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Karmacharya A, Rai K, Siwakoti S, Khanal B, Bhattarai NR. COVID-19 breakthrough infections in vaccinated individuals at BPKIHS, Nepal. BMC Infect Dis 2024; 24:1003. [PMID: 39300352 DOI: 10.1186/s12879-024-09902-z] [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: 12/24/2023] [Accepted: 09/09/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Although there have been reports of COVID-19 breakthrough infections in vaccinated individuals, the vaccines have demonstrated a high efficacy in preventing severe illness and death. Nepal has reported fewer studies of COVID-19 breakthrough infections. Hence, this study has objective to assess the prevalence, and to describe clinical characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) breakthrough infection. METHODS This descriptive study was conducted from January to December 2022. The study enrolled 200 individuals who had received the recommended doses of the COVID-19 vaccine and they were RT-PCR positive diagnosed with vaccine breakthrough infections after 14 days of completing the vaccination course. The patient's demographic and clinical profiles, as well as their outcomes in terms of severity, length of hospital stay, and mortality were recorded. RESULTS The prevalence of SARS-CoV2 infection was 6.3% (547/8682). Among fully vaccinated personnel, the prevalence of breakthrough infections was 6.2% (200/3175). This study found the Omicron variants in respondents. The mean age of the patients was 38.28 years, and 41.5% (83/200) of the breakthrough cases were healthcare workers. The mean time gap between the second dose of vaccination and a positive RT-PCR test was 354.68 days. Of the 200 breakthrough cases, 89% (178) had mild symptoms, 9% (17) had moderate symptoms requiring hospitalization, and 2% (4) were severe cases that required intensive care facility. Among the severe cases, 3 out 4 were above 60 years old. Furthermore, the patients greater than 60 years had longer hospital stays (p < 0.0001) however no deaths were recorded. CONCLUSION Fully vaccinated individuals can experience COVID-19 breakthrough infections and the majority of cases present with mild symptoms. Elderly patients have a higher likelihood of severe disease and longer hospital stay compared to younger patients. The results of this study emphasize the importance of vaccination in mitigating the severity of the disease.
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Affiliation(s)
- Abhishek Karmacharya
- Department of Microbiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
| | - Keshav Rai
- Department of Microbiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Shraddha Siwakoti
- Department of Microbiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Basudha Khanal
- Department of Microbiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Narayan Raj Bhattarai
- Department of Microbiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
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Moreno Echevarria F, Caputo M, Camp D, Reddy S, Achenbach CJ. Incidence and risk factors of SARS-CoV-2 breakthrough infection in the early Omicron variant era among vaccinated and boosted individuals in Chicago. PLoS One 2024; 19:e0302338. [PMID: 39102410 PMCID: PMC11299831 DOI: 10.1371/journal.pone.0302338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/22/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND SARS-CoV-2 vaccines are safe and effective against infection and severe COVID-19 disease worldwide. Certain co-morbid conditions cause immune dysfunction and may reduce immune response to vaccination. In contrast, those with co-morbidities may practice infection prevention strategies. Thus, the real-world clinical impact of co-morbidities on SARS-CoV-2 infection in the recent post-vaccination period is not well established. This study was performed to understand the epidemiology of Omicron breakthrough infection and evaluate associations with number of comorbidities in a vaccinated and boosted population. METHODS AND FINDINGS A retrospective clinical cohort study was performed utilizing the Northwestern Medicine Enterprise Data Warehouse. Our study population was identified as fully vaccinated adults with at least one booster. The primary risk factor of interest was the number of co-morbidities. The primary outcome was the incidence and time to the first positive SARS-CoV-2 molecular test in the Omicron predominant era. Multivariable Cox modeling analyses to determine the hazard of SARS-CoV-2 infection were stratified by calendar time (Period 1: January 1 -June 30, 2022; Period 2: July 1 -December 31, 2022) due to violations in the proportional hazards assumption. In total, 133,191 patients were analyzed. During Period 1, having 3+ comorbidities was associated with increased hazard for breakthrough (HR = 1.16 CI 1.08-1.26). During Period 2 of the study, having 2 comorbidities (HR = 1.45 95% CI 1.26-1.67) and having 3+ comorbidities (HR 1.73, 95% CI 1.51-1.97) were associated with increased hazard for Omicron breakthrough. Older age was associated with decreased hazard in Period 1 of follow-up. Interaction terms for calendar time indicated significant changes in hazard for many factors between the first and second halves of the follow-up period. CONCLUSIONS Omicron breakthrough is common with significantly higher risk for our most vulnerable patients with multiple co-morbidities. Age plays an important role in breakthrough infection with the highest incidence among young adults, which may be due to age-related behavioral factors. These findings reflect real-world differences in immunity and exposure risk behaviors for populations vulnerable to COVID-19.
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Affiliation(s)
- Fabiola Moreno Echevarria
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Mathew Caputo
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Daniel Camp
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Susheel Reddy
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Chad J. Achenbach
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, United States of America
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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Abukhalil AD, Abushehadeh RR, Shatat SS, Al-Shami N, Naseef HA, Ladadweh H, Madia R. COVID-19 Vaccines Breakthrough Infections and Adverse Effects Reported by the Birzeit University Community in Palestine. Int J Gen Med 2024; 17:3349-3360. [PMID: 39100722 PMCID: PMC11297544 DOI: 10.2147/ijgm.s466838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/20/2024] [Indexed: 08/06/2024] Open
Abstract
Background Coronavirus disease (COVID-19) vaccines play an essential role in boosting immunity, preventing severe diseases, and alleviating the Covid-19 health crisis. Objective This study aimed to explore the type and severity of short-term adverse reactions associated with BNT162 (Pfizer-BioNTech), mRNA 1273 (Moderna), and viral vector vaccines and to compare the incidence of post-vaccination Covid-19 infection among the Birzeit University community in Palestine. Methods This questionnaire-based retrospective cross-sectional study was conducted among individuals who were vaccinated with at least one dose of any COVID-19 vaccine offered in Palestine during the COVID-19 pandemic. The study included participants aged 18 years and older who were vaccinated with Pfizer, Moderna, Sputnik Light, or Sputnik v. Results A total of 558 participants who were administered COVID-19 vaccine were included in the study. Sputnik (239), Pfizer vaccine recipients (236), and Moderna vaccine recipients (83). Of the viral vector vaccine recipients, 57 (23.8%) had a post-vaccination infection, compared to 30 (12.7%) for Pfizer and seven (8.4%) for Moderna. Furthermore, the reported adverse effects in the viral victor group were higher than those in the Moderna and Pfizer groups (71.7, 66.3, and 61.9%, respectively). Chills, headache, fatigue, abdominal pain, and joint pain were significantly higher in the Viral Vector vaccine group than the Moderna and Pfizer vaccine. Vomiting, tiredness, and fatigue were significantly less likely to be complained of by Pfizer vaccine recipients compared to Moderna and Viral Vector vaccine recipients (p < 0.05). Conclusions Breakthrough infections were associated with both viral vectors and mRNA; however, the mRNA vaccine had less reported post-vaccine infection. Furthermore, the Pfizer/BioNTech COVID-19 vaccine group reported fewer commonly reported side effects (fever, chills, headache, fatigue, muscle pain, joint pain, nausea, and dizziness), followed by the Moderna and viral vector vaccines. Females and underweight participants experienced more adverse effects with both vaccines, and fewer common side effects were reported by all participants.
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Affiliation(s)
- Abdallah Damin Abukhalil
- Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Raya Riyad Abushehadeh
- Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Sireen Sultan Shatat
- Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Ni’meh Al-Shami
- Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Hani A Naseef
- Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Hosniyeh Ladadweh
- Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
| | - Raed Madia
- Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine
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ELZahrany Y, Alamry A, AlGeer A, AlKhalifah H, AlGhamdi A, AlYateem I, Alateah S, Asghar N, AlBarrak A. COVID-19 vaccine breakthrough infection among health care workers at MODHS hospitals in Saudi Arabia: A multicenter study. J Infect Public Health 2024; 17:1117-1124. [PMID: 38723321 DOI: 10.1016/j.jiph.2024.04.021] [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: 10/21/2023] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND We investigated the clinical manifestation and severity of COVID-19 infection represented as a composite outcome (hospital or ICU admission, or in-hospital death) among infected fully vaccinated HCWs, the RT-PCR test Ct value (Cycle Threshold) of positive fully vaccinated HCWs, and we measure the interval from the second vaccine to acquiring the infection. METHODS A multicenter retrospective cohort study was conducted in different regions at (16) Ministry of Defense Health Services (MODHS) hospitals. Data were restricted to fully vaccinated (minimum of 2 doses) HCWs who had a confirmed positive PCR test and employed in MODHS hospitals from August 2021 to March 2022. RESULTS A total of 45862 HCWs were vaccinated as of Aug 2021. Of these 1253 participants met the selection criteria and were included in the study. The average age of infected HCWs was 35.27 years (SD = ± 8.10) of which 57% were females. The HCWs were employed as doctors (24%), nurses (33%), and other (43%). The most administered vaccine type was mRNA (44%) followed by Adenovirus Viral Vector (39%) and mixed vaccine (17%). The incidence of COVID-19 vaccine breakthrough (BT) infection among HCWs was observed at 2.73% (m-RNA 3.19%, Viral Vector 2.83% and mixed 1.87%). CONCLUSION the overall COVID-19 (BT) infection incidence proportion was (2.73%), with the Mixed vaccine group showing the lowest (BT) incidence proportion (1.87%). The most commonly reported symptoms among (BT) infections were cough (51%), sore throat (51%), fever (47%), headache (31%), and runny nose (23%), with overall (6%) asymptomatic (BT) infections. We had (1%) hospital admissions, Zero ICU admission, and Zero deaths. our finding may indicate that infection affecting fully vaccinated patients were less severe and mostly affected the upper respiratory tract.
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Affiliation(s)
- Yazeed ELZahrany
- Center of Infection Prevention & Control (CIPC), Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia; Department of Family and Community medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Ahmed Alamry
- Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman AlGeer
- Center of Infection Prevention & Control (CIPC), Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia; Department of Family and Community medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Hamzah AlKhalifah
- Center of Infection Prevention & Control (CIPC), Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia; Department of Family and Community medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Alaa AlGhamdi
- Center of Infection Prevention & Control (CIPC), Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia
| | - Iyad AlYateem
- Center of Infection Prevention & Control (CIPC), Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia
| | - Souad Alateah
- Department of Microbiology, Virology, and molecular virology, Central Laboratory& Blood Bank, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Nassirah Asghar
- Research Center, Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia
| | - Ali AlBarrak
- Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia; Infectious Diseases Division, Department of Internal medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
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Nour D, Ismail MB, Osman M, Rafei R, Kasir D, Dabboussi F, Colson P, Hamze M. Evaluation of SARS-CoV-2 anti-Spike antibody levels and breakthrough infection risk among vaccinated adults in North Lebanon. PLoS One 2024; 19:e0302579. [PMID: 38722969 PMCID: PMC11081361 DOI: 10.1371/journal.pone.0302579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/04/2024] [Indexed: 05/13/2024] Open
Abstract
Since March 2020, the COVID-19 pandemic has swiftly propagated, triggering a competitive race among medical firms to forge vaccines that thwart the infection. Lebanon initiated its vaccination campaign on February 14, 2021. Despite numerous studies conducted to elucidate the characteristics of immune responses elicited by vaccination, the topic remains unclear. Here, we aimed to track the progression of anti-spike SARS-CoV-2 antibody titers at two-time points (T1: shortly after the second vaccination dose, T2: six months later) within a cohort of 201 adults who received Pfizer-BioNTech (BNT162b2), AstraZeneca, or Sputnik V vaccines in North Lebanon. Blood specimens were obtained from participants, and antibody titers against SARS-CoV-2 were quantified through the Elecsys-Anti-SARS-CoV-2 S assay (Roche Diagnostics, Switzerland). We used univariate analysis and multivariable logistic regression models to predict determinants influencing the decline in immune response and the occurrence of breakthrough infections among vaccinated patients. Among the 201 participants, 141 exhibited unchanging levels of antibody titers between the two sample collections, 55 displayed waning antibody titers, and only five participants demonstrated heightened antibody levels. Notably, age emerged as the sole variable significantly linked to the waning immune response. Moreover, the BNT162b2 vaccine exhibited significantly higher efficacy concerning the occurrence of breakthrough infections when compared with the AstraZeneca vaccine. Overall, our study reflected the immune status of a sample of vaccinated adults in North Lebanon. Further studies on a larger scale are needed at the national level to follow the immune response after vaccination, especially after the addition of the third vaccination dose.
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Affiliation(s)
- Dalal Nour
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
- Aix-Marseille Univ., Institut de Recherche pour le Développement (IRD), Microbes Evolution Phylogeny and Infections (MEPHI), Marseille, France
| | - Mohamad Bachar Ismail
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
- Faculty of Sciences, Lebanese University, Tripoli, Lebanon
| | - Marwan Osman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States of America
| | - Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Dalal Kasir
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Philippe Colson
- Aix-Marseille Univ., Institut de Recherche pour le Développement (IRD), Microbes Evolution Phylogeny and Infections (MEPHI), Marseille, France
- IHU Méditerranée Infection, Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
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Oni OI, Osho PO, Odesanmi TM, Raji HM, Oluranti FT, Ibina D. SARS-CoV-2 vaccine breakthrough infection and the evaluation of safety precaution practice before and after vaccination among healthcare workers in South West, Nigeria. BMC Public Health 2024; 24:1259. [PMID: 38720278 PMCID: PMC11077696 DOI: 10.1186/s12889-024-18663-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Worldwide, it has been reported that fully vaccinated people still die of COVID-19-associated symptoms, generating public uncertainty about the safety and effectiveness of the vaccines. Hence, this research is aimed at assessing the incidence of COVID-19 breakthrough infection among vaccinated Health Workers and the possible effect of changes in the practice of post-vaccination safety precautions. METHOD This was a Health facility-based descriptive cross-sectional study. Data were collected using self-administered questionnaires distributed at the participant's work unit across the selected health facilities. The nasopharyngeal specimen was also obtained from the participants and analysed using STANDARD Q COVID-19 Ag Test rapid chromatographic immunoassay for the detection of antigens to SARS-CoV-2. All data were input and analyzed using SPSS version 20. RESULTS There was a statistically significant relationship between the vaccination status of respondents and the post-vaccination test result (χ2 = 6.816, df = 1, p = 0.009). The incidence of COVID-19 infection among the vaccinated and unvaccinated HCWs was 2% and 8% respectively. 5 of the 15 respondents who tested positive for COVID-19 had been fully vaccinated. However, all 5 of them did not practice safety measures after vaccination. None of the respondents who practised safety measures after vaccination tested positive for COVID-19. The remaining 10 respondents that tested positive for COVID-19 had not been vaccinated though they practised safety precautions. CONCLUSION Vaccination and the practice of safety precautions will go a long way to preventing future COVID-19 breakthrough infections.
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Affiliation(s)
| | - Patrick Olanrewaju Osho
- Department of Haematology and Immunology, University of Medical Sciences, Ondo, Ondo State, Nigeria
| | | | | | | | - Demian Ibina
- Suddan United Mission Hospital, Abakaliki, Ebonyi State, Nigeria
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Moreno-Echevarria FM, Caputo MT, Camp DM, Reddy S, Achenbach CJ. Incidence and risk factors of omicron variant SARS-CoV-2 breakthrough infection among vaccinated and boosted individuals. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.03.24305293. [PMID: 38633797 PMCID: PMC11023664 DOI: 10.1101/2024.04.03.24305293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background SARS-CoV-2 vaccines have been shown to be safe and effective against infection and severe COVID-19 disease worldwide. Certain co-morbid conditions cause immune dysfunction and may reduce immune response to vaccination. In contrast, those with co-morbidities may practice infection prevention strategies. Thus, the real-world clinical impact of co-morbidities on SARS-CoV-2 infection in the recent post-vaccination period is not well established. We performed this study to understand the epidemiology of Omicron breakthrough infection and evaluate associations with number of comorbidities in a vaccinated and boosted population. Methods and Findings We performed a retrospective clinical cohort study utilizing the Northwestern Medicine Enterprise Data Warehouse. Our study population was identified as fully vaccinated adults with at least one booster. The primary risk factor of interest was the number of co-morbidities. Our primary outcome was incidence and time to first positive SARS-CoV-2 molecular test in the Omicron predominant era. We performed multivariable analyses stratified by calendar time using Cox modeling to determine hazard of SARS-CoV-2. In total, 133,191 patients were analyzed. Having 3+ comorbidities was associated with increased hazard for breakthrough (HR=1.2 CI 1.2-1.6). During the second half of the study, having 2 comorbidities (HR= 1.1 95% CI 1.02-1.2) and having 3+ comorbidities (HR 1.7, 95% CI 1.5-1.9) were associated with increased hazard for Omicron breakthrough. Older age was associated with decreased hazard in the first 6 months of follow-up. Interaction terms for calendar time indicated significant changes in hazard for many factors between the first and second halves of the follow-up period. Conclusions Omicron breakthrough is common with significantly higher risk for our most vulnerable patients with multiple co-morbidities. Age related behavioral factors play an important role in breakthrough infection with the highest incidence among young adults. Our findings reflect real-world differences in immunity and exposure risk behaviors for populations vulnerable to COVID-19.
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Affiliation(s)
| | - Mathew T. Caputo
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University
| | - Daniel M. Camp
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University
| | - Susheel Reddy
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University
| | - Chad J. Achenbach
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
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Oberste M, Asenova T, Ernst A, Shah-Hosseini K, Schnörch N, Buess M, Rosenberger KD, Kossow A, Dewald F, Neuhann F, Hellmich M. Results of the Cologne Corona Surveillance (CoCoS) project- a cross-sectional study: survey data on risk factors of SARS-CoV-2 infection, and moderate-to-severe course in primarily immunized adults. BMC Public Health 2024; 24:548. [PMID: 38383381 PMCID: PMC10882740 DOI: 10.1186/s12889-024-17958-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Amidst the COVID-19 pandemic, vaccination has been a crucial strategy for mitigating transmission and disease severity. However, vaccine-effectiveness may be influenced by various factors, including booster vaccination, as well as personal factors such as age, sex, BMI, smoking, and comorbidities. To investigate the potential effects of these factors on SARS-CoV-2 infection and disease severity, we analyzed data from the third round of the Cologne Corona Surveillance (CoCoS) project, a large cross-sectional survey. METHODS The study was conducted mid-February to mid-March 2022 in Cologne, Germany. A random sample of 10,000 residents aged 18 years and older were invited to participate in an online survey. Information on participants' demographics (age, sex), SARS-CoV-2 infections, vaccination status, smoking, and preexisting medical conditions were collected. The outcomes of the study were: (1) the occurrence of SARS-CoV-2 infection despite vaccination (breakthrough infection) and (2) the occurrence of moderate-to-severe disease as a result of a breakthrough infection. Cox proportional-hazards regression was used to investigate possible associations between the presence/absence of booster vaccination, personal factors and the occurrence of SARS-CoV-2 infection. Associations with moderate-to-severe infection were analyzed using the Fine and Gray subdistribution hazard model. RESULTS A sample of 2,991 residents responded to the questionnaire. A total of 2,623 primary immunized participants were included in the analysis of breakthrough infection and 2,618 in the analysis of SARS-CoV-2 infection severity after exclusions due to incomplete data. The multivariable results show that booster vaccination (HR = 0.613, 95%CI 0.415-0.823) and older age (HR = 0.974, 95%CI 0.966-0.981) were associated with a reduced hazard of breakthrough infection. Regarding the severity of breakthrough infection, older age was associated with a lower risk of moderate-to-severe breakthrough infection (HR = 0.962, 95%CI0.949-0.977). Female sex (HR = 2.570, 95%CI1.435-4.603), smoking (HR = 1.965, 95%CI1.147-3.367) and the presence of chronic lung disease (HR = 2.826, 95%CI1.465-5.450) were associated with an increased hazard of moderate-to-severe breakthrough infection. CONCLUSION The results provide a first indication of which factors may be associated with SARS-CoV-2 breakthrough infection and moderate-to-severe course of infection despite vaccination. However, the retrospective nature of the study and risk of bias in the reporting of breakthrough infection severity limit the strength of the results. TRIAL REGISTRATION DRKS.de, German Clinical Trials Register (DRKS), Identifier: DRKS00024046, Registered on 25 February 2021.
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Affiliation(s)
- Max Oberste
- Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital of Cologne, University of Cologne, Robert-Koch-Straße 10, 50931, Cologne, Germany
| | - Teodora Asenova
- Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital of Cologne, University of Cologne, Robert-Koch-Straße 10, 50931, Cologne, Germany
| | - Angela Ernst
- Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital of Cologne, University of Cologne, Robert-Koch-Straße 10, 50931, Cologne, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital of Cologne, University of Cologne, Robert-Koch-Straße 10, 50931, Cologne, Germany
| | - Nadja Schnörch
- Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital of Cologne, University of Cologne, Robert-Koch-Straße 10, 50931, Cologne, Germany
| | | | - Kerstin Daniela Rosenberger
- Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital of Cologne, University of Cologne, Robert-Koch-Straße 10, 50931, Cologne, Germany
| | - Annelene Kossow
- Cologne Health Authority, Cologne, Germany
- Institute of Hygiene, University Hospital of Muenster, University Muenster, Robert-Koch-Straße 49, 48149, Muenster, Germany
| | - Felix Dewald
- Institute of Virology, Medical Faculty and University Hospital of Cologne, University of Cologne, Fürst-Pückler-Straße 56, 50935, Cologne, Germany
| | - Florian Neuhann
- Cologne Health Authority, Cologne, Germany
- Heidelberg Institute of Global Health, University Heidelberg, Heidelberg, Germany
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Medical Faculty and University Hospital of Cologne, University of Cologne, Robert-Koch-Straße 10, 50931, Cologne, Germany.
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Bedston S, Almaghrabi F, Patterson L, Agrawal U, Woolford L, Anand SN, Joy M, Crawford A, Goudie R, Byford R, Abbasizanjani H, Smith D, Laidlaw L, Akbari A, Sullivan C, Bradley DT, Lyons RA, de Lusignan S, Hobbs FR, Robertson C, Sheikh SA, Shi T. Risk of severe COVID-19 outcomes after autumn 2022 COVID-19 booster vaccinations: a pooled analysis of national prospective cohort studies involving 7.4 million adults in England, Northern Ireland, Scotland and Wales. THE LANCET REGIONAL HEALTH. EUROPE 2024; 37:100816. [PMID: 38162515 PMCID: PMC10757260 DOI: 10.1016/j.lanepe.2023.100816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
Background UK COVID-19 vaccination policy has evolved to offering COVID-19 booster doses to individuals at increased risk of severe Illness from COVID-19. Building on our analyses of vaccine effectiveness of first, second and initial booster doses, we aimed to identify individuals at increased risk of severe outcomes (i.e., COVID-19 related hospitalisation or death) post the autumn 2022 booster dose. Methods We undertook a national population-based cohort analysis across all four UK nations through linked primary care, vaccination, hospitalisation and mortality data. We included individuals who received autumn 2022 booster doses of BNT162b2 (Comirnaty) or mRNA-1273 (Spikevax) during the period September 1, 2022 to December 31, 2022 to investigate the risk of severe COVID-19 outcomes. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CIs) for the association between demographic and clinical factors and severe COVID-19 outcomes after the autumn booster dose. Analyses were adjusted for age, sex, body mass index (BMI), deprivation, urban/rural areas and comorbidities. Stratified analyses were conducted by vaccine type. We then conducted a fixed-effect meta-analysis to combine results across the four UK nations. Findings Between September 1, 2022 and December 31, 2022, 7,451,890 individuals ≥18 years received an autumn booster dose. 3500 had severe COVID-19 outcomes (2.9 events per 1000 person-years). Being male (male vs female, aHR 1.41 (1.32-1.51)), older adults (≥80 years vs 18-49 years; 10.43 (8.06-13.50)), underweight (BMI <18.5 vs BMI 25.0-29.9; 2.94 (2.51-3.44)), those with comorbidities (≥5 comorbidities vs none; 9.45 (8.15-10.96)) had a higher risk of COVID-19 hospitalisation or death after the autumn booster dose. Those with a larger household size (≥11 people within household vs 2 people; 1.56 (1.23-1.98)) and from more deprived areas (most deprived vs least deprived quintile; 1.35 (1.21-1.51)) had modestly higher risks. We also observed at least a two-fold increase in risk for those with various chronic neurological conditions, including Down's syndrome, immunodeficiency, chronic kidney disease, cancer, chronic respiratory disease, or cardiovascular disease. Interpretation Males, older individuals, underweight individuals, those with an increasing number of comorbidities, from a larger household or more deprived areas, and those with specific underlying health conditions remained at increased risk of COVID-19 hospitalisation and death after the autumn 2022 vaccine booster dose. There is now a need to focus on these risk groups for investigating immunogenicity and efficacy of further booster doses or therapeutics. Funding National Core Studies-Immunity, UK Research and Innovation (Medical Research Council and Economic and Social Research Council), Health Data Research UK, the Scottish Government, and the University of Edinburgh.
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Affiliation(s)
- Stuart Bedston
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | - Fatima Almaghrabi
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Lynsey Patterson
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Public Health Agency, Belfast, UK
| | - Utkarsh Agrawal
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lana Woolford
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Sneha N. Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anna Crawford
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Rosalind Goudie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hoda Abbasizanjani
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | - Deb Smith
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Lynn Laidlaw
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | | | - Declan T. Bradley
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Public Health Agency, Belfast, UK
| | - Ronan A. Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health, and Life Science, Swansea University, Swansea, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - F.D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK
- Public Health Scotland, Glasgow, Scotland, UK
| | - Sir Aziz Sheikh
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
| | - Ting Shi
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, Scotland, UK
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10
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Uusküla A, Pisarev H, Tisler A, Meister T, Suija K, Huik K, Abroi A, Kalda R, Kolde R, Fischer K. Risk of SARS-CoV-2 infection and hospitalization in individuals with natural, vaccine-induced and hybrid immunity: a retrospective population-based cohort study from Estonia. Sci Rep 2023; 13:20347. [PMID: 37989858 PMCID: PMC10663482 DOI: 10.1038/s41598-023-47043-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023] Open
Abstract
A large proportion of the world's population has some form of immunity against SARS-CoV-2, through either infection ('natural'), vaccination or both ('hybrid'). This retrospective cohort study used data on SARS-CoV-2, vaccination, and hospitalization from national health system from February 2020 to June 2022 and Cox regression modelling to compare those with natural immunity to those with no (Cohort1, n = 94,982), hybrid (Cohort2, n = 47,342), and vaccine (Cohort3, n = 254,920) immunity. In Cohort 1, those with natural immunity were at lower risk for infection during the Delta (aHR 0.17, 95%CI 0.15-0.18) and higher risk (aHR 1.24, 95%CI 1.18-1.32) during the Omicron period than those with no immunity. Natural immunity conferred substantial protection against COVID-19-hospitalization. Cohort 2-in comparison to natural immunity hybrid immunity offered strong protection during the Delta (aHR 0.61, 95%CI 0.46-0.80) but not the Omicron (aHR 1.05, 95%CI 0.93-1.1) period. COVID-19-hospitalization was extremely rare among individuals with hybrid immunity. In Cohort 3, individuals with vaccine-induced immunity were at higher risk than those with natural immunity for infection (Delta aHR 4.90, 95%CI 4.48-5.36; Omicron 1.13, 95%CI 1.06-1.21) and hospitalization (Delta aHR 7.19, 95%CI 4.02-12.84). These results show that risk of infection and severe COVID-19 are driven by personal immunity history and the variant of SARS-CoV-2 causing infection.
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Affiliation(s)
- Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, 50411, Tartu, Estonia.
| | - Heti Pisarev
- Department of Family Medicine and Public Health, University of Tartu, 50411, Tartu, Estonia
| | - Anna Tisler
- Department of Family Medicine and Public Health, University of Tartu, 50411, Tartu, Estonia
| | - Tatjana Meister
- Department of Family Medicine and Public Health, University of Tartu, 50411, Tartu, Estonia
| | - Kadri Suija
- Department of Family Medicine and Public Health, University of Tartu, 50411, Tartu, Estonia
| | - Kristi Huik
- Institute of Biomedicine and Translational Medicine, University of Tartu, 50411, Tartu, Estonia
| | - Aare Abroi
- Institute of Technology, University of Tartu, 50411, Tartu, Estonia
| | - Ruth Kalda
- Department of Family Medicine and Public Health, University of Tartu, 50411, Tartu, Estonia
| | - Raivo Kolde
- Institute of Computer Science, University of Tartu, 51009, Tartu, Estonia
| | - Krista Fischer
- Institute of Mathematics and Statistics, University of Tartu, 51009, Tartu, Estonia
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11
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Tani N, Ikematsu H, Goto T, Kondo S, Gondo K, Fujiyoshi N, Minami J, Harada Y, Nagano S, Horiuchi T, Kuwano H, Akashi K, Shimono N, Chong Y. Correlation between specific antibody response to wild-type BNT162b2 booster and the risk of breakthrough infection with omicron variants: Impact of household exposure in hospital healthcare workers. Vaccine 2023; 41:6672-6678. [PMID: 37775465 DOI: 10.1016/j.vaccine.2023.09.051] [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: 04/11/2023] [Revised: 09/19/2023] [Accepted: 09/23/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The emergence of omicron variants exhibiting antigenic changes has led to an increase in breakthrough infection among individuals with a wild-type SARS-CoV-2 vaccine booster. The correlation between post-booster spike-specific antibodies and omicron infection risk remains unclear. METHODS This prospective cohort study included SARS-CoV-2-naive healthcare workers with three-dose BNT162b2. Post-booster spike-specific IgG and interferon-γ levels were measured. Breakthrough infection was documented during a 10-month omicron-predominant period. Household and healthcare contacts were followed to identify subsequent infections. The IgG titers were additionally measured at the end of follow-up, and the titers at exposure were estimated from the two-point titers. RESULTS Of 333 participants, 89 developed infection, of whom 37 (41.6 %) were household contacts. Kaplan-Meier curves indicated that higher IgG titers were significantly correlated with lower cumulative infection incidence (p = 0.029), whereas the interferon-γ levels were not (p = 0.926). Multivariate Cox analysis showed that increasing IgG titers were associated with a reduced hazard ratio (HR) of 0.26 (95% CI, 0.12-0.55). Household exposure posed a greater infection risk than healthcare exposure (HRs, 11.24 [6.88-18.40] vs. 2.82 [1.37-5.44]). The difference in geometric mean IgG titers of infected and uninfected participants was significant among household contacts (20,244 AU/mL vs. 13,842 AU/mL, p = 0.031). Estimation of IgG titers at exposure showed a significantly higher infection incidence in those exposed with titers of <3,000 AU/mL than in those with higher titers (79.2 % vs. 32.3 %, p < 0.001). CONCLUSIONS Spike-specific antibodies induced by a wild-type SARS-CoV-2 vaccine booster are suggested to be effective in protecting against omicron infection. Household exposure would be a significant source of infection for hospital healthcare workers.
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Affiliation(s)
- Naoki Tani
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka 812-8582, Japan
| | | | - Takeyuki Goto
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka 812-8582, Japan
| | - Satoko Kondo
- Department of Nursing, Fukuoka City Hospital, Fukuoka 812-0046, Japan
| | - Kei Gondo
- Clinical Laboratory, Fukuoka City Hospital, Fukuoka 812-0046, Japan
| | - Naoko Fujiyoshi
- Department of Infectious Diseases, Fukuoka City Hospital, Fukuoka 812-0046, Japan
| | - Junya Minami
- Department of Infectious Diseases, Fukuoka City Hospital, Fukuoka 812-0046, Japan
| | - Yukiko Harada
- Department of Infectious Diseases, Fukuoka City Hospital, Fukuoka 812-0046, Japan
| | - Sukehisa Nagano
- Department of Neurology, Fukuoka City Hospital, Fukuoka 812-0046, Japan
| | | | | | - Koichi Akashi
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka 812-8582, Japan
| | - Nobuyuki Shimono
- Center for the Study of Global Infection, Kyushu University Hospital, 812-8582 Fukuoka, Japan
| | - Yong Chong
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka 812-8582, Japan.
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12
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Jing X, Han M, Wang X, Zhou L. SARS-CoV-2 vaccine breakthrough infection in the older adults: a meta-analysis and systematic review. BMC Infect Dis 2023; 23:577. [PMID: 37667195 PMCID: PMC10478381 DOI: 10.1186/s12879-023-08553-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Corona Virus Disease 2019 (COVID-19) mRNA vaccine effectiveness (VE) has recently declined, and reports about COVID-19 breakthrough infection have increased. We aimed to conduct a meta-analysis on population-based studies of the prevalence and incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infection amongst older adults worldwide. METHODS Studies from PubMed, Embase, Cochrane Library, and Web of Science were systematically screened to determine the prevalence and incidence of SARS-CoV-2 breakthrough infection in older adults from inception to November 2, 2022. Our meta-analysis included 30 studies, all published in English. Pooled estimates were calculated using a random-effect model through the inverse variance method. Publication bias was tested through funnel plots and Egger's regression test, and sensitivity analyses were performed to confirm the robustness of the results. This research was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Thirty publications were included in this meta-analysis (17 on prevalence, 17 on incidence, and 4 on both). The pooled prevalence of COVID-19 breakthrough infection among older adults was 7.7 per 1,000 persons (95% confidence interval [95%CI] 4.0-15.0). At the same time, the pooled incidence was 29.1 per 1000 person-years (95%CI 15.2-55.7). CONCLUSIONS This meta-analysis provides estimates of prevalence and incidence in older adults. We concluded that the prevalence and incidence of SARS-CoV-19 breakthrough infection in older people was low. The prevalence and incidence of breakthrough infection admitted to hospital, severe-critical, and deathly was significantly lower. Otherwise, there was considerable heterogeneity among estimates in this study, which should be considered when interpreting the results.
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Affiliation(s)
- Xiaohui Jing
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, Tianjin, 301617, P.R. China.
| | - Menglin Han
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, Tianjin, 301617, P.R. China
| | - Xiaoxuan Wang
- School of Chinese Materia Medica, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, Tianjin, 301617, P.R. China
| | - Li Zhou
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, Tianjin, 301617, P.R. China
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13
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Dhoble S, Atram D, Jiwane N, Naitam A. A study to assess the severity and risk of COVID-19 breakthrough infection in admitted SARS-CoV-2 vaccinated individual. J Family Med Prim Care 2023; 12:2024-2027. [PMID: 38024935 PMCID: PMC10657084 DOI: 10.4103/jfmpc.jfmpc_485_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background No vaccine is 100% effective in prevention of infection. The possibility of breakthrough infection of SARS-CoV-2 also cannot be ruled out. So, our study aimed to find out severity and risk of breakthrough infection and find association between epidemiological factors associated with it. Methodology A retrospective cross-sectional study was conducted on 148 admitted SARS-CoV-2 vaccinated individual from May 2021 to January 2022 by universal sampling method. A data was collected in the form of socio-demographic, Covid vaccine, clinical details, and outcome of admitted patients. An appropriate statistical test was applied. Results Out of the total 148 vaccinated individuals, 66 (44.59%) belongs to 30-59 years of age group and maximum, i.e. 95 (64.19%) were males. 64.86% patients were vaccinated with both doses and 98 (66.26%) individuals were mild cases. Only 8 (5.40%) cases were re-infected with Covid-19 infection. 70.27% individual were comorbid. Out of 148 vaccinated individuals, only 11 (7.43%) individuals were died and among those 7 (63.636%) were comorbid. Conclusion Despite being vaccinated, small percentage of people are still getting infected, requires hospitalization, and die because of COVID-19. As far as pandemic continues, continuous genome sequencing and tracking of SARS-CoV-2 is essential and strategies regarding vaccination should be adjusted accordingly.
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Affiliation(s)
- Shital Dhoble
- Department of Community Medicine, GMC, Chandrapur, Maharashtra, India
| | - Devishri Atram
- Department of Community Medicine, GMC, Chandrapur, Maharashtra, India
| | - Niwrutti Jiwane
- Department of Community Medicine, GMC, Chandrapur, Maharashtra, India
| | - Anil Naitam
- Department of Community Medicine, GMC, Chandrapur, Maharashtra, India
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14
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Meister T, Kolde A, Fischer K, Pisarev H, Kolde R, Kalda R, Suija K, Tisler A, Uusküla A. A retrospective cohort study of incidence and risk factors for severe SARS-CoV-2 breakthrough infection among fully vaccinated people. Sci Rep 2023; 13:8531. [PMID: 37237050 PMCID: PMC10213588 DOI: 10.1038/s41598-023-35591-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/20/2023] [Indexed: 05/28/2023] Open
Abstract
SARS-CoV-2 vaccination is currently the mainstay in combating the COVID-19 pandemic. However, there are still people among vaccinated individuals suffering from severe forms of the disease. We conducted a retrospective cohort study based on data from nationwide e-health databases. The study included 184,132 individuals who were SARS-CoV-2 infection-naive and had received at least a primary series of COVID-19 vaccination. The incidence of BTI (breakthrough infection) was 8.03 (95% CI [confidence interval] 7.95⎼8.13/10,000 person-days), and for severe COVID-19 it was 0.093 (95% CI 0.084⎼ 0.104/10,000 person-days). The protective effect of vaccination against severe COVID-19 remained constant for up to six months, and the booster dose offered an additional pronounced benefit (hospitalization aHR 0.32, 95% CI 0.19⎼0.54). The risk of severe COVID-19 was higher among those ≥ 50 years of age (aHR [adjusted hazard ratio] 2.06, 95% CI 1.25⎼3.42) and increased constantly with every decade of life. Male sex (aHR 1.32, 95% CI 1.16⎼1.45), CCI (The Charlson Comorbidity Index) score ≥ 1 (aHR 2.09, 95% CI 1.54⎼2.83), and a range of comorbidities were associated with an increased risk of COVID-19 hospitalization. There are identifiable subgroups of COVID-19-vaccinated individuals at high risk of hospitalization due to SARS-CoV-2 infection. This information is crucial to driving vaccination programs and planning treatment strategies.
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Affiliation(s)
- Tatjana Meister
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia.
| | - Anastassia Kolde
- Institute of Mathematics and Statistics, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
- Institute of Genomics, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
| | - Krista Fischer
- Institute of Mathematics and Statistics, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
- Institute of Genomics, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
| | - Heti Pisarev
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Raivo Kolde
- Institute of Computer Science, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
| | - Ruth Kalda
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Kadri Suija
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Anna Tisler
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Anneli Uusküla
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
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15
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Smits PD, Gratzl S, Simonov M, Nachimuthu SK, Goodwin Cartwright BM, Wang MD, Baker C, Rodriguez P, Bogiages M, Althouse BM, Stucky NL. Risk of COVID-19 breakthrough infection and hospitalization in individuals with comorbidities. Vaccine 2023; 41:2447-2455. [PMID: 36803895 PMCID: PMC9933320 DOI: 10.1016/j.vaccine.2023.02.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND The successful development of multiple COVID-19 vaccines has led to a global vaccination effort to reduce severe COVID-19 infection and mortality. However, the effectiveness of the COVID-19 vaccines wane over time leading to breakthrough infections where vaccinated individuals experience a COVID-19 infection. Here we estimate the risks of breakthrough infection and subsequent hospitalization in individuals with common comorbidities who had completed an initial vaccination series. METHODS Our study population included vaccinated patients between January 1, 2021 to March 31, 2022 who are present in the Truveta patient population. Models were developed to describe 1) time from completing primary vaccination series till breakthrough infection; and 2) if a patient was hospitalized within 14 days of breakthrough infection. We adjusted for age, race, ethnicity, sex, and year-month of vaccination. RESULTS Of 1,218,630 patients in the Truveta Platform who had completed an initial vaccination sequence between January 1, 2021 and March 31, 2022, 2.85, 3.42, 2.75, and 2.88 percent of patients with CKD, chronic lung disease, diabetes, or are in an immunocompromised state experienced breakthrough infection, respectively, compared to 1.46 percent of the population without any of these four comorbidities. We found an increased risk of breakthrough infection and subsequent hospitalization in individuals with any of the four comorbidities when compared to individuals without these four comorbidities. CONCLUSIONS Vaccinated individuals with any of the studied comorbidities experienced an increased risk of breakthrough COVID-19 infection and subsequent hospitalizations compared to the people without any of the studied comorbidities. Individuals with immunocompromising conditions and chronic lung disease were most at risk of breakthrough infection, while people with CKD were most at risk of hospitalization following breakthrough infection. Patients with multiple comorbidities have an even greater risk of breakthrough infection or hospitalization compared to patients with none of the studied comorbidities. Individuals with common comorbidities should remain vigilant against infection even if vaccinated.
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Affiliation(s)
| | | | - Michael Simonov
- Truveta, Inc, Bellevue, WA, United States; Yale School of Medicine, New Haven, CT, United States
| | | | | | | | | | | | | | - Benjamin M Althouse
- Truveta, Inc, Bellevue, WA, United States; University of Washington, Seattle, Washington, United States; New Mexico State University, Las Cruces, New Mexico, United States
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16
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Clinical features and severe outcome predictors of COVID-19 vaccine breakthrough infection among hospitalized patients: results from Egypt severe acute respiratory infections sentinel surveillance, 2021-2022. BMC Infect Dis 2023; 23:130. [PMID: 36879217 PMCID: PMC9987052 DOI: 10.1186/s12879-023-08097-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND COVID-19 vaccines are effective against infections and outcomes; however, breakthrough infections (VBT) are increasingly reported, possibly due to waning of vaccine-induced immunity or emerging variants. Most studies have focused on determining VBT rate based on antibody levels. This study aims at describing clinical features, risks, time trends, and outcomes of COVID-19 VBT among hospitalized patients in Egypt. METHODS Data of SARS-CoV-2 confirmed patients hospitalized in 16 hospitals was obtained from the severe acute respiratory infections surveillance database, September 2021-April 2022. Data includes patients' demographics, clinical picture, and outcomes. Descriptive analysis was performed and patients with VBT were compared to not fully vaccinated (UPV). Bivariate and multivariate analyses were performed using Epi Info7 with a significance level < 0.05 to identify VBT risk factors. RESULTS Overall, 1,297 patients enrolled, their mean age 56.7 ± 17.0 years, 41.5% were males, 64.7% received inactivated, 25.% viral vector, and 7.7% mRNA vaccine. VBT was identified in 156(12.0%) patients with an increasing trend over time. VBT significantly was higher in (16-35 years) age, males, in those who received inactivated vaccine compared to corresponding groups of UPV (14.1 vs. 9.0%, p < 0.05 and 57.1 vs. 39.4%, p < 0.001 and 64.7 vs. 45.1, p < 0.01 respectively). Whereas receiving mRNA vaccine was significantly protective against VBT (7.7 vs. 21.6%, p < 001). VBT patients tend to have shorter hospital stays and lower case fatality (mean hospital days = 6.6 ± 5.5 vs. 7.9 ± 5.9, p < 0.01 and CFR = 28.2 vs. 33.1, p < 0.01 respectively). MVA identified younger ages, male gender, and inactivated vaccines as risks for VBT. CONCLUSION The study indicated that COVID-19 vaccines significantly reduce hospital days and fatality. VBT trend is on the rise and males, young ages, and inactivated vaccine receivers are at higher risk. Caution regarding relaxation of personal preventive measures in areas with higher or increasing incidences of COVID-19, particularly for the at-risk group even if they are vaccinated. The vaccination strategy should be revised to reduce VBT rate and increase vaccine effectiveness.
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17
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Barzegar M, Manteghinejad A, Afshari-Safavi A, Mirmosayyeb O, Nasirian M, Bagherieh S, Mazaheri S, Rahimi M, zabeti A, Javanmard SH, Shaygannejad V. Effectiveness of BBIBP-CorV vaccine in preventing SARS-CoV2 infection and severe outcomes in people living with multiple sclerosis: A population-based study. Mult Scler Relat Disord 2023; 71:104548. [PMID: 36827877 PMCID: PMC9894758 DOI: 10.1016/j.msard.2023.104548] [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: 11/16/2022] [Revised: 01/08/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND The objective of the present study was to estimate the effectiveness of the BBIBP-CorV vaccine (VE) in preventing SARS-CoV-2 infection, related hospitalization, and death among people living with multiple sclerosis (PLWMS). METHODS In this population-based retrospective observational study, data on all PLWMS, vaccination, SARS-CoV-2 tests, hospitalization, and deaths were collected in Isfahan, Iran between February 9, 2021, and November 4, 2021. We estimated the hazard ratio between vaccinated (partially and fully) and unvaccinated groups using the Andersen-Gill extension of the Cox proportional hazards model. We also performed Cox proportional hazards analysis to identify risk factors for breakthrough infection and COVID-19-related hospitalization in fully-immunized group. RESULTS Of the 9869 PLWMS, 1368 were in partially-vaccinated group, 4107 were in the fully-vaccinated group, and 3794 were in the unvaccinated group. In the partially-vaccinated group, the estimated VE against COVID-19 infection was 39.3% (16%, 56.1%), hospitalization was 64.9% (1.3%, 87.5%), and mortality was 92.7% (88.8%, 100%). The respective results for the fully-vaccinated group were 63.9% (56%, 70.3%), 75.7% (57.5%, 86.1%), and 100%. Progressive MS was independently associated with a greater risk of breakthrough infection (HR=1.952, 95%CI: 1.174-3.246, p = 0.010). Older adults (≥50 years vs. 18-49 years, HR=3.115, 95%CI: 1.145-8.470, p = 0.026) and those on rituximab (HR=7.584; 95% CI: 1.864-30.854; p = 0.005) were at an increased risk of COVID-19-related hospitalization. CONCLUSION This study showed that two doses of the BBIBP-CorV vaccine can effectively prevent COVID-19 infection and hospitalization among PLWMS. Old PLWMS and those who treating with rituximab are at increased risk of hospitalization after receiving two doses of the vaccine.
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Affiliation(s)
- Mahdi Barzegar
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirreza Manteghinejad
- Cancer Prevention Research Center, Omid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Afshari-Safavi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran,Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Omid Mirmosayyeb
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Nasirian
- Department of Biostatistics and Epidemiology, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Bagherieh
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahrbanoo Mazaheri
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Rahimi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aram zabeti
- University of Cincinnati, Cincinnati, OH, USA
| | - Shaghayegh Haghjooy Javanmard
- Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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18
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Dash NR, Barqawi HJ, Obaideen AA, Al Chame HQ, Samara KA, Qadri R, Eldesouki S. COVID-19 Breakthrough Infection Among Vaccinated Population in the United Arab Emirates. J Epidemiol Glob Health 2023; 13:67-90. [PMID: 36795274 PMCID: PMC9933808 DOI: 10.1007/s44197-023-00090-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/12/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Despite significant efforts to contain the Coronavirus Disease 2019 (COVID-19) pandemic through mass vaccination, numerous nations throughout the world have recorded breakout infections. The incidence and severity of COVID-19 breakthrough infections in the United Arab Emirates (UAE) remain unknown despite extensive COVID-19 vaccine coverage. The goal of this research is to establish the characteristics of COVID-19 breakthrough infections in the UAE's vaccinated population. METHODS Between February and March 2022, we conducted a descriptive cross-sectional study in the UAE with 1533 participants to examine the characteristics of COVID-19 breakthrough infection among the vaccinated population. RESULTS The vaccination coverage was 97.97%, and the COVID-19 breakthrough infection rate was 32.1%, requiring hospitalization in 7.7% of cases. The bulk of the 492 COVID-19 breakthrough infections reported was among young adults (67%), with the majority experiencing mild to moderate symptoms (70.7%) or remaining asymptomatic (21.5%). CONCLUSIONS COVID-19 breakthrough infection were reported in younger age, male sex, non-healthcare professions, vaccination with inactivated whole virus vaccine (Sinopharm), and not receiving a booster dose. Information on breakthrough infection in the UAE might influence public health decisions and motivate measures such as providing additional booster doses of the vaccines to the people.
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Affiliation(s)
- Nihar Ranjan Dash
- Clinical Sciences Department, College of Medicine, University of Sharjah, 27272, Sharjah, United Arab Emirates.
| | - Hiba Jawdat Barqawi
- Clinical Sciences Department, College of Medicine, University of Sharjah, 27272, Sharjah, United Arab Emirates
| | - Anas A Obaideen
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | | | - Kamel A Samara
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Rama Qadri
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Salma Eldesouki
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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19
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Lee JE, Hwang M, Kim YH, Chung MJ, Sim BH, Jeong WG, Jeong YJ. SARS-CoV-2 Variants Infection in Relationship to Imaging-based Pneumonia and Clinical Outcomes. Radiology 2023; 306:e221795. [PMID: 36165791 PMCID: PMC9527969 DOI: 10.1148/radiol.221795] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/03/2022] [Accepted: 09/13/2022] [Indexed: 11/11/2022]
Abstract
Background Few reports have evaluated the effect of the SARS-CoV-2 variant and vaccination on the clinical and imaging features of COVID-19. Purpose To evaluate and compare the effect of vaccination and variant prevalence on the clinical and imaging features of infections by the SARS-CoV-2. Materials and Methods Consecutive adults hospitalized for confirmed COVID-19 at three centers (two academic medical centers and one community hospital) and registered in a nationwide open data repository for COVID-19 between August 2021 and March 2022 were retrospectively included. All patients had available chest radiographs or CT images. Patients were divided into two groups according to predominant variant type over the study period. Differences between clinical and imaging features were analyzed with use of the Pearson χ2 test, Fisher exact test, or the independent t test. Multivariable logistic regression analyses were used to evaluate the effect of variant predominance and vaccination status on imaging features of pneumonia and clinical severity. Results Of the 2180 patients (mean age, 57 years ± 21; 1171 women), 1022 patients (47%) were treated during the Delta variant predominant period and 1158 (53%) during the Omicron period. The Omicron variant prevalence was associated with lower pneumonia severity based on CT scores (odds ratio [OR], 0.71 [95% CI: 0.51, 0.99; P = .04]) and lower clinical severity based on intensive care unit (ICU) admission or in-hospital death (OR, 0.43 [95% CI: 0.24, 0.77; P = .004]) than the Delta variant prevalence. Vaccination was associated with the lowest odds of severe pneumonia based on CT scores (OR, 0.05 [95% CI: 0.03, 0.13; P < .001]) and clinical severity based on ICU admission or in-hospital death (OR, 0.15 [95% CI: 0.07, 0.31; P < .001]) relative to no vaccination. Conclusion The SARS-CoV-2 Omicron variant prevalence and vaccination were associated with better clinical outcomes and lower severe pneumonia risk relative to Delta variant prevalence. © RSNA, 2022 Supplemental material is available for this article. See also the editorial by Little in this issue.
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Affiliation(s)
- Jong Eun Lee
- From the Department of Radiology, Chonnam National University
Hospital, Gwangju, Korea (J.E.L., Y.H.K.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine and
Biomedical Research Institute, Busan, Korea (M.H.); Department of Radiology and
Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, Korea (M.J.C.); Department of Radiology, Namwon
Medical Center, Namwon, Korea (B.H.S.); Department of Radiology, Chonnam
National University Hwasun Hospital, Chonnam National University Medical School,
Hwasun, Korea (W.G.J.); and Department of Radiology, Research Institute for
Convergence of Biomedical Science and Technology, Pusan National University
Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro,
Mulgeum-eup, Yangsan 50612, Korea (Y.J.J.)
| | - Minhee Hwang
- From the Department of Radiology, Chonnam National University
Hospital, Gwangju, Korea (J.E.L., Y.H.K.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine and
Biomedical Research Institute, Busan, Korea (M.H.); Department of Radiology and
Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, Korea (M.J.C.); Department of Radiology, Namwon
Medical Center, Namwon, Korea (B.H.S.); Department of Radiology, Chonnam
National University Hwasun Hospital, Chonnam National University Medical School,
Hwasun, Korea (W.G.J.); and Department of Radiology, Research Institute for
Convergence of Biomedical Science and Technology, Pusan National University
Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro,
Mulgeum-eup, Yangsan 50612, Korea (Y.J.J.)
| | - Yun-Hyeon Kim
- From the Department of Radiology, Chonnam National University
Hospital, Gwangju, Korea (J.E.L., Y.H.K.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine and
Biomedical Research Institute, Busan, Korea (M.H.); Department of Radiology and
Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, Korea (M.J.C.); Department of Radiology, Namwon
Medical Center, Namwon, Korea (B.H.S.); Department of Radiology, Chonnam
National University Hwasun Hospital, Chonnam National University Medical School,
Hwasun, Korea (W.G.J.); and Department of Radiology, Research Institute for
Convergence of Biomedical Science and Technology, Pusan National University
Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro,
Mulgeum-eup, Yangsan 50612, Korea (Y.J.J.)
| | - Myung Jin Chung
- From the Department of Radiology, Chonnam National University
Hospital, Gwangju, Korea (J.E.L., Y.H.K.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine and
Biomedical Research Institute, Busan, Korea (M.H.); Department of Radiology and
Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, Korea (M.J.C.); Department of Radiology, Namwon
Medical Center, Namwon, Korea (B.H.S.); Department of Radiology, Chonnam
National University Hwasun Hospital, Chonnam National University Medical School,
Hwasun, Korea (W.G.J.); and Department of Radiology, Research Institute for
Convergence of Biomedical Science and Technology, Pusan National University
Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro,
Mulgeum-eup, Yangsan 50612, Korea (Y.J.J.)
| | - Byeong Hak Sim
- From the Department of Radiology, Chonnam National University
Hospital, Gwangju, Korea (J.E.L., Y.H.K.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine and
Biomedical Research Institute, Busan, Korea (M.H.); Department of Radiology and
Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, Korea (M.J.C.); Department of Radiology, Namwon
Medical Center, Namwon, Korea (B.H.S.); Department of Radiology, Chonnam
National University Hwasun Hospital, Chonnam National University Medical School,
Hwasun, Korea (W.G.J.); and Department of Radiology, Research Institute for
Convergence of Biomedical Science and Technology, Pusan National University
Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro,
Mulgeum-eup, Yangsan 50612, Korea (Y.J.J.)
| | - Won Gi Jeong
- From the Department of Radiology, Chonnam National University
Hospital, Gwangju, Korea (J.E.L., Y.H.K.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine and
Biomedical Research Institute, Busan, Korea (M.H.); Department of Radiology and
Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, Korea (M.J.C.); Department of Radiology, Namwon
Medical Center, Namwon, Korea (B.H.S.); Department of Radiology, Chonnam
National University Hwasun Hospital, Chonnam National University Medical School,
Hwasun, Korea (W.G.J.); and Department of Radiology, Research Institute for
Convergence of Biomedical Science and Technology, Pusan National University
Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro,
Mulgeum-eup, Yangsan 50612, Korea (Y.J.J.)
| | - Yeon Joo Jeong
- From the Department of Radiology, Chonnam National University
Hospital, Gwangju, Korea (J.E.L., Y.H.K.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine and
Biomedical Research Institute, Busan, Korea (M.H.); Department of Radiology and
Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University
School of Medicine, Seoul, Korea (M.J.C.); Department of Radiology, Namwon
Medical Center, Namwon, Korea (B.H.S.); Department of Radiology, Chonnam
National University Hwasun Hospital, Chonnam National University Medical School,
Hwasun, Korea (W.G.J.); and Department of Radiology, Research Institute for
Convergence of Biomedical Science and Technology, Pusan National University
Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro,
Mulgeum-eup, Yangsan 50612, Korea (Y.J.J.)
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20
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Cheetham NJ, Kibble M, Wong A, Silverwood RJ, Knuppel A, Williams DM, Hamilton OKL, Lee PH, Bridger Staatz C, Di Gessa G, Zhu J, Katikireddi SV, Ploubidis GB, Thompson EJ, Bowyer RCE, Zhang X, Abbasian G, Garcia MP, Hart D, Seow J, Graham C, Kouphou N, Acors S, Malim MH, Mitchell RE, Northstone K, Major-Smith D, Matthews S, Breeze T, Crawford M, Molloy L, Kwong ASF, Doores K, Chaturvedi N, Duncan EL, Timpson NJ, Steves CJ. Antibody levels following vaccination against SARS-CoV-2: associations with post-vaccination infection and risk factors in two UK longitudinal studies. eLife 2023; 12:e80428. [PMID: 36692910 PMCID: PMC9940912 DOI: 10.7554/elife.80428] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 12/22/2022] [Indexed: 01/25/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody levels can be used to assess humoral immune responses following SARS-CoV-2 infection or vaccination, and may predict risk of future infection. Higher levels of SARS-CoV-2 anti-Spike antibodies are known to be associated with increased protection against future SARS-CoV-2 infection. However, variation in antibody levels and risk factors for lower antibody levels following each round of SARS-CoV-2 vaccination have not been explored across a wide range of socio-demographic, SARS-CoV-2 infection and vaccination, and health factors within population-based cohorts. Methods Samples were collected from 9361 individuals from TwinsUK and ALSPAC UK population-based longitudinal studies and tested for SARS-CoV-2 antibodies. Cross-sectional sampling was undertaken jointly in April-May 2021 (TwinsUK, N=4256; ALSPAC, N=4622), and in TwinsUK only in November 2021-January 2022 (N=3575). Variation in antibody levels after first, second, and third SARS-CoV-2 vaccination with health, socio-demographic, SARS-CoV-2 infection, and SARS-CoV-2 vaccination variables were analysed. Using multivariable logistic regression models, we tested associations between antibody levels following vaccination and: (1) SARS-CoV-2 infection following vaccination(s); (2) health, socio-demographic, SARS-CoV-2 infection, and SARS-CoV-2 vaccination variables. Results Within TwinsUK, single-vaccinated individuals with the lowest 20% of anti-Spike antibody levels at initial testing had threefold greater odds of SARS-CoV-2 infection over the next 6-9 months (OR = 2.9, 95% CI: 1.4, 6.0), compared to the top 20%. In TwinsUK and ALSPAC, individuals identified as at increased risk of COVID-19 complication through the UK 'Shielded Patient List' had consistently greater odds (two- to fourfold) of having antibody levels in the lowest 10%. Third vaccination increased absolute antibody levels for almost all individuals, and reduced relative disparities compared with earlier vaccinations. Conclusions These findings quantify the association between antibody level and risk of subsequent infection, and support a policy of triple vaccination for the generation of protective antibodies. Funding Antibody testing was funded by UK Health Security Agency. The National Core Studies program is funded by COVID-19 Longitudinal Health and Wellbeing - National Core Study (LHW-NCS) HMT/UKRI/MRC ([MC_PC_20030] and [MC_PC_20059]). Related funding was also provided by the NIHR 606 (CONVALESCENCE grant [COV-LT-0009]). TwinsUK is funded by the Wellcome Trust, Medical Research Council, Versus Arthritis, European Union Horizon 2020, Chronic Disease Research Foundation (CDRF), Zoe Ltd and the National Institute for Health Research (NIHR) Clinical Research Network (CRN) and Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London. The UK Medical Research Council and Wellcome (Grant ref: [217065/Z/19/Z]) and the University of Bristol provide core support for ALSPAC.
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Affiliation(s)
- Nathan J Cheetham
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
| | - Milla Kibble
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
- Department of Applied Mathematics and Theoretical Physics, University of CambridgeCambridgeUnited Kingdom
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing, University College LondonLondonUnited Kingdom
| | | | - Anika Knuppel
- MRC Unit for Lifelong Health and Ageing, University College LondonLondonUnited Kingdom
| | - Dylan M Williams
- MRC Unit for Lifelong Health and Ageing, University College LondonLondonUnited Kingdom
- Department of Medical Epidemiology and Biostatistics, Karolinska InstitutetStockholmSweden
| | - Olivia KL Hamilton
- MRC/CSO Social and Public Health Sciences Unit, University of GlasgowGlasgowUnited Kingdom
| | - Paul H Lee
- Department of Health Sciences, University of LeicesterLeicesterUnited Kingdom
| | | | - Giorgio Di Gessa
- Department of Epidemiology and Public Health, University College LondonLondonUnited Kingdom
| | - Jingmin Zhu
- Department of Epidemiology and Public Health, University College LondonLondonUnited Kingdom
| | | | - George B Ploubidis
- Centre for Longitudinal Studies, University College LondonLondonUnited Kingdom
| | - Ellen J Thompson
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
- MRC Unit for Lifelong Health and Ageing, University College LondonLondonUnited Kingdom
| | - Ruth CE Bowyer
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
- AI for Science and Government, The Alan Turing InstituteLondonUnited Kingdom
| | - Xinyuan Zhang
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
| | - Golboo Abbasian
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
| | - Maria Paz Garcia
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
| | - Deborah Hart
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
| | - Jeffrey Seow
- Department of Infectious Diseases, King's College LondonLondonUnited Kingdom
| | - Carl Graham
- Department of Infectious Diseases, King's College LondonLondonUnited Kingdom
| | - Neophytos Kouphou
- Department of Infectious Diseases, King's College LondonLondonUnited Kingdom
| | - Sam Acors
- Department of Infectious Diseases, King's College LondonLondonUnited Kingdom
| | - Michael H Malim
- Department of Infectious Diseases, King's College LondonLondonUnited Kingdom
| | - Ruth E Mitchell
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Kate Northstone
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Daniel Major-Smith
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Sarah Matthews
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Thomas Breeze
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Michael Crawford
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Lynn Molloy
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Alex SF Kwong
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
- Division of Psychiatry, University of EdinburghEdinburghUnited Kingdom
| | - Katie Doores
- Department of Infectious Diseases, King's College LondonLondonUnited Kingdom
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College LondonLondonUnited Kingdom
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
- Guy’s & St Thomas’s NHS Foundation TrustLondonUnited Kingdom
| | - Nicholas J Timpson
- Population Health Sciences, Bristol Medical School, University of BristolBristolUnited Kingdom
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King’s College LondonLondonUnited Kingdom
- Guy’s & St Thomas’s NHS Foundation TrustLondonUnited Kingdom
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Abdulrazaq MK, Al Redha Jebur AA, Ali Hamdan BJ, Ibrahim AK. Frequency and Clinical Characteristics of Breakthrough Cases Post COVID-19 Vaccine and Predictive Risk Factors in College Students.. [DOI: 10.1101/2023.01.20.23284814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
ABSTRACTBACKGROUNDCOVID-19 vaccines help protect against infection, severe illness, hospitalization and death. When someone who is vaccinated with either a primary series or a primary series plus a booster dose gets infected with the virus that causes COVID-19, it is referred to as a “vaccine breakthrough infection.”OBJECTIVESTo assess the frequency and clinical characteristics of breakthrough cases of COVID-19 infection and to study the predictive risk factors.SUBJECTS&METHODSA cross-sectional study was carried out including 604 undergraduate medical and non-medical students in Iraq from 10thof August to 29thof September 2022. Data was collected via an online specific questionnaire and analysed to estimate the frequency of COVID-19 breakthrough cases post vaccination, and number of doses of vaccine used. The association of different factors including age, gender, grade, body mass index, smoking, and comorbidities was also studied as predictive risk factors. We used the data to formulate tables, figures and perform statistical tests in IBM SPSS Statistics 25.RESULTSMean age of study sample was 21.78 year ± 3.26 and 339 (56%) were females. In terms of COVID-19 vaccination data, 97 (16%) have received one dose, 459 (76%) two doses and 48 (8%) three doses. Regarding PCR test, 74 (12%) were positive after the first dose compared to 49 (8%) after the second dose. About the symptoms developed, the most frequent were fever in 372 (61.1%), unusual fatigue in 96 (15.79%), chills in 29 (4.77%) and persistent cough in 26 (4.28%). For most predictive factors, results were statistically insignificant.CONCLUSIONSIn current study; demographic factors showed no statistically significant impact on prevalence of COVID-19 breakthrough cases. Despite this; number of participants who develop symptoms after the second dose of vaccine was high; and having 3 or more symptoms. About half of participants showed symptoms even after being fully vaccinated.
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22
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Bhattacharya S, Chatterji S, Chandy M, Mahajan AY, Goel G, Mishra D, Vivek P, Das P, Mandal S, Chugani A, Mittal A, Perumal RC, Ramprasad VL, Gupta R. Molecular epidemiology of SARS-CoV-2 in healthcare workers and identification of viral genomic correlates of transmissibility and vaccine break through infection: A retrospective observational study from a cancer hospital in eastern India. Indian J Med Microbiol 2023; 41:104-110. [PMID: 36244851 PMCID: PMC9558092 DOI: 10.1016/j.ijmmb.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 09/01/2022] [Accepted: 09/25/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Despite COVID vaccination with ChAdOx1 ncov-19 (COVISHIELD®) (ChAdOx1 ncov-19) a large number of healthcare workers (HCWs) were getting infected in wave-2 of the pandemic in a cancer hospital of India. It was important therefore to determine the genotypes responsible for vaccine breakthrough infections. METHODS & OBJECTIVES Retrospective observational study of HCWs. Whole genome sequencing of SARS CoV-2 using Illumina NovaSeq was done. Mutations from both waves were compared to identify genomic correlates of transmissibility and vaccine breakthrough infections. RESULTS Vaccine breakthrough infections were seen in 127 HCWs out of 1806 fully vaccinated staff (7.03%). Median number of HCWs infected per day in wave-1 was 0.92 versus 3.25 in wave-2. Majority of wave-1 samples belonged to B.1 and B.1.1 lineage. Variant of concern- Delta variant (90%), and variant of interest- Kappa variant (10%), was seen in only wave-2 samples. Total mutation observed in wave-2 samples (median = 44) was 1.8 times than wave-1 sample (median = 24). Spike protein in wave-2 samples had 13 non-synonymous mutation as compared to 8 seen in wave-1 samples. E484Q-vaccine escape mutant was detected in five samples of wave-2; T478K - highly infectious mutation was seen in 31 samples of wave-2. We identified a novelcoding disruptive in-frame deletion (c.467_472delAGTTCA, p. Glu156_Arg158delinsGly) in the Spike protein. This mutation was seen only in wave-2 (78%, n = 39) samples. CONCLUSION The circulating virus strains in wave-2 infections demonstrated a greater degree of infectivity. There was a significant change in the genotypes observed in wave-1 and wave-2 infections along with almost twice the number of mutations. We noted that vaccine breakthrough infections (although mostly mild).
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Affiliation(s)
- Sanjay Bhattacharya
- Department of Microbiology, Tata Medical Center, 14 MAR, Kolkata, 700160, India
| | - Soumyadip Chatterji
- Department of Infectious Diseases, Tata Medical Center, 14 MAR, Kolkata, 700160, India.
| | - Mammen Chandy
- Department of Clinical Hematology, Tata Medical Center, 14 MAR, Kolkata, 700160, India
| | | | - Gaurav Goel
- Department of Microbiology, Tata Medical Center, 14 MAR, Kolkata, 700160, India
| | - Deepak Mishra
- Department of Laboratory Sciences, Tata Medical Center, Kolkata, India
| | - Priyanka Vivek
- Department of Staff Health, Tata Medical Center, 14 MAR, Kolkata, 700160, India
| | - Parijat Das
- Department of Microbiology, Tata Medical Center, 14 MAR, Kolkata, 700160, India
| | - Sudipto Mandal
- Department of Microbiology, Tata Medical Center, 14 MAR, Kolkata, 700160, India
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Taus E, Hofmann C, Ibarrondo FJ, Gong LS, Hausner MA, Fulcher JA, Krogstad P, Kitchen SG, Ferbas KG, Tobin NH, Rimoin AW, Aldrovandi GM, Yang OO. Persistent memory despite rapid contraction of circulating T Cell responses to SARS-CoV-2 mRNA vaccination. Front Immunol 2023; 14:1100594. [PMID: 36860850 PMCID: PMC9968837 DOI: 10.3389/fimmu.2023.1100594] [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: 11/17/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction While antibodies raised by SARS-CoV-2 mRNA vaccines have had compromised efficacy to prevent breakthrough infections due to both limited durability and spike sequence variation, the vaccines have remained highly protective against severe illness. This protection is mediated through cellular immunity, particularly CD8+ T cells, and lasts at least a few months. Although several studies have documented rapidly waning levels of vaccine-elicited antibodies, the kinetics of T cell responses have not been well defined. Methods Interferon (IFN)-γ enzyme-linked immunosorbent spot (ELISpot) assay and intracellular cytokine staining (ICS) were utilized to assess cellular immune responses (in isolated CD8+ T cells or whole peripheral blood mononuclear cells, PBMCs) to pooled peptides spanning spike. ELISA was performed to quantitate serum antibodies against the spike receptor binding domain (RBD). Results In two persons receiving primary vaccination, tightly serially evaluated frequencies of anti-spike CD8+ T cells using ELISpot assays revealed strikingly short-lived responses, peaking after about 10 days and becoming undetectable by about 20 days after each dose. This pattern was also observed in cross-sectional analyses of persons after the first and second doses during primary vaccination with mRNA vaccines. In contrast, cross-sectional analysis of COVID-19-recovered persons using the same assay showed persisting responses in most persons through 45 days after symptom onset. Cross-sectional analysis using IFN-γ ICS of PBMCs from persons 13 to 235 days after mRNA vaccination also demonstrated undetectable CD8+ T cells against spike soon after vaccination, and extended the observation to include CD4+ T cells. However, ICS analyses of the same PBMCs after culturing with the mRNA-1273 vaccine in vitro showed CD4+ and CD8+ T cell responses that were readily detectable in most persons out to 235 days after vaccination. Discussion Overall, we find that detection of spike-targeted responses from mRNA vaccines using typical IFN-γ assays is remarkably transient, which may be a function of the mRNA vaccine platform and an intrinsic property of the spike protein as an immune target. However, robust memory, as demonstrated by capacity for rapid expansion of T cells responding to spike, is maintained at least several months after vaccination. This is consistent with the clinical observation of vaccine protection from severe illness lasting months. The level of such memory responsiveness required for clinical protection remains to be defined.
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Affiliation(s)
- Ellie Taus
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Christian Hofmann
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - F Javier Ibarrondo
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Laura S Gong
- Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Mary Ann Hausner
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Jennifer A Fulcher
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Paul Krogstad
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Scott G Kitchen
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Kathie G Ferbas
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Nicole H Tobin
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Anne W Rimoin
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | - Grace M Aldrovandi
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Otto O Yang
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States.,Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
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24
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Ekström N, Haveri A, Solastie A, Virta C, Österlund P, Nohynek H, Nieminen T, Ivaska L, Tähtinen PA, Lempainen J, Jalkanen P, Julkunen I, Palmu AA, Melin M. Strong Neutralizing Antibody Responses to SARS-CoV-2 Variants Following a Single Vaccine Dose in Subjects With Previous SARS-CoV-2 Infection. Open Forum Infect Dis 2022; 9:ofac625. [PMID: 36519113 PMCID: PMC9745780 DOI: 10.1093/ofid/ofac625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/15/2022] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection primes the immune system; thus individuals who have recovered from infection have enhanced immune responses to subsequent vaccination (hybrid immunity). However, it remains unclear how well hybrid immunity induced by severe or mild infection can cross-neutralize emerging variants. We aimed to compare the strength and breadth of antibody responses in vaccinated recovered and uninfected subjects. METHODS We measured spike-specific immunoglobulin (Ig)G and neutralizing antibodies (NAbs) from vaccinated subjects including 320 with hybrid immunity and 20 without previous infection. From 29 subjects with a previous severe or mild infection, we also measured NAb responses against Alpha (B.1.1.7), Beta (B.1.351), Delta (B.1.617.2), and Omicron (B.1.1.529/BA.1) variants following vaccination. RESULTS A single vaccine dose induced 2-fold higher anti-spike IgG concentrations and up to 4-fold higher neutralizing potency of antibodies in subjects with a previous infection compared with vaccinated subjects without a previous infection. Hybrid immunity was more enhanced after a severe than a mild infection, with sequentially decreasing NAb titers against Alpha, Beta, Delta, and Omicron variants. We found similar IgG concentrations in subjects with a previous infection after 1 or 2 vaccine doses. CONCLUSIONS Hybrid immunity induced strong IgG responses, particularly after severe infection. However, the NAb titers were low against heterologous variants, especially against Omicron.
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Affiliation(s)
- Nina Ekström
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anu Haveri
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anna Solastie
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Camilla Virta
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pamela Österlund
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuomo Nieminen
- Data and Analytics Unit, Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Lauri Ivaska
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Paula A Tähtinen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Johanna Lempainen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Clinical Microbiology, Turku University Hospital, Turku, Finland
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Pinja Jalkanen
- Infection and Immunity, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Ilkka Julkunen
- Clinical Microbiology, Turku University Hospital, Turku, Finland
- Infection and Immunity, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Arto A Palmu
- Interventions Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Tampere, Finland
| | - Merit Melin
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
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25
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Ben Fredj S, Ghammem R, Zammit N, Maatouk A, Haddad N, Haddad N, Kachroudi M, Rebai S, Laadhari H, Ghodhbani MM, Maatoug J, Ghannem H. Risk factors for severe Covid-19 breakthrough infections: an observational longitudinal study. BMC Infect Dis 2022; 22:894. [DOI: 10.1186/s12879-022-07859-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
The drive to vaccinate large populations is nowadays the main instrument for combating the pandemic and preventing serious disease and death. However, breakthrough infection (post-vaccination infection) still happens after vaccination among fully vaccinated people. We aimed to assess the severity outcomes and to determine its associated factors among vaccinated COVID-19 cases in the governorate of Sousse, Tunisia.
Methods
We carried out a five-month observational longitudinal study including all the population of Sousse. Confirmed infections of SARS-CoV-2 and the vaccination status are recorded in the daily COVID- 19 database of the Regional Office of the Tunisian Ministry of Health. We included all post-vaccination COVID-19 cases for the analysis of the COVID-19 serious outcomes. Data were collected via 15-min telephonic call interviews conducted by trained interviewers. Descriptive analysis with calculating incidence rates of confirmed COVID-19 cases per 100,000 inhabitants was conducted. In binary logistic regression, adjusted odds ratios along with 95% intervals confidence were performed to determine factors related to severe or critical COVID-19.
Results
As of 31 July 2021, 107,545 persons over 19 years old have received at least one dose of COVID-19 vaccination. Among the vaccinated population, we traced and included 765 breakthrough infection cases, and the incidence rate was 711.3 per week. The majority were female (sex-ratio = 0.8), and the average age of the overall cases was 55.7 years. The prevalence of severe or critical cases in vaccinated COVID-19 patients occurs in 10.8% of cases. Patients with a medical history of cardiovascular diseases had more than two times increased odds to have a severe or critical disease. We also found the highest self-estimation of adherence to preventive measures was inversely correlated to serious cases and having an incomplete vaccination schema was strongly associated with complications.
Conclusions
We tried to provide evidence about the breakthrough infections to improve measures of prevention and control of COVID-19. Boosting immunity for vulnerable patients added to maintaining and promoting preventive measures are not only essential to prevent severe cases of breakthrough infections of COVID-19, but also other influenza-like diseases.
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26
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Gabashvili IS. The Incidence and Effect of Adverse Events Due to COVID-19 Vaccines on Breakthrough Infections: Decentralized Observational Study With Underrepresented Groups. JMIR Form Res 2022; 6:e41914. [PMID: 36309347 PMCID: PMC9640199 DOI: 10.2196/41914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/13/2022] [Accepted: 10/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background Despite continuing efforts to improve the inclusion of underserved groups in clinical research, gaps in diversity remain. Participation of special populations is especially important when facing problems of unprecedented complexity such as the COVID-19 pandemic. A better understanding of factors associated with the immune response in diverse populations would advance future preventive and curative approaches. Objective The objective of this study was to investigate the factors potentially responsible for adverse events following COVID-19 immunization. The study population included adults from rural areas, transitional countries, and those with medically understudied conditions, across a broad age range. Methods The study evolved from peer support networks developed during the COVID-19 pandemic. Participants were recruited digitally through online neighborhood and health communities. Some of the participants volunteered as study investigators assisting with offline recruitment and safety monitoring. Individuals who consented to participate were asked to share their vaccination experiences either using constantly evolving web-based surveys or via one-on-one communication. Inferential statistical analysis to estimate differences between study groups was performed using parametric and nonparametric tests. Results Of 1430 participants who shared their vaccination experiences, 648 had outcome measures at their 1.5-year follow-up. Significant differences were found between age groups, types of vaccine adverse events (VAEs), incidences of breakthrough infections, and health conditions linked to the microbiome. Pairwise comparisons showed that VAEs interfering with daily activities were significantly higher in both younger (18-59 years) and older age groups (80-100 years, P<.001) than in the 60-79–year age group. Short-term VAEs were associated with lower incidence of breakthrough COVID-19 infections relative to those who reported either minimal or long-term adverse events (P<.001). A genetic origin was suggested for some adverse reactions. Conclusions The findings of this study demonstrate that vaccine adverse reactions in older individuals are being overlooked, and the incidence of VAEs impairing immunity may be higher than previously perceived. Better preventive measures are needed for all those at risk for life-threatening and long-term adverse events due to vaccination. Supportive community-based studies focusing on these populations could add important data to the current body of knowledge. Further and more comprehensive studies should follow. Trial Registration ClinicalTrials.gov NCT04832932; https://clinicaltrials.gov/ct2/show/NCT04832932 International Registered Report Identifier (IRRID) RR2-10.1101/2021.06.28.21256779
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27
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Almufty HB, Mamani MMA, Ali AH, Merza MA. COVID-19 vaccine breakthrough infection among fully vaccinated healthcare workers in Duhok governorate, Iraqi Kurdistan: A retrospective cohort study. J Med Virol 2022; 94:5244-5250. [PMID: 35811398 PMCID: PMC9350230 DOI: 10.1002/jmv.27985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/15/2022] [Accepted: 07/02/2022] [Indexed: 12/15/2022]
Abstract
The aims of this study were: to determine the incidence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection among vaccinated healthcare workers (HCWs), assess risk factors associated with the vaccine breakthrough (BT), and compare the effectiveness of vaccine manufacturers against SARS-CoV-2 variant of concern among HCWs in Duhok governorate. It is a multicenter retrospective cohort study, which enrolled 944 HCWs through March 2022. COVID-19 vaccinated HCWs aging 18 and above were included. A random sampling process was performed by asking the participants to fill out a standardized questionnaire by means of interviews or participant-completed surveys. Fully vaccinated HCWs with positive polymerase chain reaction tests were considered to have vaccine BT infection. Two hundred and eighty-four (30.1%) out of 944 vaccinated HCWs had SARS-CoV-2 infection postvaccination, of whom 241 (84.9%) were fully vaccinated, concluding that the incidence of BT infection is 25.5%. There were 422 (44.7%) males and 522 (55.3%) females. Most vaccine BT infections had developed in SARS-CoV-2 Omicron variant (53.5%). The majority of BT infections were mild to moderate (95.5%). Occupation, namely dentist was a significant risk factor, with a p value of 0.001. HCWs with a history of SARS-CoV-2 infection prevaccination were more prone to a vaccine BT infection (p value =0.002). Pfizer vaccine manufacturers revealed the highest effectiveness against BT infection (p value =0.0001). Paramedics showed a significant association with the disease severity (p value =0.02). The three available vaccine manufacturers in the Duhok governorate are effective against COVID-19 BT infections. Dentists and paramedics were significantly associated with poor COVID-19 outcomes.
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Affiliation(s)
- Hind B. Almufty
- Department of Clinical Pharmacy, College of PharmacyUniversity of DuhokDuhokIraqi KurdistanIraq
| | - Masoud M. Ameen Mamani
- Department of Pharmaceutics, College of PharmacyUniversity of DuhokDuhokIraqi KurdistanIraq
| | - Ali H. Ali
- Duhok Directorate of HealthDuhokIraqi KurdistanIraq
| | - Muayad A. Merza
- Department of Internal Medicine, Azadi Teaching Hospital, College of PharmacyUniversity of DuhokDuhokIraqi KurdistanIraq
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28
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Effectiveness of COVID-19 vaccination in healthcare workers in Shiga Prefecture, Japan. Sci Rep 2022; 12:17621. [PMID: 36271136 PMCID: PMC9586956 DOI: 10.1038/s41598-022-22682-3] [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: 08/11/2022] [Accepted: 10/18/2022] [Indexed: 01/13/2023] Open
Abstract
This study, which included serological and cellular immunity tests, evaluated whether coronavirus disease 2019 (COVID-19) vaccination adequately protected healthcare workers (HCWs) from COVID-19. Serological investigations were conducted among 1600 HCWs (mean ± standard deviation, 7.4 ± 1.4 months after the last COVID-19 vaccination). Anti-SARS-CoV-2 antibodies N-Ig, Spike-Ig (Roche), N-IgG, Spike-IgM, and -IgG (Abbott), were evaluated using a questionnaire of health condition. 161 HCWs were analyzed for cellular immunity using T-SPOT® SARS-CoV-2 kit before, and 52 HCWs were followed up until 138.3 ± 15.7 days after their third vaccination. Spike-IgG value was 954.4 ± 2282.6 AU/mL. Forty-nine of the 1600 HCWs (3.06%) had pre-existing SARS-CoV-2 infection. None of the infectious seropositive HCWs required hospitalization. T-SPOT value was 85.0 ± 84.2 SFU/106 cells before the third vaccination, which increased to 219.4 ± 230.4 SFU/106 cells immediately after, but attenuated later (to 111.1 ± 133.6 SFU/106 cells). Poor counts (< 40 SFU/106 cells) were present in 34.8% and 38.5% of HCWs before and after the third vaccination, respectively. Our findings provide insights into humoral and cellular immune responses to repeated COVID-19 vaccinations. COVID-19 vaccination was effective in protecting HCWs from serious illness during the original Wuhan-1, Alpha, Delta and also ongoing Omicron-predominance periods. However, repeated vaccinations using current vaccine versions may not induce sufficient cellular immunity in all HCWs.
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29
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Kara S, Lazovic G, Chohan F, Lawrence JA, Sukaina M, Edaki O, Nedd K. Third wave COVID-19 delta variant breakthrough infection in a Hispanic-dominant suburb of Miami, Florida: ethical dilemma and vaccination hesitancy. Ther Adv Vaccines Immunother 2022; 10:25151355221128086. [PMID: 36225944 PMCID: PMC9548452 DOI: 10.1177/25151355221128086] [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: 03/24/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Aims The peak of the third wave of COVID-19 infection was in the summer (August-September) of 2021, dominated by the Delta variant. Florida was the epicenter of the third wave with more than 151,449 cases in the first week of August with a positivity rate of 20%. The purpose of this study is to identify the percentage of COVID-19 infection in vaccinated patients in a minority population in south Florida and to elucidate the relationship, if any, between demographics and breakthrough infections, the rate of vaccine hesitancy, as well as the willingness to receive the monoclonal antibody REGEN-COV for the treatment of COVID-19. Methods This cross-sectional study was performed at the Emergency Department, Larkin Community Hospital Palm Spring Campus, located in Hialeah, the fourth largest city in Florida. Hialeah is dominated (94.7%) by Hispanics and Latinos. This city represents a cross-sectional sample of US cities in general and Florida in specific. We enrolled 127 COVID-19 PCR-positive patients. Results The infection in vaccinated patients (breakthrough) was found to be about one in three (34%). Despite the high infection rate and mounting death toll, about 73% of our unvaccinated patients answered no to the question 'knowing the consequences of being infected with COVID-19 and the fact that you are positive, would you have chosen to be vaccinated earlier?' However, about 27% of these patients agreed to receive the vaccine and 20.5% received the monoclonal antibody REGEN-COV. Conclusions Our study revealed that vaccine hesitancy in South Florida continues to be a major challenge, especially with the emergence of mutations including Delta plus and Omicron.
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Affiliation(s)
| | - Gavrilo Lazovic
- Department of Emergency Medicine, Larkin
Community Hospital Palm Springs Campus, Hialeah, FL, USA
| | - Farah Chohan
- Department of Internal Medicine, Larkin
Community Hospital Palm Springs Campus, Hialeah, FL, USA
| | - Jannel A. Lawrence
- Department of Research & Academic Affairs,
Larkin Community Hospital, South Miami, FL, USA,Department of Internal Medicine, Ross
University School of Medicine, Bridgetown, Barbados
| | - Mahnoor Sukaina
- Department of Research & Academic Affairs,
Larkin Community Hospital, South Miami, FL, USA,Department of Internal Medicine, Karachi
Medical and Dental College, Karachi, Pakistan
| | - Omoyeme Edaki
- Department of Research & Academic Affairs,
Larkin Community Hospital, South Miami, FL, USA
| | - Kester Nedd
- Department of Neurology, Larkin Community
Hospital Palm Springs Campus, Hialeah, FL, USA
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30
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Calcoen B, Callewaert N, Vandenbulcke A, Kerstens W, Imbrechts M, Vercruysse T, Dallmeier K, Van Weyenbergh J, Maes P, Bossuyt X, Zapf D, Dieckmann K, Callebaut K, Thibaut HJ, Vanhoorelbeke K, De Meyer SF, Maes W, Geukens N. High Incidence of SARS-CoV-2 Variant of Concern Breakthrough Infections Despite Residual Humoral and Cellular Immunity Induced by BNT162b2 Vaccination in Healthcare Workers: A Long-Term Follow-Up Study in Belgium. Viruses 2022; 14:1257. [PMID: 35746728 PMCID: PMC9228150 DOI: 10.3390/v14061257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/26/2022] Open
Abstract
To mitigate the massive COVID-19 burden caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), several vaccination campaigns were initiated. We performed a single-center observational trial to monitor the mid- (3 months) and long-term (10 months) adaptive immune response and to document breakthrough infections (BTI) in healthcare workers (n = 84) upon BNT162b2 vaccination in a real-world setting. Firstly, serology was determined through immunoassays. Secondly, antibody functionality was analyzed via in vitro binding inhibition and pseudovirus neutralization and circulating receptor-binding domain (RBD)-specific B cells were assessed. Moreover, the induction of SARS-CoV-2-specific T cells was investigated by an interferon-γ release assay combined with flowcytometric profiling of activated CD4+ and CD8+ T cells. Within individuals that did not experience BTI (n = 62), vaccine-induced humoral and cellular immune responses were not correlated. Interestingly, waning over time was more pronounced within humoral compared to cellular immunity. In particular, 45 of these 62 subjects no longer displayed functional neutralization against the delta variant of concern (VoC) at long-term follow-up. Noteworthily, we reported a high incidence of symptomatic BTI cases (17.11%) caused by alpha and delta VoCs, although vaccine-induced immunity was only slightly reduced compared to subjects without BTI at mid-term follow-up.
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Affiliation(s)
- Bas Calcoen
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, 8500 Kortrijk, Belgium; (B.C.); (A.V.); (K.V.); (S.F.D.M.)
| | - Nico Callewaert
- AZ Groeninge Hospital, Department of Laboratory Medicine, 8500 Kortrijk, Belgium; (K.C.); (N.C.)
| | - Aline Vandenbulcke
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, 8500 Kortrijk, Belgium; (B.C.); (A.V.); (K.V.); (S.F.D.M.)
| | - Winnie Kerstens
- Laboratory of Virology and Chemotherapy, Translational Platform Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, KU Leuven Rega Institute, 3000 Leuven, Belgium; (W.K.); (T.V.); (H.J.T.)
| | - Maya Imbrechts
- PharmAbs, the KU Leuven Antibody Center, KU Leuven, 3000 Leuven, Belgium; (M.I.); (N.G.)
| | - Thomas Vercruysse
- Laboratory of Virology and Chemotherapy, Translational Platform Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, KU Leuven Rega Institute, 3000 Leuven, Belgium; (W.K.); (T.V.); (H.J.T.)
| | - Kai Dallmeier
- Laboratory of Virology, Molecular Vaccinology and Vaccine Discovery, Department of Microbiology, Immunology and Transplantation, KU Leuven Rega Institute, 3000 Leuven, Belgium;
| | - Johan Van Weyenbergh
- Laboratory for Clinical and Epidemiological Virology, KU Leuven Rega Institute, 3000 Leuven, Belgium; (J.V.W.); (P.M.)
| | - Piet Maes
- Laboratory for Clinical and Epidemiological Virology, KU Leuven Rega Institute, 3000 Leuven, Belgium; (J.V.W.); (P.M.)
| | - Xavier Bossuyt
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium;
- Department of Laboratory Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Dorinja Zapf
- Institut für Experimentelle Immunologie, EUROIMMUN Medizinische Labordiagnostika AG, 23552 Lübeck, Germany; (D.Z.); (K.D.)
| | - Kersten Dieckmann
- Institut für Experimentelle Immunologie, EUROIMMUN Medizinische Labordiagnostika AG, 23552 Lübeck, Germany; (D.Z.); (K.D.)
| | - Kim Callebaut
- AZ Groeninge Hospital, Department of Laboratory Medicine, 8500 Kortrijk, Belgium; (K.C.); (N.C.)
| | - Hendrik Jan Thibaut
- Laboratory of Virology and Chemotherapy, Translational Platform Virology and Chemotherapy, Department of Microbiology, Immunology and Transplantation, KU Leuven Rega Institute, 3000 Leuven, Belgium; (W.K.); (T.V.); (H.J.T.)
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, 8500 Kortrijk, Belgium; (B.C.); (A.V.); (K.V.); (S.F.D.M.)
- PharmAbs, the KU Leuven Antibody Center, KU Leuven, 3000 Leuven, Belgium; (M.I.); (N.G.)
| | - Simon F. De Meyer
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, 8500 Kortrijk, Belgium; (B.C.); (A.V.); (K.V.); (S.F.D.M.)
| | - Wim Maes
- PharmAbs, the KU Leuven Antibody Center, KU Leuven, 3000 Leuven, Belgium; (M.I.); (N.G.)
| | - Nick Geukens
- PharmAbs, the KU Leuven Antibody Center, KU Leuven, 3000 Leuven, Belgium; (M.I.); (N.G.)
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