hospitalisations averted by vaccination of older adults (above 60 years old) in Brazil. Methods We fit a linear model to predict the number of deaths and hospitalisations of older adults as a function of vaccination coverage in this group and casualties in younger adults. We used this model in a counterfactual analysis, simulating alternative scenarios without vaccination or with faster vaccination roll-out. We estimated the direct effects of COVID-19 vaccination by computing the difference between hypothetical and realised scenarios. Findings We estimated that more than 165,000 individuals above 60 years of age were not hospitalised due to COVID-19 in the first seven months of the vaccination campaign. An additional contingent of 104,000 hospitalisations could have been averted if vaccination had started earlier. We also estimated that more than 58 thousand lives were saved by vaccinations in the period analysed for the same age group and that an additional 47 thousand lives could have been saved had the Brazilian government started the vaccination programme earlier. Interpretation Our estimates provided a lower bound for vaccination impacts in Brazil, demonstrating the importance of preventing the suffering and loss of older Brazilian adults. Once vaccines were approved, an early vaccination roll-out could have saved many more lives, especially when facing a pandemic. Funding The Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brazil (Finance Code 001 to F.M.D.M. and L.S.F.), Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brazil (grant number: 315854/2020-0 to M.E.B., 141698/2018-7 to R.L.P.d.S., 313055/2020-3 to P.I.P., 311832/2017-2 to R.A.K.), Fundação de Amparo à Pesquisa do Estado de São Paulo - Brazil (contract number: 2016/01343-7 to R.A.K.), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro - Brazil (grant number: E-26/201.277/2021 to L.S.B.) and Inova Fiocruz/Fundação Oswaldo Cruz - Brazil (grant number: 48401485034116) to L.S.B., O.G.C. and M.G.d.F.C. The funding agencies had no role in the conceptualization of the study.
Collapse
Affiliation(s)
- Leonardo Souto Ferreira
- Instituto de Física Teórica, Universidade Estadual Paulista, São Paulo, Brazil,Observatório COVID-19 BR, Brazil
| | - Flavia Maria Darcie Marquitti
- Observatório COVID-19 BR, Brazil,Instituto de Física ‘Gleb Wataghin’ and Instituto de Biologia, Universidade Estadual de Campinas, Campinas, Brazil,Corresponding author. Instituto de Física ‘Gleb Wataghin’, Rua Sérgio Buarque de Holanda, 777 - Cidade Universitária, Universidade Estadual de Campinas, Campinas, Brazil Zip-code: 13083-859
| | - Rafael Lopes Paixão da Silva
- Instituto de Física Teórica, Universidade Estadual Paulista, São Paulo, Brazil,Observatório COVID-19 BR, Brazil
| | | | | | - Oswaldo Gonçalves Cruz
- Observatório COVID-19 BR, Brazil,Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de Janeiro, Brazil
| | - Roberto André Kraenkel
- Instituto de Física Teórica, Universidade Estadual Paulista, São Paulo, Brazil,Observatório COVID-19 BR, Brazil
| | - Renato Mendes Coutinho
- Observatório COVID-19 BR, Brazil,Centro de Matemática, Computação e Cognição, Universidade Federal do ABC, Santo André, Brazil
| | - Paulo Inácio Prado
- Observatório COVID-19 BR, Brazil,Instituto de Biociências, Universidade de São Paulo, São Paulo, Brazil
| | - Leonardo Soares Bastos
- Observatório COVID-19 BR, Brazil,Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de Janeiro, Brazil
| |
Collapse
|
9
|
Serological Responses up to 9 Months following COVID-19 mRNA Vaccination in Residents and Health-Care Workers of Long-Term Care Facilities: A Multicenter Prospective Cohort Study in Northern Italy. Vaccines (Basel) 2022; 10:vaccines10122183. [PMID: 36560593 PMCID: PMC9784767 DOI: 10.3390/vaccines10122183] [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: 11/18/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Long-term care facilities (LTCFs) were severely affected by COVID-19, in particular in Northern Italy. We aimed to assess antibody responses among residents and healthcare workers (HCWs) of 13 LTCFs through serum samples collected at three time points: prior to, two weeks, and 9 months after receiving Pfizer/BNT162b2 SARS-CoV-2 mRNA vaccine (respectively t0, t1, and t2). IgG antibodies targeted towards the S1 domain of the spike protein were measured, and results were expressed in binding antibody units (BAU/mL). Friedman's average rank test was performed to compare antibody titres between the three time points. Two logistic regression models were built to identify independent predictors of (1) developing and (2) maintaining a significant antibody response to vaccination, using a previously identified threshold. In total, 534 subjects were enrolled (371 HCWs and 163 residents). The antibody titres at t1 were the highest; at t2, the IgG titres significantly decreased, remaining however 10 times higher compared to titres at t0. Previous infection was the only significant predictor of developing and maintaining a response over threshold in both models. Results of this study provided further insights on the humoral response elicited by vaccination, and on host factors determining variations in its magnitude and kinetics.
Collapse
|
10
|
Ruiz-Huerta C, Canto MV, Ruiz C, González I, Lozano-Montoya I, Quezada-Feijoo M, Gómez-Pavón FJ. COVID-19 Mortality in Patients Aged 80 and over Residing in Nursing Homes-Six Pandemic Waves: OCTA-COVID Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912019. [PMID: 36231321 PMCID: PMC9565141 DOI: 10.3390/ijerph191912019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/20/2022] [Indexed: 05/31/2023]
Abstract
During the first COVID-19 pandemic wave in Spain, 50% of deaths occurred in nursing homes, making it necessary for some hospitals to support these facilities with the care of infected patients. This study compares origin, characteristics, and mortality of patients admitted with COVID-19 during six pandemic waves in the Hospital Central de la Cruz Roja in Madrid. It is a retrospective observational study of patients ≥80 years old, admitted with an acute SARS-CoV-2 infection, with a total of 546 patients included, whose final outcome was death or discharge. During the first wave, those from nursing homes had a higher risk of death than those from home; during the two successive waves, the risk was higher for those from home; and in the last two waves, the risk equalized and decreased exponentially in both groups. Men had 72% higher risk of death than women. For each year of age, the risk increased by 4% (p = 0.036). For each Charlson index point, the risk increased by 14% (p = 0.019). Individuals in nursing homes, despite being older with higher comorbidity, did not show a higher overall lethality. The mortality decreased progressively in each successive wave due to high vaccination rates and COVID-19 control measures in this population.
Collapse
Affiliation(s)
- Claudia Ruiz-Huerta
- Department of Preventive Medicine, Hospital Central de la Cruz Roja, 28003 Madrid, Spain
- Faculty of Medicine, “Alfonso X el Sabio” University, 28691 Madrid, Spain
| | - Marcelle V. Canto
- Department of Preventive Medicine, Hospital Central de la Cruz Roja, 28003 Madrid, Spain
| | - Carmen Ruiz
- Department of Preventive Medicine, Hospital Central de la Cruz Roja, 28003 Madrid, Spain
| | - Ildefonso González
- Department of Preventive Medicine, Hospital Central de la Cruz Roja, 28003 Madrid, Spain
- Faculty of Medicine, “Alfonso X el Sabio” University, 28691 Madrid, Spain
| | - Isabel Lozano-Montoya
- Faculty of Medicine, “Alfonso X el Sabio” University, 28691 Madrid, Spain
- Department of Geriatric Medicine, Hospital Central de la Cruz Roja, 28003 Madrid, Spain
| | - Maribel Quezada-Feijoo
- Faculty of Medicine, “Alfonso X el Sabio” University, 28691 Madrid, Spain
- Department of Cardiology, Hospital Central de la Cruz Roja, 28003 Madrid, Spain
| | - Francisco J. Gómez-Pavón
- Faculty of Medicine, “Alfonso X el Sabio” University, 28691 Madrid, Spain
- Department of Geriatric Medicine, Hospital Central de la Cruz Roja, 28003 Madrid, Spain
| |
Collapse
|
11
|
Dyer AH, Fallon A, Noonan C, Dolphin H, O'Farrelly C, Bourke NM, O'Neill D, Kennelly SP. Managing the Impact of COVID-19 in Nursing Homes and Long-Term Care Facilities: An Update. J Am Med Dir Assoc 2022; 23:1590-1602. [PMID: 35922016 PMCID: PMC9250924 DOI: 10.1016/j.jamda.2022.06.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/26/2022]
Abstract
Older adults in nursing homes are at greatest risk of morbidity and mortality from SARS-CoV-2 infection. Nursing home residents constituted one-third to more than half of all deaths during the early waves of the COVID-19 pandemic. Following this, widespread adaptation of infection prevention and control measures and the supply and use of personal protective equipment resulted in a significant decrease in nursing home infections and deaths. For nursing homes, the most important determinant of experiencing a SARS-CoV-2 outbreak in the first instance appears to be community-transmission levels (particularly with variants of concern), although nursing home size and quality, for-profit status, and sociodemographic characteristics are also important. Use of visitation bans, imposed to reduce the impact of COVID-19 on residents, must be delicately balanced against their impact on resident, friend or family, and staff well-being. The successful rollout of primary vaccination has resulted in a sharp decrease in morbidity and mortality from SARS-CoV-2 in nursing homes. However, emerging evidence suggests that vaccine efficacy may wane over time, and the use of a third or additional vaccine "booster" doses in nursing home residents restores protection afforded by primary vaccination. Ongoing monitoring of vaccine efficacy in terms of infection, morbidity, and mortality is crucial in this vulnerable group in informing ongoing SARS-CoV-2 vaccine boosting strategies. Here, we detail the impact of SARS-CoV-2 on nursing home residents and discuss important considerations in the management of nursing home SARS-CoV-2 outbreaks. We additionally examine the use of testing strategies, nonpharmacologic outbreak control measures and vaccination strategies in this cohort. Finally, the impact of SARS-CoV-2 on the sector is reflected on as we emphasize the need for adoption of universal standards of medical care and integration with wider public health infrastructure in nursing homes in order to provide a safe and effective long-term care sector.
Collapse
Affiliation(s)
- Adam H Dyer
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Aoife Fallon
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Claire Noonan
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Helena Dolphin
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland
| | - Cliona O'Farrelly
- Comparative Immunology, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nollaig M Bourke
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland; Inflammageing Research Group, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Desmond O'Neill
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sean P Kennelly
- Department of Age-Related Healthcare, Tallaght University Hospital, Dublin, Ireland; Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
12
|
Rahmani K, Shavaleh R, Forouhi M, Disfani HF, Kamandi M, Oskooi RK, Foogerdi M, Soltani M, Rahchamani M, Mohaddespour M, Dianatinasab M. The effectiveness of COVID-19 vaccines in reducing the incidence, hospitalization, and mortality from COVID-19: A systematic review and meta-analysis. Front Public Health 2022; 10:873596. [PMID: 36091533 PMCID: PMC9459165 DOI: 10.3389/fpubh.2022.873596] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/26/2022] [Indexed: 01/21/2023] Open
Abstract
Background Vaccination, one of the most important and effective ways of preventing infectious diseases, has recently been used to control the COVID-19 pandemic. The present meta-analysis study aimed to evaluate the effectiveness of COVID-19 vaccines in reducing the incidence, hospitalization, and mortality from COVID-19. Methods A systematic search was performed independently in Scopus, PubMed via Medline, ProQuest, and Google Scholar electronic databases as well as preprint servers using the keywords under study. We used random-effect models and the heterogeneity of the studies was assessed using I 2 and χ2 statistics. In addition, the Pooled Vaccine Effectiveness (PVE) obtained from the studies was calculated by converting based on the type of outcome. Results A total of 54 studies were included in this meta-analysis. The PVE against SARS-COV 2 infection were 71% [odds ratio (OR) = 0.29, 95% confidence intervals (CI): 0.23-0.36] in the first dose and 87% (OR = 0.13, 95% CI: 0.08-0.21) in the second dose. The PVE for preventing hospitalization due to COVID-19 infection was 73% (OR = 0.27, 95% CI: 0.18-0.41) in the first dose and 89% (OR = 0.11, 95% CI: 0.07-0.17) in the second dose. With regard to the type of vaccine, mRNA-1273 and combined studies in the first dose and ChAdOx1 and mRNA-1273 in the second dose had the highest effectiveness in preventing infection. Regarding the COVID-19-related mortality, PVE was 68% (HR = 0.32, 95% CI: 0.23-0.45) in the first dose and 92% (HR = 0.08, 95% CI: 0.02-0.29) in the second dose. Conclusion The results of this meta-analysis indicated that vaccination against COVID-19 with BNT162b2 mRNA, mRNA-1273, and ChAdOx1, and also their combination, was associated with a favorable effectiveness against SARS-CoV2 incidence rate, hospitalization, and mortality rate in the first and second doses in different populations. We suggest that to prevent the severe form of the disease in the future, and, in particular, in the coming epidemic picks, vaccination could be the best strategy to prevent the severe form of the disease. Systematic review registration PROSPERO International Prospective Register of Systematic Reviews: http://www.crd.york.ac.uk/PROSPERO/, identifier [CRD42021289937].
Collapse
Affiliation(s)
- Kazem Rahmani
- Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Rasoul Shavaleh
- Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran,*Correspondence: Rasoul Shavaleh
| | - Mahtab Forouhi
- Department of Pharmacy, Shahid Behest University of Medical Sciences, Tehran, Iran
| | - Hamideh Feiz Disfani
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mostafa Kamandi
- Hematologist-Oncologist, Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Rozita Khatamian Oskooi
- Department of Emergency Medicine, Faculty of Medicine, Birgand University of Medical Sciences, Birjand, Iran
| | - Molood Foogerdi
- Department of Emergency Medicine, Faculty of Medicine, Birgand University of Medical Sciences, Birjand, Iran
| | - Moslem Soltani
- Department of Gastroenterology and Hepatology, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Maryam Rahchamani
- Department of Internal Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohaddespour
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mostafa Dianatinasab
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands,Mostafa Dianatinasab
| |
Collapse
|
13
|
Hatfield KM, Baggs J, Wolford H, Fang M, Sattar AA, Montgomery KS, Jin S, Jernigan J, Pilishvili T. Effectiveness of Coronavirus Disease 2019 (COVID-19) Vaccination Against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection Among Residents of US Nursing Homes Before and During the Delta Variant Predominance, December 2020-November 2021. Clin Infect Dis 2022; 75:S147-S154. [PMID: 35856635 PMCID: PMC9384512 DOI: 10.1093/cid/ciac562] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Residents of nursing homes experience disproportionate morbidity and mortality related to coronavirus disease 2019 (COVID-19) and were prioritized for vaccine introduction. We evaluated COVID-19 vaccine effectiveness (VE) in preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections among nursing home residents. METHODS We used a retrospective cohort of 4315 nursing home residents during 14 December 2020-9 November 2021. A Cox proportional hazards model was used to estimate hazard ratios comparing residents with a completed vaccination series with unvaccinated among those with and without prior SARS-CoV-2 infection, by vaccine product, and by time period. RESULTS Overall adjusted VE was 58% (95% confidence interval [CI], 44% to 69%) among residents without a history of SARS-CoV-2 infection. During the pre-Delta period, the VE within 150 days of receipt of the second dose of Pfizer-BioNTech (67%; 95% CI, 40% to 82%) and Moderna (75%; 95% CI, 32% to 91%) was similar. During the Delta period, VE measured >150 days after the second dose was 33% (95% CI, -2% to 56%) for Pfizer-BioNTech and 77% (95% CI, 48% to 91%) for Moderna. Rates of infection were 78% lower (95% CI, 67% to 85%) among residents with prior SARS-CoV-2 infection and completed vaccination series compared with unvaccinated residents without a history of SARS-CoV-2 infection. CONCLUSIONS COVID-19 vaccines were effective in preventing SARS-CoV-2 infections among nursing home residents, and history of prior SARS-CoV-2 infection provided additional protection. Maintaining high coverage of recommended doses of COVID-19 vaccines remains a critical tool for preventing infections in nursing homes.
Collapse
Affiliation(s)
| | - James Baggs
- COVID-19 response team,Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases
| | - Hannah Wolford
- COVID-19 response team,Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases
| | | | | | | | | | - John Jernigan
- COVID-19 response team,Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases
| | - Tamara Pilishvili
- COVID-19 response team,Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention
| |
Collapse
|
14
|
Godoy P, Castilla J, Astray J, Godoy S, Tuells J, Barrabeig I, Domínguez Á. [Towards COVID-19 control through vaccination: obstacles, challenges and opportunities. SESPAS Report 2022]. GACETA SANITARIA 2022; 36 Suppl 1:S82-S86. [PMID: 35781154 PMCID: PMC9244662 DOI: 10.1016/j.gaceta.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/10/2022] [Accepted: 03/17/2022] [Indexed: 01/09/2023]
Abstract
En España se inició el programa de vacunación en un contexto de alta transmisión y baja disponibilidad de vacunas. El objetivo de este artículo es revisar el programa de vacunación frente a la COVID-19 (3-3-2022) y valorar los obstáculos, los desafíos y las oportunidades que plantea el control de esta enfermedad. Se dispone actualmente de cinco vacunas: dos basadas en la tecnología ARNm (Comirnaty® y Spikevax®), dos basadas en un vector no replicativo (Vaxzevria® y Janssen) y una basada en la subunidad S (Novavax®). Las autoridades sanitarias han desarrollado estrategias de vacunación priorizando la prevención de hospitalizaciones y defunciones. En marzo de 2022 se superó el 90% de la población diana con vacunación completa y el 95% de cobertura en mayores de 50 años. El nuevo reto es conseguir coberturas similares para una tercera dosis. La vacunación en la infancia y la adolescencia se ha convertido en una prioridad por las implicaciones educativas y sociales que comporta la COVID-19. Se deberán renovar las estrategias comunicativas y eliminar las barreras de acceso para conseguir buenas coberturas. En España se han publicado estudios que muestran una alta efectividad de la vacunación. La principal estrategia para el control de la pandemia y para recuperar la actividad social es la vacunación, pero todo indica que serán necesarios niveles muy altos de cobertura vacunal y seguir con medidas no farmacológicas. En un mundo globalizado, el control de la COVID-19 solo se alcanzará con una estrategia global coordinada y el apoyo a la vacunación en los países con pocos recursos.
Collapse
Affiliation(s)
- Pere Godoy
- Agència de Salut Pública de Catalunya, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, España.
| | - Jesús Castilla
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Salud Pública de Navarra-IdiSNA, Pamplona, España
| | - Jenaro Astray
- Dirección General de Salud Pública, Subdirección General de Epidemiología, Comunidad de Madrid, Madrid, España
| | - Sofía Godoy
- Institut Català de la Salut (ICS), Lleida, España
| | - José Tuells
- Departamento de Salud Pública, Universidad de Alicante, Alicante, España
| | - Irene Barrabeig
- Agència de Salut Pública de Catalunya, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Ángela Domínguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Departament de Medicina, Universitat de Barcelona, Barcelona, España
| |
Collapse
|
15
|
Shrotri M, Krutikov M, Nacer-Laidi H, Azmi B, Palmer T, Giddings R, Fuller C, Irwin-Singer A, Baynton V, Tut G, Moss P, Hayward A, Copas A, Shallcross L. Duration of vaccine effectiveness against SARS-CoV-2 infection, hospitalisation, and death in residents and staff of long-term care facilities in England (VIVALDI): a prospective cohort study. THE LANCET. HEALTHY LONGEVITY 2022; 3:e470-e480. [PMID: 35813279 PMCID: PMC9252508 DOI: 10.1016/s2666-7568(22)00147-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Residents and staff in long-term care facilities have been prioritised for vaccination against SARS-CoV-2, but data on potential waning of vaccine effectiveness and the effect of booster doses in this vulnerable population are scarce. We aimed to evaluate effectiveness of one, two, and three vaccine doses against infection and severe clinical outcomes in staff and residents of long-term care facilities in England over the first year following vaccine roll-out. Methods The VIVALDI study is a prospective cohort study done in 331 long-term care facilities in England. Residents aged 65 years or older and staff aged 18 years or older were eligible for participation. Participants had routine PCR testing throughout the study period between Dec 8, 2020, and Dec 11, 2021. We retrieved all PCR results and cycle threshold values for PCR-positive samples from routine testing in long-term care facilities, and positive PCR results from clinical testing in hospitals through the UK's COVID-19 Datastore. PCR results were linked to participants using pseudo-identifiers based on individuals' unique UK National Health Service (NHS) numbers, which were also used to retrieve vaccination records from the National Immunisation Management Service, hospitalisation records from NHS England, and deaths data from the Office for National Statistics through the COVID-19 Datastore. In a Cox proportional hazards regression, we estimated vaccine effectiveness against SARS-CoV-2 infection, COVID-19-related hospitalisation, and COVID-19-related death after one, two, and three vaccine doses, separately by previous SARS-CoV-2 exposure. This study is registered with the ISRCTN Registry, ISRCTN 14447421. Findings 80 186 residents and staff of long-term care facilities had records available for the study period, of whom 15 518 eligible residents and 19 515 eligible staff were included in the analysis. For residents without evidence of previous SARS-CoV-2 exposure, vaccine effectiveness decreased from 61·7% (95% CI 35·1 to 77·4) to 22·0% (-14·9 to 47·0) against infection; from 89·0% (70·6 to 95·9) to 56·3% (30·1 to 72·6) against hospitalisation; and from 96·4% (84·3 to 99·2) to 64·4% (36·1 to 80·1) against death, when comparing 14-83 days after dose two and 84 days or more after dose two. For staff without evidence of previous exposure, vaccine effectiveness against infection decreased slightly from 57·9% (43·1 to 68·9) at 14-83 days after dose two to 42·1% (29·9 to 52·2) at 84 days or more after dose two. There were no hospitalisations or deaths among unexposed staff at 14-83 days, but seven hospitalisations (vaccine effectiveness 91·0% [95% CI 74·3 to 96·8]) and one death were observed at 84 days or more after dose two. High vaccine effectiveness was restored following a third vaccine dose, with vaccine effectiveness in unexposed residents of 72·7% (55·8 to 83·1) against infection, 90·1% (80·6 to 95·0) against hospitalisation, and 97·5% (88·1 to 99·5) against death; and vaccine effectiveness in unexposed staff of 78·2% (70·0 to 84·1) against infection and 95·8% (49·9 to 99·6) against hospitalisation. There were no COVID-19-related deaths among unexposed staff after the third vaccine dose. Interpretation Our findings showed substantial waning of SARS-CoV-2 vaccine effectiveness against all outcomes in residents of long-term care facilities from 12 weeks after a primary course of ChAdOx1-S or mRNA vaccines. Boosters restored protection, and maximised immunity across all outcomes. These findings show the importance of boosting and the need for ongoing surveillance in this vulnerable cohort. Funding UK Government Department of Health and Social Care.
Collapse
Affiliation(s)
| | | | | | | | - Tom Palmer
- UCL Institute for Global Health, London, UK
| | | | | | | | | | - Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Andrew Hayward
- UCL Institute of Epidemiology and Healthcare, London, UK
- Health Data Research UK, London, UK
| | | | | |
Collapse
|
16
|
Glatman-Freedman A, Feldman SF, Hershkovitz Y, Kaufman Z, Dichtiar R, Keinan-Boker L, Bromberg M. Vaccine Coverage Associated With Ending a Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Wave: A Retrospective Longitudinal Analysis. Clin Infect Dis 2022; 76:e207-e215. [PMID: 35762838 PMCID: PMC9278214 DOI: 10.1093/cid/ciac524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/14/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Two SARS-CoV-2 waves in Israel ended while a substantial number of individuals remained unvaccinated or partially vaccinated. The indirect protective effect of the first BNT162b2 vaccination campaign in Israel was evaluated between 22 December 2020 and 18 May 2021. METHODS The daily percentage of new polymerase chain reaction (PCR)-confirmed SARS-CoV-2 cases among unvaccinated individuals was analyzed for trends. Major shifts were identified using piecewise linear regression analysis. At these shifts, the percentage of naturally vaccinated (past SARS-CoV-2 cases) and the percentage of actively vaccinated (by inoculation) individuals were weighted and summed to determine the percentage of natural and active vaccination (NAV). RESULTS A first decline among unvaccinated individuals occurred during a lockdown period, when the percentage of NAV was 8.16%. The major decline occurred after the end of the lockdown when the percentage of NAV reached 52.05%. SARS-CoV-2 cases ultimately declined among unvaccinated individuals when the percentage of NAV reached 63.55%. During the study period, the Alpha variant was prevalent and the use of nonpharmaceutical interventions, including social distancing, existed to varying degrees. CONCLUSIONS The vaccination campaign played a major role in the decline of SARS-CoV-2 infection among unvaccinated individuals, leading to the end of the first 2021 SARS-CoV-2 wave (Alpha variant) in Israel. Infection in unvaccinated individuals stopped when two-thirds of the population were naturally or actively vaccinated. Any change in characteristics of the virus or the population can lead to a new outbreak.
Collapse
Affiliation(s)
- Aharona Glatman-Freedman
- Corresponding author: Aharona Glatman-Freedman, The Israel Center for Disease Control, Tel Hashomer, Ramat Gan, Israel. E mail: aharona.freedman@ moh.gov.il
| | - Sarah F Feldman
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Yael Hershkovitz
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Zalman Kaufman
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Rita Dichtiar
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel,School of Public Health, Haifa University, Haifa, Israel
| | - Michal Bromberg
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel,Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
17
|
Freise NF, Kivel M, Grebe O, Meyer C, Wafaisade B, Peiper M, Zeus T, Schmidt J, Neuwahl J, Jazmati D, Luedde T, Bölke E, Feldt T, Jensen BEO, Bode J, Keitel V, Haussmann J, Tamaskovics B, Budach W, Fischer JC, Knoefel WT, Schneider M, Gerber PA, Pedoto A, Häussinger D, van Griensven M, Rezazadeh A, Flaig Y, Kirchner J, Antoch G, Schelzig H, Matuschek C. Acute cardiac side effects after COVID-19 mRNA vaccination: a case series. Eur J Med Res 2022; 27:80. [PMID: 35655235 PMCID: PMC9160507 DOI: 10.1186/s40001-022-00695-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/27/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Vaccination against SARS-CoV-2 has been the main tool to contain the pandemic. The rush development of the 3 vaccines and their expedited approval have led to inoculation of millions of patients around the world, leading to a containment of the disease. Despite continuous viral mutations and the identification of weaker variants, the severity of the infections has been mild, with many patients being either asymptomatic or recovering at home. Currently the focus has shifted from the host of organ damage related to the infection to potential side effects of the vaccine. Myocarditis has been reported as one of the potential side effects from the mRNA vaccine, affecting young healthy individuals. Up to September 30, 2021, 1.243 cases of myocarditis after vaccination with BNT162b2 Comirnaty© were registered in young adults by the Paul-Ehrlich-Institute in Germany alone. The exact pathophysiology and the risk factors for myocarditis following vaccination remain unclear. We present a case series of eight patients with cardiac symptom shortly after SARS-CoV-2 mRNA vaccination (BNT162b6, Biontech, Comirnaty© or mRNA-1237 Moderna, Spikevax©). PATIENTS AND METHODS Eight patients between 13 and 56 years of age, vaccinated with either BNT162b2 or mRNA-1273 mRNA vaccine between January and August 2021 developed cardiac side effects shortly after either their first or second dose of the vaccine. Clinical data were retrieved from the clinical information system and analyzed. To support diagnosis of myocarditis or pericarditis, cardiac magnetic resonance imaging (MRI) was performed shortly after the onset of symptoms, with further investigations in severe cases. Symptoms were defined as dyspnea, chest pain and cardiac arrhythmia as determined by electrocardiography. RESULTS Eight patients (5 males and 3 females) developed cardiac symptoms compatible with myocarditis, according to the CDC criteria, shortly after SARS-CoV-2 mRNA vaccination. Three patients (2 males, 1 female) required hospitalization due to severe chest pain and elevated troponin levels. All patients recovered fully within 7 days from the symptom onset. CONCLUSIONS Our data suggest that cardiac adverse events such as myocarditis or pericarditis shortly after SARS-CoV-2 mRNA vaccination are rare but possible and occur particularly in male patients.
Collapse
Affiliation(s)
- Noemi F Freise
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Milena Kivel
- Department of Pediatric, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Olaf Grebe
- Department of Cardiology and Rhythmology, Petrus Hospital, Wuppertal, Germany
| | - Christian Meyer
- Department for Cardiology, Rhythmology, Angiology and Intensive Care Medicine, cNEP Research Consortium, EVK Düsseldorf, Düsseldorf, Germany
| | - Bahram Wafaisade
- Department for Cardiology, Rhythmology, Angiology and Intensive Care Medicine, cNEP Research Consortium, EVK Düsseldorf, Düsseldorf, Germany
| | - Matthias Peiper
- Department for Cardiology, Rhythmology, Angiology and Intensive Care Medicine, cNEP Research Consortium, EVK Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Medical Faculty, Department of Cardiology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Jan Schmidt
- Medical Faculty, Department of Cardiology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Judith Neuwahl
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Danny Jazmati
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Björn Erik Ole Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Johannes Bode
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Verena Keitel
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Medical Faculty of Otto Von Guericke University Magdeburg, Leipziger Str. 44, 39104, Magdeburg, Germany
| | - Jan Haussmann
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Balint Tamaskovics
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Johannes C Fischer
- Institute for Transplant Diagnostics and Cell Therapeutics, Heinrich Heine University, Düsseldorf, Germany
| | - Wolfram Trudo Knoefel
- Medical Faculty, Department of Surgery and Interdisciplinary Surgical Intensive Care Unit, Heinrich Heine University, Düsseldorf, Germany
| | - Marion Schneider
- Division of Experimental Anesthesiology, University Hospital Ulm, Ulm, Germany
| | - Peter Arne Gerber
- Medical Faculty, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - Alessia Pedoto
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Martijn van Griensven
- Department cBITE, Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht, The Netherlands
| | - Amir Rezazadeh
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Yechan Flaig
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Julian Kirchner
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Gerald Antoch
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Hospital of Düsseldorf, Dusseldorf, Germany
| | - Hubert Schelzig
- Medical Faculty, Department of Vascular Surgery, University Hospital Heinrich Heine University, Düsseldorf, Germany
| | - Christiane Matuschek
- Department of Radiation Oncology, University Hospital, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
| |
Collapse
|
18
|
Cerqueira-Silva T, Andrews JR, Boaventura VS, Ranzani OT, de Araújo Oliveira V, Paixão ES, Júnior JB, Machado TM, Hitchings MDT, Dorion M, Lind ML, Penna GO, Cummings DAT, Dean NE, Werneck GL, Pearce N, Barreto ML, Ko AI, Croda J, Barral-Netto M. Effectiveness of CoronaVac, ChAdOx1 nCoV-19, BNT162b2, and Ad26.COV2.S among individuals with previous SARS-CoV-2 infection in Brazil: a test-negative, case-control study. THE LANCET. INFECTIOUS DISEASES 2022; 22:791-801. [PMID: 35366959 PMCID: PMC8971277 DOI: 10.1016/s1473-3099(22)00140-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND COVID-19 vaccines have proven highly effective among individuals without a previous SARS-CoV-2 infection, but their effectiveness in preventing symptomatic infection and severe outcomes among individuals with previous infection is less clear. We aimed to estimate the effectiveness of four COVID-19 vaccines against symptomatic infection, hospitalisation, and death for individuals with laboratory-confirmed previous SARS-CoV-2 infection. METHODS Using national COVID-19 notification, hospitalisation, and vaccination datasets from Brazil, we did a test-negative, case-control study to assess the effectiveness of four vaccines (CoronaVac [Sinovac], ChAdOx1 nCoV-19 [AstraZeneca], Ad26.COV2.S [Janssen], and BNT162b2 [Pfizer-BioNtech]) for individuals with laboratory-confirmed previous SARS-CoV-2 infection. We matched cases with RT-PCR positive, symptomatic COVID-19 with up to ten controls with negative RT-PCR tests who presented with symptomatic illnesses, restricting both groups to tests done at least 90 days after an initial infection. We used multivariable conditional logistic regression to compare the odds of test positivity and the odds of hospitalisation or death due to COVID-19, according to vaccination status and time since first or second dose of vaccines. FINDINGS Between Feb 24, 2020, and Nov 11, 2021, we identified 213 457 individuals who had a subsequent, symptomatic illness with RT-PCR testing done at least 90 days after their initial SARS-CoV-2 infection and after the vaccination programme started. Among these, 30 910 (14·5%) had a positive RT-PCR test consistent with reinfection, and we matched 22 566 of these cases with 145 055 negative RT-PCR tests from 68 426 individuals as controls. Among individuals with previous SARS-CoV-2 infection, vaccine effectiveness against symptomatic infection 14 or more days from vaccine series completion was 39·4% (95% CI 36·1-42·6) for CoronaVac, 56·0% (51·4-60·2) for ChAdOx1 nCoV-19, 44·0% (31·5-54·2) for Ad26.COV2.S, and 64·8% (54·9-72·4) for BNT162b2. For the two-dose vaccine series (CoronaVac, ChAdOx1 nCoV-19, and BNT162b2), effectiveness against symptomatic infection was significantly greater after the second dose than after the first dose. Effectiveness against hospitalisation or death 14 or more days from vaccine series completion was 81·3% (75·3-85·8) for CoronaVac, 89·9% (83·5-93·8) for ChAdOx1 nCoV-19, 57·7% (-2·6 to 82·5) for Ad26.COV2.S, and 89·7% (54·3-97·7) for BNT162b2. INTERPRETATION All four vaccines conferred additional protection against symptomatic infections and severe outcomes among individuals with previous SARS-CoV-2 infection. The provision of a full vaccine series to individuals after recovery from COVID-19 might reduce morbidity and mortality. FUNDING Brazilian National Research Council, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, Oswaldo Cruz Foundation, JBS, Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Generalitat de Catalunya.
Collapse
Affiliation(s)
- Thiago Cerqueira-Silva
- Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Viviane S Boaventura
- Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Otavio T Ranzani
- Barcelona Institute for Global Health, Barcelona, Spain; Pulmonary Division, Heart Institute, Hospital das Clínicas, Faculdade de Medicina, São Paulo, SP, Brazil
| | - Vinicius de Araújo Oliveira
- Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil; Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, BA, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Enny S Paixão
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Juracy Bertoldo Júnior
- Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, BA, Brazil; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Tales Mota Machado
- Diretoria de Tecnologia da Informação, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil
| | - Matt D T Hitchings
- Department of Biostatistics, College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| | - Murilo Dorion
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Margaret L Lind
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Gerson O Penna
- Núcleo de Medicina Tropical, Universidade de Brasília, Brasília, DF, Brazil; Escola Fiocruz de Governo, Fiocruz Brasília, Brasília, DF, Brazil
| | - Derek A T Cummings
- Department of Biology, University of Florida, Gainesville, FL, USA; Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Natalie E Dean
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, BA, Brazil; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Albert I Ko
- Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Julio Croda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA; Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil; Fiocruz Mato Grosso do Sul, Fiocruz, Campo Grande, MS, Brazil.
| | - Manoel Barral-Netto
- Instituto Gonçalo Moniz, Fiocruz, Salvador, BA, Brazil; Center for Data and Knowledge Integration for Health, Fiocruz, Salvador, BA, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil
| |
Collapse
|
19
|
Young M, Crook H, Scott J, Edison P. Covid-19: virology, variants, and vaccines. BMJ MEDICINE 2022; 1:e000040. [PMID: 36936563 PMCID: PMC9951271 DOI: 10.1136/bmjmed-2021-000040] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/01/2022] [Indexed: 12/12/2022]
Abstract
As of 25 January 2022, over 349 million individuals have received a confirmed diagnosis of covid-19, with over 5.59 million confirmed deaths associated with the SARS-CoV-2 virus. The covid-19 pandemic has prompted an extensive global effort to study the molecular evolution of the virus and develop vaccines to prevent its spread. Although rigorous determination of SARS-CoV-2 infectivity remains elusive, owing to the continuous evolution of the virus, steps have been made to understand its genome, structure, and emerging genetic mutations. The SARS-CoV-2 genome is composed of several open reading frames and structural proteins, including the spike protein, which is essential for entry into host cells. As of 25 January 2022, the World Health Organization has reported five variants of concern, two variants of interest, and three variants under monitoring. Additional sublineages have since been identified, and are being monitored. The mutations harboured in these variants confer an increased transmissibility, severity of disease, and escape from neutralising antibodies compared with the primary strain. The current vaccine strategy, including booster doses, provides protection from severe disease. As of 24 January 2022, 33 vaccines have been approved for use in 197 countries. In this review, we discuss the genetics, structure, and transmission methods of SARS-CoV-2 and its variants, highlighting how mutations provide enhanced abilities to spread and inflict disease. This review also outlines the vaccines currently in use around the world, providing evidence for every vaccine's immunogenicity and effectiveness.
Collapse
Affiliation(s)
- Megan Young
- Faculty of Medicine, Imperial College London, London, UK
| | - Harry Crook
- Faculty of Medicine, Imperial College London, London, UK
| | - Janet Scott
- Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Paul Edison
- Faculty of Medicine, Imperial College London, London, UK
- School of Medicine, Cardiff University, Cardiff, South Glamorgan, Wales, UK
| |
Collapse
|
20
|
Evaluation of BNT162b2 Vaccine Effectiveness in Galicia, Northwest Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074039. [PMID: 35409724 PMCID: PMC8998680 DOI: 10.3390/ijerph19074039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022]
Abstract
Investigating vaccine effectiveness (VE) in real-world conditions is crucial, especially its variation across different settings and populations. We undertook a test-negative control study in Galicia (Northwest Spain) to assess BNT162b2 effectiveness against acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as well as COVID-19 associated hospitalization, intensive care unit (ICU) admission and mortality. A total of 44,401 positive and 817,025 negative SARS-CoV-2 test results belonging to adults were included. Adjusted odds ratios of vaccination and their 95% confidence interval (CI) were estimated using multivariate logistic-regression models. BNT162b2 showed high effectiveness in reducing SARS-CoV-2 infections in all age categories, reaching maximum VE ≥ 14 days after administering the second dose [18-64 years: VE = 92.9% (95%CI: 90.2-95.1); 65-79 years: VE = 85.8% (95%CI: 77.3-91.9), and ≥80 years: VE = 91.4% (95%CI: 87.9-94.1)]. BNT162b2 also demonstrated effectiveness in preventing COVID-19 hospitalization for all age categories, with VE more pronounced for those aged ≥80 years [VE = 60.0% (95%CI: 49.4-68.3)]. Moreover, there was a considerable reduction in ICU admission [VE = 88.0% (95%CI: 74.6-95.8)] and mortality [VE = 38.0% (95%CI: 15.9-55.4)] in the overall population. BNT162b2 showed substantial protection against SARS-CoV-2 infections and COVID-19 severity. Our findings would prove useful for systematic reviews and meta-analysis on COVID-19 VE.
Collapse
|
21
|
Nagao M, Matsumura Y, Yamamoto M, Shinohara K, Yukawa S, Noguchi T, Tsuchido Y, Ikeda T. Analysis of a city-wide COVID-19 prevention strategy for aged-care facilities during third and fifth waves of COVID-19 in Kyoto City, Kyoto, Japan. Influenza Other Respir Viruses 2022; 16:690-695. [PMID: 35262286 PMCID: PMC9111714 DOI: 10.1111/irv.12981] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND During the third wave of the COVID-19 pandemic at the end of 2020, clusters occurred frequently in aged-care facilities (ACFs), which put pressure on the medical field in Japan. Based on this experience, Kyoto University and Kyoto City collaborated to promote a citywide COVID-19 prevention strategy to prevent the spread of COVID-19 within ACFs. The aim of this study was to clarify the effect of the prevention strategy among ACFs in Kyoto City during the third and fifth waves of the pandemic. METHODS During the study period, the following measures were adopted as the prevention strategy in all ACFs: (1) active polymerase chain reaction (PCR) mass testing and facility-wide testing when a single case was identified, (2) implementation of strategies to prevent transmission within a facility, and (3) vaccination program for ACFs. RESULTS Of the 1,144 facilities subjected to the mass testing, 71.0% participated in the whole program including active PCR testing. The remainder participated in the rest of the programs. The prevalence of ACF-related COVID-19 cases among total COVID-19 cases in Kyoto City decreased from 7.9% in the third wave to 4.1% in the fourth wave and 2.1% in the fifth wave. The incidence of clusters and proportion of severe elderly cases also decreased during the study period. CONCLUSIONS A city-wide multidisciplinary effort including PCR mass testing and a vaccination program in cooperation with a university and local administrative office successfully reduced the clusters and transmission in ACFs in Kyoto City, Japan.
Collapse
Affiliation(s)
- Miki Nagao
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Clinical Laboratory, Department of Infection Prevention, Kyoto University Hospital, Kyoto, Japan
| | - Yasufumi Matsumura
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Clinical Laboratory, Department of Infection Prevention, Kyoto University Hospital, Kyoto, Japan
| | - Masaki Yamamoto
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Clinical Laboratory, Department of Infection Prevention, Kyoto University Hospital, Kyoto, Japan
| | - Koh Shinohara
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Clinical Laboratory, Department of Infection Prevention, Kyoto University Hospital, Kyoto, Japan
| | - Satomi Yukawa
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Clinical Laboratory, Department of Infection Prevention, Kyoto University Hospital, Kyoto, Japan
| | - Taro Noguchi
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Clinical Laboratory, Department of Infection Prevention, Kyoto University Hospital, Kyoto, Japan
| | - Yasuhiro Tsuchido
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Clinical Laboratory, Department of Infection Prevention, Kyoto University Hospital, Kyoto, Japan
| | - Takeshi Ikeda
- Public Health and Welfare Bureau of Kyoto City, Kyoto, Japan
| |
Collapse
|
22
|
Salo J, Hägg M, Kortelainen M, Leino T, Saxell T, Siikanen M, Sääksvuori L. The indirect effect of mRNA-based COVID-19 vaccination on healthcare workers' unvaccinated household members. Nat Commun 2022; 13:1162. [PMID: 35246536 PMCID: PMC8897446 DOI: 10.1038/s41467-022-28825-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 02/14/2022] [Indexed: 11/09/2022] Open
Abstract
Mass vaccination is effective in reducing SARS-CoV-2 infections among vaccinated individuals. However, it remains unclear how effectively COVID-19 vaccines prevent people from spreading the virus to their close contacts. Using nationwide administrative datasets on SARS-CoV-2 infections, vaccination records, demographics, and unique household IDs, we conducted an observational cohort study to estimate the direct and indirect effectiveness of mRNA-based COVID-19 vaccines in reducing infections among vaccinated healthcare workers and their unvaccinated household members. Our estimates for adults imply indirect effectiveness of 39.1% (95% CI: −7.1% to 65.3%) two weeks and 39.0% (95% CI: 18.9% to 54.0%) eight weeks after the second dose. We find that the indirect effect of mRNA-based COVID-19 vaccines within households is smaller for unvaccinated children than for adults and statistically insignificant. Here, we show that mRNA-based COVID-19 vaccines are associated with a reduction in SARS-CoV-2 infections not only among vaccinated individuals but also among unvaccinated adult household members in a real-world setting. COVID-19 vaccines are effective in preventing disease, but the extent of protection against transmission is unclear. Here, the authors use data from a cohort of healthcare workers in Finland and show that vaccination is associated with reduced infection in their unvaccinated adult household contacts.
Collapse
Affiliation(s)
- Jussipekka Salo
- Department of Economics, University of Helsinki, Arkadiankatu 7, P.O. Box 17, 00014, Helsinki, Finland.,VATT Institute for Economic Research, Arkadiankatu 7, P.O. Box 1279, 00101, Helsinki, Finland.,Department of Economics, Aalto University School of Business, Aalto University, P.O. Box 21210, 00076, Espoo, Finland.,Helsinki GSE, Economicum, Arkadiankatu 7, 00100, Helsinki, Finland
| | - Milla Hägg
- Department of Economics, University of Helsinki, Arkadiankatu 7, P.O. Box 17, 00014, Helsinki, Finland.,VATT Institute for Economic Research, Arkadiankatu 7, P.O. Box 1279, 00101, Helsinki, Finland.,Department of Economics, Aalto University School of Business, Aalto University, P.O. Box 21210, 00076, Espoo, Finland.,Helsinki GSE, Economicum, Arkadiankatu 7, 00100, Helsinki, Finland
| | - Mika Kortelainen
- VATT Institute for Economic Research, Arkadiankatu 7, P.O. Box 1279, 00101, Helsinki, Finland.,Helsinki GSE, Economicum, Arkadiankatu 7, 00100, Helsinki, Finland.,Department of Economics, Turku School of Economics, Rehtorinpellonkatu 3, 20500, Turku, Finland.,InFLAMES Research Flagship Center, University of Turku, Turku, Finland
| | - Tuija Leino
- Infectious Disease Control and Vaccinations Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Tanja Saxell
- VATT Institute for Economic Research, Arkadiankatu 7, P.O. Box 1279, 00101, Helsinki, Finland.,Helsinki GSE, Economicum, Arkadiankatu 7, 00100, Helsinki, Finland
| | - Markku Siikanen
- VATT Institute for Economic Research, Arkadiankatu 7, P.O. Box 1279, 00101, Helsinki, Finland.,Helsinki GSE, Economicum, Arkadiankatu 7, 00100, Helsinki, Finland
| | - Lauri Sääksvuori
- Health Science Unit, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland. .,INVEST Research Flagship Center, University of Turku, Assistentinkatu 7, 20014, Turku, Finland. .,Finnish Institute for Health and Welfare, Centre for Health and Social Economic, P.O. Box 30, 00271, Helsinki, Finland.
| |
Collapse
|
23
|
Petrović V, Vuković V, Marković M, Ristić M. Early Effectiveness of Four SARS-CoV-2 Vaccines in Preventing COVID-19 among Adults Aged ≥60 Years in Vojvodina, Serbia. Vaccines (Basel) 2022; 10:vaccines10030389. [PMID: 35335021 PMCID: PMC8954033 DOI: 10.3390/vaccines10030389] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
Real-world evidence of the vaccine effectiveness (VE) of different COVID-19 vaccines is needed in order to better shape vaccine recommendations and policies and increase vaccine acceptance, especially among vulnerable populations such as the elderly. We analyzed the early effectiveness of four COVID-19 vaccines, namely BNT162b2, BBIBP-CorV, Gam-COVID-Vac and ChAdOx1 nCoV-19 in population aged ≥60 years for symptomatic, mild and severe COVID-19, in the period January–April 2021 in Vojvodina, a northern province of Serbia. Incidence rates of SARS-CoV-2 infection were calculated using data from the provincial COVID-19 surveillance registry, and vaccination coverage data were obtained from the nationwide registry of administered COVID-19 vaccines. During the observation period, 134,535 subjects aged ≥60 years were fully vaccinated, of whom 87.7% received BBIBP-CorV, 7.1% BNT162b2 and 5.2% Gam-COVID-Vac vaccines. The estimated VE in fully vaccinated persons was 86.9% (95% CI, 86–87.7) for BBIBP-CorV, 95% (95% CI, 92.4–96.7) for Gam-COVID-Vac and 99% (95% CI, 97.8–99.5) for BNT162b2, while VE after the first dose of ChAdOx1 nCoV-19 was 88.6% (95% CI, 80.5–93.4). Estimates were similar when stratifying the analyses to severe and mild SARS-CoV-2 infections. Our analysis provides evidence of high early effectiveness of BNT162b2, BBIBP-CorV, Gam-COVID-Vac and ChAdOx1 nCoV-19 in elderly people in preventing symptomatic, severe and mild COVID-19 disease, particularly after being fully vaccinated.
Collapse
Affiliation(s)
- Vladimir Petrović
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (V.P.); (M.R.)
- Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia
| | - Vladimir Vuković
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (V.P.); (M.R.)
- Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia
- Correspondence: ; Tel.: +381-21-4897-800
| | - Miloš Marković
- Department of Immunology, Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia;
| | - Mioljub Ristić
- Department of Epidemiology, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia; (V.P.); (M.R.)
- Institute of Public Health of Vojvodina, 21000 Novi Sad, Serbia
| |
Collapse
|
24
|
Effectiveness of Vaccination against SARS-CoV-2 Infection in the Pre-Delta Era: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 10:vaccines10020157. [PMID: 35214615 PMCID: PMC8879968 DOI: 10.3390/vaccines10020157] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 12/15/2022] Open
Abstract
(1) Background: The objective of this study was to assess the effectiveness of SARS-CoV-2 vaccines in terms of prevention of disease and transmission in the pre-Delta era. The evaluation was narrowed to two mRNA vaccines and two modified adenovirus-vectored vaccines. (2) Methods: The overall risk of any SARS-CoV-2 infection confirmed by positive real-time Polymerase Chain Reaction (PCR) test was estimated in partially and fully vaccinated individuals. The evidence synthesis was pursued through a random-effects meta-analysis. The effect size was expressed as relative risk (RR) and RRR (RR reduction) of SARS-CoV-2 infection following vaccination. Heterogeneity was investigated through a between-study heterogeneity analysis and a subgroup meta-analysis. (3) Results: The systematic review identified 27 studies eligible for the quantitative synthesis. Partially vaccinated individuals presented a RRR = 73% (95%CI = 59–83%) for positive SARS-CoV-2 PCR (RR = 0.27) and a RRR=79% (95%CI = 30–93%) for symptomatic SARS-CoV-2 PCR (RR = 0.21). Fully vaccinated individuals showed a RRR = 94% (95%CI = 88–98%) for SARS-CoV-2 positive PCR (RR = 0.06) compared to unvaccinated individuals. The full BNT162b2 vaccination protocol achieved a RRR = 84–94% against any SARS-CoV-2-positive PCR and a RRR = 68–84% against symptomatic positive PCR. (4) Conclusions: The meta-analysis results suggest that full vaccination might block transmission. In particular, the risk of SARS-CoV-2 infection appeared higher for non-B.1.1.7 variants and individuals aged ≥69 years. Considering the high level of heterogeneity, these findings must be taken with caution. Further research on SARS-CoV-2 vaccine effectiveness against emerging SARS-CoV-2 variants is encouraged.
Collapse
|
25
|
Fernández-Ferreiro A, Formigo-Couceiro FJ, Veiga-Gutierrez R, Maldonado-Lobón JA, Hermida-Cao AM, Rodriguez C, Bañuelos O, Olivares M, Blanco-Rojo R. Effects of Loigolactobacillus coryniformis K8 CECT 5711 on the Immune Response of Elderly Subjects to COVID-19 Vaccination: A Randomized Controlled Trial. Nutrients 2022; 14:228. [PMID: 35011103 PMCID: PMC8747230 DOI: 10.3390/nu14010228] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/29/2021] [Accepted: 01/02/2022] [Indexed: 02/04/2023] Open
Abstract
Elderly people are particularly vulnerable to COVID-19, with a high risk of developing severe disease and a reduced immune response to the COVID-19 vaccine. A randomized, placebo-controlled, double-blind trial to assess the effect of the consumption of the probiotic Loigolactobacillus coryniformis K8 CECT 5711 on the immune response generated by the COVID-19 vaccine in an elderly population was performed. Two hundred nursing home residents >60 yrs that had not COVID-19 were randomized to receive L. coryniformis K8 or a placebo daily for 3 months. All volunteers received a complete vaccination schedule of a mRNA vaccine, starting the intervention ten days after the first dose. Specific IgG and IgA antibody levels were analyzed 56 days after the end of the immunization process. No differences between the groups were observed in the antibody levels. During the intervention, 19 subjects had COVID-19 (11 receiving K8 vs. 8 receiving placebo, p = 0.457). Subgroup analysis in these patients showed that levels of IgG were significantly higher in those receiving K8 compared to placebo (p = 0.038). Among subjects >85 yrs that did not get COVID-19, administration of K8 tended to increase the IgA levels (p = 0.082). The administration of K8 may enhance the specific immune response against COVID-19 and may improve the COVID-19 vaccine-specific responses in elderly populations.
Collapse
Affiliation(s)
- Anxo Fernández-Ferreiro
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain; (A.F.-F.); (R.V.-G.); (A.M.H.-C.)
- Pharmacology Group, Health Research Institute Santiago Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | | | - Roi Veiga-Gutierrez
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain; (A.F.-F.); (R.V.-G.); (A.M.H.-C.)
- Pharmacology Group, Health Research Institute Santiago Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Jose A. Maldonado-Lobón
- Research and Development Department, Biosearch Life, a Kerry Company, 18004 Granada, Spain; (J.A.M.-L.); (C.R.); (O.B.); (M.O.)
| | - Ana M. Hermida-Cao
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain; (A.F.-F.); (R.V.-G.); (A.M.H.-C.)
- Pharmacology Group, Health Research Institute Santiago Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Carlos Rodriguez
- Research and Development Department, Biosearch Life, a Kerry Company, 18004 Granada, Spain; (J.A.M.-L.); (C.R.); (O.B.); (M.O.)
| | - Oscar Bañuelos
- Research and Development Department, Biosearch Life, a Kerry Company, 18004 Granada, Spain; (J.A.M.-L.); (C.R.); (O.B.); (M.O.)
| | - Mónica Olivares
- Research and Development Department, Biosearch Life, a Kerry Company, 18004 Granada, Spain; (J.A.M.-L.); (C.R.); (O.B.); (M.O.)
| | - Ruth Blanco-Rojo
- Research and Development Department, Biosearch Life, a Kerry Company, 18004 Granada, Spain; (J.A.M.-L.); (C.R.); (O.B.); (M.O.)
| |
Collapse
|
26
|
Nanduri S, Pilishvili T, Derado G, Soe MM, Dollard P, Wu H, Li Q, Bagchi S, Dubendris H, Link-Gelles R, Jernigan JA, Budnitz D, Bell J, Benin A, Shang N, Edwards JR, Verani JR, Schrag SJ. Effectiveness of Pfizer-BioNTech and Moderna Vaccines in Preventing SARS-CoV-2 Infection Among Nursing Home Residents Before and During Widespread Circulation of the SARS-CoV-2 B.1.617.2 (Delta) Variant - National Healthcare Safety Network, March 1-August 1, 2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1163-1166. [PMID: 34437519 PMCID: PMC8389386 DOI: 10.15585/mmwr.mm7034e3] [Citation(s) in RCA: 212] [Impact Index Per Article: 70.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nursing home and long-term care facility residents live in congregate settings and are often elderly and frail, putting them at high risk for infection with SARS-CoV-2, the virus that causes COVID-19, and severe COVID-19-associated outcomes; therefore, this population was prioritized for early vaccination in the United States (1). Following rapid distribution and administration of the mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna) under an Emergency Use Authorization by the Food and Drug Administration (2), observational studies among nursing home residents demonstrated vaccine effectiveness (VE) ranging from 53% to 92% against SARS-CoV-2 infection (3-6). However, concerns about the potential for waning vaccine-induced immunity and the recent emergence of the highly transmissible SARS-CoV-2 B.1.617.2 (Delta) variant† highlight the need to continue to monitor VE (7). Weekly data reported by the Centers for Medicaid & Medicare (CMS)-certified skilled nursing facilities or nursing homes to CDC's National Healthcare Safety Network (NHSN)§ were analyzed to evaluate effectiveness of full vaccination (2 doses received ≥14 days earlier) with any of the two currently authorized mRNA COVID-19 vaccines during the period soon after vaccine introduction and before the Delta variant was circulating (pre-Delta [March 1-May 9, 2021]), and when the Delta variant predominated¶ (Delta [June 21-August 1, 2021]). Using 17,407 weekly reports from 3,862 facilities from the pre-Delta period, adjusted effectiveness against infection for any mRNA vaccine was 74.7% (95% confidence interval [CI] = 70.0%-78.8%). Analysis using 33,160 weekly reports from 11,581 facilities during an intermediate period (May 10-June 20) found that the adjusted effectiveness was 67.5% (95% CI = 60.1%-73.5%). Analysis using 85,593 weekly reports from 14,917 facilities during the Delta period found that the adjusted effectiveness was 53.1% (95% CI = 49.1%-56.7%). Effectiveness estimates were similar for Pfizer-BioNTech and Moderna vaccines. These findings indicate that mRNA vaccines provide protection against SARS-CoV-2 infection among nursing home residents; however, VE was lower after the Delta variant became the predominant circulating strain in the United States. This analysis assessed VE against any infection, without being able to distinguish between asymptomatic and symptomatic presentations. Additional evaluations are needed to understand protection against severe disease in nursing home residents over time. Because nursing home residents might remain at some risk for SARS-CoV-2 infection despite vaccination, multiple COVID-19 prevention strategies, including infection control, testing, and vaccination of nursing home staff members, residents, and visitors, are critical. An additional dose of COVID-19 vaccine might be considered for nursing home and long-term care facility residents to optimize a protective immune response.
Collapse
|