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Adhikari B, Bednash JS, Horowitz JC, Rubinstein MP, Vlasova AN. Brief research report: impact of vaccination on antibody responses and mortality from severe COVID-19. Front Immunol 2024; 15:1325243. [PMID: 38390335 PMCID: PMC10883056 DOI: 10.3389/fimmu.2024.1325243] [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: 10/20/2023] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction While it is established that vaccination reduces risk of hospitalization, there is conflicting data on whether it improves outcome among hospitalized COVID-19 patients. This study evaluated clinical outcomes and antibody (Ab) responses to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection/vaccines in patients with acute respiratory failure (ARF) and various comorbidities. Methods In this single-center study, 152 adult patients were admitted to Ohio State University hospital with ARF (05/2020 - 11/2022) including 112 COVID-19-positive and 40 COVID-19-negative patients. Of the COVID-19 positive patients, 23 were vaccinated for SARS-CoV-2 (Vax), and 89 were not (NVax). Of the NVax COVID-19 patients, 46 were admitted before and 43 after SARS-CoV-2 vaccines were approved. SARS-CoV-2 Ab levels were measured/analyzed based on various demographic and clinical parameters of COVID-19 patients. Additionally, total IgG4 Ab concentrations were compared between the Vax and NVax patients. Results While mortality rates were 36% (n=25) and 27% (n=15) for non-COVID-19 NVax and Vax patients, respectively, in COVID-19 patients mortality rates were 37% (NVax, n=89) and 70% (Vax, n=23). Among COVID-19 patients, mortality rate was significantly higher among Vax vs. NVax patients (p=0.002). The Charlson's Comorbidity Index score (CCI) was also significantly higher among Vax vs. NVax COVID-19 patients. However, the mortality risk remained significantly higher (p=0.02) when we compared COVID-19 Vax vs. NVax patients with similar CCI score, suggesting that additional factors may increase risk of mortality. Higher levels of SARS-CoV-2 Abs were noted among survivors, suggestive of their protective role. We observed a trend for increased total IgG4 Ab, which promotes immune tolerance, in the Vax vs. NVax patients in week 3. Conclusion Although our cohort size is small, our results suggest that vaccination status of hospital-admitted COVID-19 patients may not be instructive in determining mortality risk. This may reflect that within the general population, those individuals at highest risk for COVID-19 mortality/immune failure are likely to be vaccinated. Importantly, the value of vaccination may be in preventing hospitalization as opposed to stratifying outcome among hospitalized patients, although our data do not address this possibility. Additional research to identify factors predictive of aberrant immunogenic responses to vaccination is warranted.
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Affiliation(s)
- Bindu Adhikari
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Wooster, OH, United States
- Center for Food Animal Health, Department of Animal Sciences, Ohio Agriculture Research and Development Center (OARDC), College of Food, Agricultural and Environmental Sciences, The Ohio State University, Wooster, OH, United States
| | - Joseph S. Bednash
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University, Columbus, OH, United States
| | - Jeffrey C. Horowitz
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University, Columbus, OH, United States
| | - Mark P. Rubinstein
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
- The Pelotonia Institute of Immuno-Oncology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH, United States
| | - Anastasia N. Vlasova
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Wooster, OH, United States
- Center for Food Animal Health, Department of Animal Sciences, Ohio Agriculture Research and Development Center (OARDC), College of Food, Agricultural and Environmental Sciences, The Ohio State University, Wooster, OH, United States
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Mendoza-Hernandez MA, Guzman-Esquivel J, Ramos-Rojas MA, Santillan-Luna VV, Sanchez-Ramirez CA, Hernandez-Fuentes GA, Diaz-Martinez J, Melnikov V, Rojas-Larios F, Martinez-Fierro ML, Tiburcio-Jimenez D, Rodriguez-Sanchez IP, Delgado-Enciso OG, Cabrera-Licona A, Delgado-Enciso I. Differences in the Evolution of Clinical, Biochemical, and Hematological Indicators in Hospitalized Patients with COVID-19 According to Their Vaccination Scheme: A Cohort Study in One of the World's Highest Hospital Mortality Populations. Vaccines (Basel) 2024; 12:72. [PMID: 38250885 PMCID: PMC10821037 DOI: 10.3390/vaccines12010072] [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: 11/30/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
COVID-19 vaccines primarily prevent severe illnesses or hospitalization, but there is limited data on their impact during hospitalization for seriously ill patients. In a Mexican cohort with high COVID-19 mortality, a study assessed vaccination's effects. From 2021 to 2022, 462 patients with 4455 hospital days were analyzed. The generalized multivariate linear mixed model (GENLINMIXED) with binary logistic regression link, survival analysis and ROC curves were used to identify risk factors for death. The results showed that the vaccinated individuals were almost half as likely to die (adRR = 0.54, 95% CI = 0.30-0.97, p = 0.041). When stratifying by vaccine, the Pfizer group (BNT162b2) had a 2.4-times lower risk of death (adRR = 0.41, 95% CI = 0.2-0.8, p = 0.008), while the AstraZeneca group (ChAdOx1-S) group did not significantly differ from the non-vaccinated (adRR = 1.04, 95% CI = 0.5-2.3, p = 0.915). The Pfizer group exhibited a higher survival, the unvaccinated showed increasing mortality, and the AstraZeneca group remained intermediate (p = 0.003, multigroup log-rank test). Additionally, BNT162b2-vaccinated individuals had lower values for markers, such as ferritin and D-dimer. Biochemical and hematological indicators suggested a protective effect of both types of vaccines, possibly linked to higher lymphocyte counts and lower platelet-to-lymphocyte ratio (PLR). It is imperative to highlight that these results reinforce the efficacy of COVID-19 vaccines. However, further studies are warranted for a comprehensive understanding of these findings.
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Affiliation(s)
- Martha A. Mendoza-Hernandez
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
- General Hospital of Zone 1, Colima Delegation, Mexican Institute of Social Security, Villa de Álvarez, Colima 28984, Mexico;
| | - Jose Guzman-Esquivel
- Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Villa de Alvarez, Colima 28984, Mexico;
| | - Marco A. Ramos-Rojas
- General Hospital of Zone 1, Colima Delegation, Mexican Institute of Social Security, Villa de Álvarez, Colima 28984, Mexico;
| | - Vanessa V. Santillan-Luna
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
| | - Carmen A. Sanchez-Ramirez
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
| | - Gustavo A. Hernandez-Fuentes
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
- Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico;
| | - Janet Diaz-Martinez
- Research Center in Minority Institutions, Robert Stempel College of Public Health, Florida International University, Miami, FL 33199, USA;
| | - Valery Melnikov
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
| | - Fabian Rojas-Larios
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
| | - Margarita L. Martinez-Fierro
- Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Autonomous University of Zacatecas, Zacatecas 98160, Mexico;
| | - Daniel Tiburcio-Jimenez
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
| | - Iram P. Rodriguez-Sanchez
- Molecular and Structural Physiology Laboratory, School of Biological Sciences, Autonomous University of Nuevo Leon, San Nicolas de los Garza 66455, Mexico;
| | - Osiris G. Delgado-Enciso
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
| | | | - Ivan Delgado-Enciso
- School of Medicine, University of Colima, Colima 28040, Mexico; (M.A.M.-H.); (V.V.S.-L.); (C.A.S.-R.); (G.A.H.-F.); (V.M.); (F.R.-L.); (D.T.-J.); (O.G.D.-E.)
- Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico;
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
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Binay UD, Karavaş E, Karakeçili F, Barkay O, Aydin S, Şenbil DC. Effect of vaccination status on CORADS and computed tomography severity score in hospitalized COVID-19 patients: A retrospective study. World J Methodol 2023; 13:456-465. [PMID: 38229950 PMCID: PMC10789104 DOI: 10.5662/wjm.v13.i5.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/06/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is continuing. The disease most commonly affects the lungs. Since the beginning of the pandemic thorax computed tomography (CT) has been an indispensable imaging method for diagnosis and follow-up. The disease is tried to be controlled with vaccines. Vaccination reduces the possibility of a severe course of the disease. AIM The aim of this study is to investigate whether the vaccination status of patients hospitalized due to COVID-19 has an effect on the CT severity score (CT-SS) and CORADS score obtained during hospitalization. METHODS The files of patients hospitalized between April 1, 2021 and April 1, 2022 due to COVID-19 were retrospectively reviewed. A total of 224 patients who were older than 18 years of age, whose vaccination status was accessible, whose severe acute respiratory syndrome coronavirus 2 polymerase chain reaction result was positive, and who had a Thorax CT scan during hospitalization were included in the study. RESULTS Among the patients included in the study, 52.2% were female and the mean age was 61.85 years. The patients applied to the hospital on the average 7th day of their complaints. While 63 patients were unvaccinated (Group 1), 20 were vaccinated with a single dose of CoronaVac (Group 2), 24 with a single dose of BioNTech (Group 3), 38 with 2 doses of CoronaVac (Group 4), 40 with 2 doses of BioNTech (Group 5), and 39 with 3 doses of vaccine (2 doses of CoronaVac followed by a single dose of BioNTech, Group 6). CT-SS ranged from 5 to 23, with a mean of 12.17.CT-SS mean of the groups were determined as 14.17, 13.35, 11.58, 10.87, 11.28, 10.85, respectively. Accordingly, as a result of the comparisons between the groups, the CT-SS levels of the unvaccinated patients found to be significantly higher than the other groups. As the vaccination rates increased, the rate of typical COVID-19 findings on CT was found to be significantly lower. CONCLUSION Increased vaccination rates in COVID-19 patients reduce the probability of typical COVID-19 symptoms in the lungs. It also reduces the risk of severe disease and decreases CT Severity Scores. This may lead to a loss of importance of Thorax CT in the diagnosis of COVID-19 pneumonia as the end of the pandemic approaches.
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Affiliation(s)
- Umut Devrim Binay
- Department of Infectious Diseases and Clinical Microbiology, Erzincan Binali Yildirim University, Faculty of Medicine, Erzincan 24000, Turkey
| | - Erdal Karavaş
- Department of Radiology, Bandırma 17 Eylül University, Faculty of Medicine, Balıkesir 10200, Turkey
| | - Faruk Karakeçili
- Department of Infectious Diseases and Clinical Microbiology, Erzincan Binali Yildirim University, Faculty of Medicine, Erzincan 24000, Turkey
| | - Orçun Barkay
- Department of Infectious Diseases and Clinical Microbiology, Erzincan Binali Yildirim University, Faculty of Medicine, Erzincan 24000, Turkey
| | - Sonay Aydin
- Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Erzincan 24000, Turkey
| | - Düzgün Can Şenbil
- Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Erzincan 24000, Turkey
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Cao Y, Han Y, Wu J, Sun J, Dai Y, Qiao G, Li K, Li A, Zhang Y, Ma Y, Song Q. During the Omicron Pandemic Wave, the Severe Systemic Inflammatory Status of COVID-19 Indicated a Higher Risk of In-Hospital Mortality and Mediated the Clinical Efficacy of Corticosteroids. Infect Drug Resist 2023; 16:7377-7387. [PMID: 38053579 PMCID: PMC10695125 DOI: 10.2147/idr.s432679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/16/2023] [Indexed: 12/07/2023] Open
Abstract
Background For the distinct immune/inflammatory responses from Omicron variant infection, this study aimed to investigate the diagnostic efficacy of systemic inflammatory indicators and the clinical efficacy of corticosteroids on the in-hospital mortality among COVID-19 patients. Methods Under a retrospective cohort study, 1081 COVID-19 patients were recruited from Beijing Youan Hospital, Capital Medical University between November 16, 2022 and January 30, 2023. We chose neutrophil-to-lymphocyte ratio (NLR), CRP-to-lymphocyte ratio (CLR), and CRP-to-albumin ratio (CAR) as the systemic inflammatory indicators. Receiver operating curve (ROC) and multivariate logistic regression analysis were used to determine the diagnostic efficacy of systemic inflammatory indicators and the association between systemic inflammatory indicators and in-hospital mortality. Results Among 684 patients included in analysis, 96 died during hospitalization. NLR, CLR and CAR performed well (with an area under the curve (AUC) greater than 0.75) in discriminating in-hospital mortality among COVID-19 patients. The severe status of systemic inflammation, with optimal cut-off value derived from ROC analysis, significantly associated higher risk of in-hospital mortality (OR = 3.81 for NLR ≥ 6.131; OR = 3.76 for CLR ≥ 45.455; OR = 5.10 for CAR ≥ 1.436). Corticosteroids use within 72 hours of admission increased the in-hospital mortality 2.88-fold for COVID-19 patients. In the subgroup of patients with severe systemic inflammation, corticosteroids increased the risk of in-hospital mortality (OR = 2.11 for NLR, p = 0.055; OR = 2.94 for CLR, p = 0.005; OR = 2.31 for CAR, p = 0.036). Conclusion Systemic inflammatory indicators had good diagnostic performance for in-hospital mortality. Patients with severe systemic inflammatory status should not receive corticosteroid treatment and further studies are warranted for confirmation.
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Affiliation(s)
- Yu Cao
- Department of Clinical Epidemiology, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ying Han
- Center of Liver Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jiangping Wu
- Department of Clinical Epidemiology, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jianping Sun
- Center of Biobank, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yanchao Dai
- Center of Biobank, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Guifang Qiao
- Center of Biobank, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Kang Li
- Center of Biobank, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ang Li
- Center of Biobank, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yonghong Zhang
- Department of Hepatic Intervention, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yingmin Ma
- Department of Respiratory and Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Qingkun Song
- Department of Clinical Epidemiology, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
- Center of Biobank, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China
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Poniedziałek B, Rzymski P, Zarębska-Michaluk D, Rogalska M, Rorat M, Czupryna P, Kozielewicz D, Hawro M, Kowalska J, Jaroszewicz J, Sikorska K, Flisiak R. Short-term exposure to ambient air pollution and COVID-19 severity during SARS-CoV-2 Delta and Omicron waves: A multicenter study. J Med Virol 2023; 95:e28962. [PMID: 37466326 DOI: 10.1002/jmv.28962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023]
Abstract
Air pollution may affect the clinical course of respiratory diseases, including COVID-19. This study aimed to evaluate the relationship between exposure of adult patients to mean 24 h levels of particulate matter sized <10 μm (PM10 ) and <2.5 μm (PM2.5 ) and benzo(a)pyrene (B(a)P) during a week before their hospitalization due to SARS-CoV-2 infection and symptomatology, hyperinflammation, coagulopathy, the clinical course of disease, and outcome. The analyses were conducted during two pandemic waves: (i) dominated by highly pathogenic Delta variant (n = 1440) and (ii) clinically less-severe Omicron (n = 785), while the analyzed associations were adjusted for patient's age, BMI, gender, and comorbidities. The exposure to mean 24 h B(a)P exceeding the limits was associated with increased odds of fever and fatigue as early COVID-19 symptoms, hyperinflammation due to serum C-reactive protein >200 mg/L and interleukin-6 >100 pg/mL, coagulopathy due to d-dimer >2 mg/L and fatal outcome. Elevated PM10 and PM2. 5 levels were associated with higher odds of respiratory symptoms, procalcitonin >0.25 ng/mL and interleukin >100 pg/mL, lower oxygen saturation, need for oxygen support, and death. The significant relationships between exposure to air pollutants and the course and outcomes of COVID-19 were observed during both pandemic waves. Short-term exposure to elevated PM and B(a)P levels can be associated with a worse clinical course of COVID-19 in patients requiring hospitalization and, ultimately, contribute to the health burden caused by SARS-CoV-2 variants of higher and lower clinical significance.
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Affiliation(s)
- Barbara Poniedziałek
- Department of Environmental Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, Poznań, Poland
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), Poznań, Poland
| | | | - Magdalena Rogalska
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, Poland
| | - Marta Rorat
- Department of Forensic Medicine, Wrocław Medical University, Wroclaw, Poland
| | - Piotr Czupryna
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Bialystok, Poland
| | - Dorota Kozielewicz
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Marcin Hawro
- Department of Infectious Diseases and Hepatology, Medical Center in Łańcut, Łańcut, Poland
| | - Justyna Kowalska
- Department of Adult's Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jerzy Jaroszewicz
- Department of Infectious Diseases and Hepatology, Medical University of Silesia in Katowice, Bytom, Poland
| | - Katarzyna Sikorska
- Division of Tropical Medicine and Epidemiology, Faculty of Health Sciences, Medical University of Gdańsk, Gdańsk, Poland
- Division of Tropical and Parasitic Diseases, Faculty of Health Sciences, Medical University of Gdańsk, Gdańsk, Poland
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, Poland
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Huespe IA, Ferraris A, Lalueza A, Valdez PR, Peroni ML, Cayetti LA, Mirofsky MA, Boietti B, Gómez-Huelgas R, Casas-Rojo JM, Antón-Santos JM, Núñez-Cortés JM, Lumbreras C, Ramos-Rincón JM, Barrio NG, Pedrera-Jiménez M, Martin-Escalante MD, Ruiz FR, Onieva-García MÁ, Toso CR, Risk MR, Klén R, Pollán JA, Gómez-Varela D. COVID-19 vaccines reduce mortality in hospitalized patients with oxygen requirements: Differences between vaccine subtypes. A multicontinental cohort study. J Med Virol 2023; 95:e28786. [PMID: 37212340 DOI: 10.1002/jmv.28786] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/21/2023] [Accepted: 05/01/2023] [Indexed: 05/23/2023]
Abstract
The aim of this study was to analyze whether the coronavirus disease 2019 (COVID-19) vaccine reduces mortality in patients with moderate or severe COVID-19 disease requiring oxygen therapy. A retrospective cohort study, with data from 148 hospitals in both Spain (111 hospitals) and Argentina (37 hospitals), was conducted. We evaluated hospitalized patients for COVID-19 older than 18 years with oxygen requirements. Vaccine protection against death was assessed through a multivariable logistic regression and propensity score matching. We also performed a subgroup analysis according to vaccine type. The adjusted model was used to determine the population attributable risk. Between January 2020 and May 2022, we evaluated 21,479 COVID-19 hospitalized patients with oxygen requirements. Of these, 338 (1.5%) patients received a single dose of the COVID-19 vaccine and 379 (1.8%) were fully vaccinated. In vaccinated patients, mortality was 20.9% (95% confidence interval [CI]: 17.9-24), compared to 19.5% (95% CI: 19-20) in unvaccinated patients, resulting in a crude odds ratio (OR) of 1.07 (95% CI: 0.89-1.29; p = 0.41). However, after considering the multiple comorbidities in the vaccinated group, the adjusted OR was 0.73 (95% CI: 0.56-0.95; p = 0.02) with a population attributable risk reduction of 4.3% (95% CI: 1-5). The higher risk reduction for mortality was with messenger RNA (mRNA) BNT162b2 (Pfizer) (OR 0.37; 95% CI: 0.23-0.59; p < 0.01), ChAdOx1 nCoV-19 (AstraZeneca) (OR 0.42; 95% CI: 0.20-0.86; p = 0.02), and mRNA-1273 (Moderna) (OR 0.68; 95% CI: 0.41-1.12; p = 0.13), and lower with Gam-COVID-Vac (Sputnik) (OR 0.93; 95% CI: 0.6-1.45; p = 0.76). COVID-19 vaccines significantly reduce the probability of death in patients suffering from a moderate or severe disease (oxygen therapy).
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Affiliation(s)
- Ivan A Huespe
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
- Medicine Department, University of Buenos Aires, Buenos Aires, Argentina
| | - Augusto Ferraris
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Antonio Lalueza
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense University, Madrid, Spain
| | | | - Maria L Peroni
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Luis A Cayetti
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Matias A Mirofsky
- Hospital Municipal de Agudos "Dr. Leónidas Lucero", Bahía Blanca, Argentina
| | - Bruno Boietti
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Gómez-Huelgas
- Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Málaga, Spain
| | | | | | | | - Carlos Lumbreras
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense University, Madrid, Spain
| | | | - Noelia G Barrio
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense University, Madrid, Spain
| | - Miguel Pedrera-Jiménez
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense University, Madrid, Spain
| | | | | | | | - Carlos R Toso
- Medicine Department, University of Buenos Aires, Buenos Aires, Argentina
| | - Marcelo R Risk
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), CONICET-HIBA-IUHI, Buenos Aires, Argentina
| | - Riku Klén
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Javier A Pollán
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - David Gómez-Varela
- Department of Pharmaceutical Sciences, Division of Pharmacology and Toxicology, University of Vienna, Vienna, Austria
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7
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The Effect of Reduced Oxygen Saturation on Retinal Microvascularization in COVID-19 Patients with Bilateral Pneumonia Based on Optical Coherence Tomography Study. J Pers Med 2022; 12:jpm12111824. [PMID: 36573721 PMCID: PMC9692346 DOI: 10.3390/jpm12111824] [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: 08/30/2022] [Revised: 10/25/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
Abstract
The aim of the study was to evaluate changes in the retinal thickness and microvasculature based on optical coherence tomography (OCT) depending on baseline oxygen saturation (SpO2) in patients hospitalized due to COVID-19 bilateral pneumonia. The prospective study was carried out among 62 patients with COVID-19 pneumonia who underwent ophthalmic examination after hospital discharge. They were divided into three groups depending on the oxygen saturation (SpO2) on admission: ≤90% (group 1), >90% and ≤95% (group 2), and >95% (group 3). The following parameters were assessed in the ophthalmological examination and correlated with the baseline SpO2: ganglion cell layer (GCL), the retinal nerve fiber layer (RNFL) in the macular area, RNFL in the peripapillary area, the foveal avascular zone (FAZ) in superficial capillary plexus (SCP) and deep capillary plexus (DCP), vessel density (VD) in SCP, in DCP, and in the choriocapillaris plexus (CC). Baseline saturation ≤90% in COVID-19 patients caused a decrease of VD in some areas of SCP and DCP and an increase in FAZ area in SCP and DCP. In the group of patients with SpO2 ≤ 90% statistically significant thinning of the retina in the inner superior ring (ISR) (p = 0.029), the inner temporal ring (ITR) (p = 0.34), the outer superior ring (OSR) (p = 0.012), and the outer temporal ring (OTR) (p= 0.004)] was observed. The statistically significant thickening of RNFL optic disc and thinning of RNFL retina in some macular areas in patients with SpO2 ≤ 90% were reported. The size of FAZ area in SCP and vessel density were significantly greater in some areas of SCP, DCP, and CC in patients with SpO2 ≤ 90% (p = 0.025). Baseline oxygen saturation ≤90% has been found to influence the ocular parameters of OCT in COVID-19 patients. We noticed a widened FAZ zone in SCP and increased VD in some regions of the retina and choroid as a response to systemic hypoxia.
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Attitudes toward Receiving COVID-19 Booster Dose in the Middle East and North Africa (MENA) Region: A Cross-Sectional Study of 3041 Fully Vaccinated Participants. Vaccines (Basel) 2022; 10:vaccines10081270. [PMID: 36016158 PMCID: PMC9414713 DOI: 10.3390/vaccines10081270] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 01/14/2023] Open
Abstract
COVID-19 vaccines are crucial to control the pandemic and avoid COVID-19 severe infections. The rapid evolution of COVID-19 variants such as B.1.1.529 is alarming, especially with the gradual decrease in serum antibody levels in vaccinated individuals. Middle Eastern countries were less likely to accept the initial doses of vaccines. This study was directed to determine COVID-19 vaccine booster acceptance and its associated factors in the general population in the MENA region to attain public herd immunity. We conducted an online survey in five countries (Egypt, Iraq, Palestine, Saudi Arabia, and Sudan) in November and December 2021. The questionnaire included self-reported information about the vaccine type, side effects, fear level, and several demographic factors. Kruskal−Wallis ANOVA was used to associate the fear level with the type of COVID-19 vaccine. Logistic regression was performed to confirm the results and reported as odds ratios (ORs) and 95% confidence intervals. The final analysis included 3041 fully vaccinated participants. Overall, 60.2% of the respondents reported willingness to receive the COVID-19 booster dose, while 20.4% were hesitant. Safety uncertainties and opinions that the booster dose is not necessary were the primary reasons for refusing the booster dose. The willingness to receive the booster dose was in a triangular relationship with the side effects of first and second doses and the fear (p < 0.0001). Females, individuals with normal body mass index, history of COVID-19 infection, and influenza-unvaccinated individuals were significantly associated with declining the booster dose. Higher fear levels were observed in females, rural citizens, and chronic and immunosuppressed patients. Our results suggest that vaccine hesitancy and fear in several highlighted groups continue to be challenges for healthcare providers, necessitating public health intervention, prioritizing the need for targeted awareness campaigns, and facilitating the spread of evidence-based scientific communication.
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Rzymski P, Poniedziałek B, Rosińska J, Rogalska M, Zarębska-Michaluk D, Rorat M, Moniuszko-Malinowska A, Lorenc B, Kozielewicz D, Piekarska A, Sikorska K, Dworzańska A, Bolewska B, Angielski G, Kowalska J, Podlasin R, Oczko-Grzesik B, Mazur W, Szymczak A, Flisiak R. The association of airborne particulate matter and benzo[a]pyrene with the clinical course of COVID-19 in patients hospitalized in Poland. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 306:119469. [PMID: 35580710 PMCID: PMC9106990 DOI: 10.1016/j.envpol.2022.119469] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 05/06/2023]
Abstract
Air pollution can adversely affect the immune response and increase the severity of the viral disease. The present study aimed to explore the relationship between symptomatology, clinical course, and inflammation markers of adult patients with coronavirus disease 2019 (COVID-19) hospitalized in Poland (n = 4432) and air pollution levels, i.e., mean 24 h and max 24 h level of benzo(a)pyrene (B(a)P) and particulate matter <10 μm (PM10) and <2.5 μm (PM2.5) during a week before their hospitalization. Exposures to PM2.5 and B(a)P exceeding the limits were associated with higher odds of early respiratory symptoms of COVID-19 and hyperinflammatory state: interleukin-6 > 100 pg/mL, procalcitonin >0.25 ng/mL, and white blood cells count >11 × 103/mL. Except for the mean 24 h PM10 level, the exceedance of other air pollution parameters was associated with increased odds for oxygen saturation <90%. Exposure to elevated PM2.5 and B(a)P levels increased the odds of oxygen therapy and death. This study evidences that worse air quality is related to increased severity of COVID-19 and worse outcome in hospitalized patients. Mitigating air pollution shall be an integral part of measures undertaken to decrease the disease burden during a pandemic of viral respiratory illness.
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Affiliation(s)
- Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806, Poznań, Poland; Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), 60-806, Poznań, Poland.
| | - Barbara Poniedziałek
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806, Poznań, Poland.
| | - Joanna Rosińska
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806, Poznań, Poland.
| | - Magdalena Rogalska
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-089, Białystok, Poland.
| | | | - Marta Rorat
- Department of Forensic Medicine, Wrocław Medical University, 50-367, Wrocław, Poland; First Infectious Diseases Ward, Gromkowski Regional Specialist Hospital in Wrocław, 51-149, Wrocław, Poland.
| | - Anna Moniuszko-Malinowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, 15-089, Białystok, Poland.
| | - Beata Lorenc
- Pomeranian Center of Infectious Diseases, Department of Infectious Diseases, 80-210, Gdańsk, Poland.
| | - Dorota Kozielewicz
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100, Toruń, Poland.
| | - Anna Piekarska
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, 90-549, Łódź, Poland.
| | - Katarzyna Sikorska
- Department of Tropical Medicine and Epidemiology, Medical University of Gdańsk, 80-210, Gdańsk, Poland.
| | - Anna Dworzańska
- Department of Infectious Diseases and Hepatology, Medical University of Lublin, 20-059, Lublin, Poland.
| | - Beata Bolewska
- Department of Infectious Diseases, Poznan University of Medical Sciences, 61-701, Poznań, Poland.
| | | | - Justyna Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, 02-091, Warsaw, Poland.
| | - Regina Podlasin
- Regional Hospital of Infectious Diseases in Warsaw, Warsaw, Poland.
| | - Barbara Oczko-Grzesik
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, 40-055, Katowice, Poland.
| | - Włodzimierz Mazur
- Clinical Department of Infectious Diseases in Chorzów, Medical University of Silesia, Katowice, Poland.
| | - Aleksandra Szymczak
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiencies, Wroclaw Medical University, Wrocław, Poland.
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-089, Białystok, Poland.
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Otto M, Burrell AJ, Serpa Neto A, Alliegro PV, Trapani T, Cheng A, Udy AA. Clinical Characteristics and Outcomes of Critically Ill Patients with 1, 2 and 3 doses of Vaccination against COVID-19 in Australia. Intern Med J 2022; 53:330-338. [PMID: 35841294 PMCID: PMC9349669 DOI: 10.1111/imj.15884] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/03/2022] [Indexed: 01/08/2023]
Abstract
Background Vaccination has been shown to be highly effective in preventing death and severe disease from severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Currently few studies have directly compared vaccinated and unvaccinated patients with severe COVID‐19 in the intensive care unit (ICU). Aims Our aim was to compare the clinical characteristics and outcomes of vaccine recipients and unvaccinated patients with SARS‐CoV‐2 infection admitted to the ICU in a nationwide setting. Materials and Methods Data were extracted from the Short PeRiod IncideNce sTudy of Severe Acute Respiratory Infection Australia, in 57 ICUs during Delta and Omicron predominant periods of the COVID‐19 pandemic. The primary outcome was in‐hospital mortality. Secondary outcomes included duration of mechanical ventilation, ICU length of stay, hospital length of stay, and ICU mortality. Results 2,970 patients were admitted to ICU across participating sites from 26 June 2021 to 8 February 2022. 1,134 (38.2%) patients were vaccine recipients, and 1,836 (61.8%) patients were unvaccinated. Vaccine recipients were older, more comorbid, and less likely to require organ support. Unadjusted in‐hospital mortality was greater in the vaccinated cohort. After adjusting for age, gender and comorbid status, no statistically significant association between in‐hospital or ICU mortality, and vaccination status, was apparent. Conclusion We found COVID‐19 infection can cause severe disease and death in vaccine recipients, though comorbid status and older age were significant contributors to mortality. Organ support requirements and the number of deaths were highest in the unvaccinated cohort. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Madeleine Otto
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Aidan Jc Burrell
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Patricia Villodre Alliegro
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Tony Trapani
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Allen Cheng
- Infection Prevention and Healthcare Epidemiology Unit, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Infectious Diseases Epidemiology, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Andrew A Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia.,Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Bajpai J, Kant S, Verma A, Patwa AK, Atam V, Chaudhary SC, Pandey A. The Severity of COVID 19 Pneumonia in Vaccinated vs. Non-vaccinated Patients in the Second Wave: An Experience From a Tertiary Care Center in India. Cureus 2022; 14:e25378. [PMID: 35774652 PMCID: PMC9236633 DOI: 10.7759/cureus.25378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 11/05/2022] Open
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12
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Mikhael EM, Ong SC, Sheikh Ghadzi SM. Efficacy and Safety of Sitagliptin in the Treatment of COVID-19. J Pharm Pract 2022:8971900221102119. [PMID: 35581701 PMCID: PMC9121144 DOI: 10.1177/08971900221102119] [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] [Indexed: 01/17/2023]
Abstract
Background: Coronavirus disease 2019 (COVID-19) is associated with a high risk of mortality especially among diabetes mellitus (DM) patients. Effective treatments against COVID-19 can complement the vaccination effort worldwide. Many review articles studied the effects of the dipeptidyl peptidase 4 (DPP-4) inhibitors among COVID-19 patients and found conflicting results. This heterogeneity may be due to different systemic pleiotropic effects of different DPP-4 inhibitors. Sitagliptin appears to be one of the good DPP-4 inhibitors that have antiinflammatory and antithrombotic effect. Therefore, this review assessed the benefits and safety of sitagliptin in the treatment of COVID-19. Methods: A detailed literature review using the electronic databases of Pubmed and Google Scholar was conducted during July and August 2021 to find out studies that published in English language and discussed the role of sitagliptin for COVID-19 patients. Results: 14 articles were eligible and thus included in this narrative review. Nine of these articles agreed to the benefit of sitagliptin in the treatment of COVID-19, while 3 studies considered sitagliptin as non useful or even risky, and one study was neutral in its conclusion towards the usage of sitagliptin in COVID-19. Only one study focused on the safety of sitagliptin and found that it is safe. Conclusion: Sitagliptin has anti-inflammatory, antifibrotic and antiapoptotic properties; such effects may be beneficial in reducing risks of COVID-19. Sitagliptin has good safety and fair benefits to reduce mortality among DM patients with COVID-19. Further randomized clinical trials are needed to confirm these benefits especially among patients without DM.
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Affiliation(s)
- Ehab Mudher Mikhael
- School of Pharmaceutical Sciences, 26689Universiti Sains Malaysia, Penang, Malaysia.,Clinical Pharmacy Department - College of Pharmacy, 108491University of Baghdad, Baghdad, Iraq
| | - Siew Chin Ong
- School of Pharmaceutical Sciences, 26689Universiti Sains Malaysia, Penang, Malaysia
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13
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Freund O, Tau L, Weiss TE, Zornitzki L, Frydman S, Jacob G, Bornstein G. Associations of vaccine status with characteristics and outcomes of hospitalized severe COVID-19 patients in the booster era. PLoS One 2022; 17:e0268050. [PMID: 35536849 PMCID: PMC9089907 DOI: 10.1371/journal.pone.0268050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/20/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The resurgence of COVID-19 cases since June 2021, referred to as the fourth COVID-19 wave, has led to the approval and administration of booster vaccines. Our study aims to identify any associations between vaccine status with the characteristics and outcomes of patients hospitalized with severe COVID-19 disease. METHODS We retrospectively reviewed all COVID-19 patients admitted to a large tertiary center between July 25 and October 25, 2021 (fourth wave in Israel). Univariant and multivariant analyses of variables associated with vaccine status were performed. FINDINGS Overall, 349 patients with severe or critical disease were included. Patients were either not vaccinated (58%), had the first two vaccine doses (35%) or had the booster vaccine (7%). Vaccinated patients were significantly older, male predominant, and with a higher number of comorbidities including diabetes, hyperlipidemia, ischemic heart disease, heart failure, immunodeficient state, kidney disease and cognitive decline. Time from the first symptom to hospital admission was longer among non-vaccinated patients (7.2 ± 4.4 days, p = 0.002). Critical disease (p<0.05), admissions to the intensive care unit (p = 0.01) and advanced oxygen support (p = 0.004) were inversely proportional to the number of vaccines given, lowest among the booster vaccine group. Death (20%, p = 0.83) and hospital stay duration (8.05± 8.47, p = 0.19) were similar between the groups. CONCLUSION Hospitalized vaccinated patients with severe COVID-19 had significantly higher rates of most known risk factors for COVID-19 adverse outcomes. Still, all disease outcomes were similar or better compared with the non-vaccinated patients.
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Affiliation(s)
- Ophir Freund
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Luba Tau
- Infectious Diseases Unit, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tali Epstein Weiss
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Zornitzki
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Frydman
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giris Jacob
- Medicine F, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Bornstein
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Yavuz SŞ, Tunçer G, Altuntaş-Aydın Ö, Aydın M, Pehlivanoğlu F, Tok Y, Mese S, Gündüz A, Güçlü CG, Özdoğan İ, Hemiş-Aydın B, Soğuksu P, Benli A, Başaran S, Midilli K, Eraksoy H. Comparison of the Clinical and Laboratory Findings and Outcomes of Hospitalized COVID-19 Patients Who Were Either Fully Vaccinated with Coronavac or Not: An Analytical, Cross Sectional Study. Vaccines (Basel) 2022; 10:733. [PMID: 35632489 PMCID: PMC9148084 DOI: 10.3390/vaccines10050733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 01/27/2023] Open
Abstract
COVID-19 vaccines are highly protective against severe disease; however, vaccine breakthrough infections resulting in hospitalization may still occur in a small percentage of vaccinated individuals. We investigated whether the clinical and microbiological features and outcomes were different between hospitalized COVID-19 patients who were either fully vaccinated with Coronovac or not. All hospitalized COVID-19 patients who had at least one dose of Coronavac were included in the study. The oldest unvaccinated patients with comorbidities, who were hospitalized during the same period, were chosen as controls. All epidemiologic, clinical and laboratory data of the patients were recorded and compared between the fully vaccinated and unvaccinated individuals. There were 69 and 217 patients who had been either fully vaccinated with Coronavac or not, respectively. All breakthrough infections occurred in the first 3 months of vaccination. Fully vaccinated patients were older and had more comorbidities than unvaccinated patients. There were minor differences between the groups in symptoms, physical and laboratory findings, anti-spike IgG positivity rate and level, the severity of COVID-19, complications, and clinical improvement rate. The mortality rate of fully vaccinated patients was higher than the mortality rate in unvaccinated patients in univariate analysis, which was attributed to the fact that vaccinated patients were older and had more comorbidities. The severity and clinical outcomes of hospitalized patients with breakthrough COVID-19 after Coronavac vaccination were similar to those of unvaccinated patients. Our findings suggest that the immune response elicited by Coronovac could be insufficient to prevent COVID-19-related severe disease and death within 3 months of vaccination among elderly people with comorbidities.
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Affiliation(s)
- Serap Şimşek Yavuz
- Department of Infectious Disease and Clinical Microbiology, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey; (B.H.-A.); (A.B.); (S.B.); (H.E.)
| | - Gülşah Tunçer
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, İstanbul 34093, Turkey; (G.T.); (F.P.); (C.G.G.)
| | - Özlem Altuntaş-Aydın
- Department of Infectious Diseases and Clinical Microbiology, Çam and Sakura City Hospital, İstanbul 34093, Turkey; (Ö.A.-A.); (A.G.)
| | - Mehtap Aydın
- Department of Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, İstanbul 34093, Turkey; (M.A.); (İ.Ö.)
| | - Filiz Pehlivanoğlu
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, İstanbul 34093, Turkey; (G.T.); (F.P.); (C.G.G.)
| | - Yeşim Tok
- Department of Medical Microbiology, Cerrahpaşa Faculty of Medicine, Division of Virology, Istanbul Cerrahpaşa University, İstanbul 34093, Turkey; (Y.T.); (K.M.)
| | - Sevim Mese
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Division of Virology and Fundamental Immunology, Istanbul University, İstanbul 34093, Turkey; (S.M.); (P.S.)
| | - Alper Gündüz
- Department of Infectious Diseases and Clinical Microbiology, Çam and Sakura City Hospital, İstanbul 34093, Turkey; (Ö.A.-A.); (A.G.)
| | - Ceyda Geyiktepe Güçlü
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital, İstanbul 34093, Turkey; (G.T.); (F.P.); (C.G.G.)
| | - İklima Özdoğan
- Department of Infectious Diseases and Clinical Microbiology, Ümraniye Training and Research Hospital, İstanbul 34093, Turkey; (M.A.); (İ.Ö.)
| | - Börçe Hemiş-Aydın
- Department of Infectious Disease and Clinical Microbiology, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey; (B.H.-A.); (A.B.); (S.B.); (H.E.)
| | - Pınar Soğuksu
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Division of Virology and Fundamental Immunology, Istanbul University, İstanbul 34093, Turkey; (S.M.); (P.S.)
| | - Aysun Benli
- Department of Infectious Disease and Clinical Microbiology, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey; (B.H.-A.); (A.B.); (S.B.); (H.E.)
| | - Seniha Başaran
- Department of Infectious Disease and Clinical Microbiology, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey; (B.H.-A.); (A.B.); (S.B.); (H.E.)
| | - Kenan Midilli
- Department of Medical Microbiology, Cerrahpaşa Faculty of Medicine, Division of Virology, Istanbul Cerrahpaşa University, İstanbul 34093, Turkey; (Y.T.); (K.M.)
| | - Haluk Eraksoy
- Department of Infectious Disease and Clinical Microbiology, İstanbul Faculty of Medicine, İstanbul University, İstanbul 34093, Turkey; (B.H.-A.); (A.B.); (S.B.); (H.E.)
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15
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Rzymski P, Pazgan-Simon M, Kamerys J, Moniuszko-Malinowska A, Sikorska K, Wernik J, Zarębska-Michaluk D, Supronowicz Ł, Sobala-Szczygieł B, Skrzat-Klapaczyńska A, Simon K, Piekarska A, Czupryna P, Pawłowska M, Brzdęk M, Jaroszewicz J, Kowalska J, Renke M, Flisiak R. Severe Breakthrough COVID-19 Cases during Six Months of Delta Variant (B.1.617.2) Domination in Poland. Vaccines (Basel) 2022; 10:557. [PMID: 35455306 PMCID: PMC9025315 DOI: 10.3390/vaccines10040557] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 02/04/2023] Open
Abstract
The emergence of a highly transmissible and a more pathogenic B.1.617.2 (delta) variant of SARS-CoV-2 has brought concern over COVID-19 vaccine efficacy and the increased risk of severe breakthrough infections. The objective of this study was to assess the frequency and the clinical characteristics of severe breakthrough COVID-19 cases recorded in 10 Polish healthcare units between 1 June and 31 December 2021, a period during which a rapid surge in the share of B.1.617.2 infections was seen, while a significant number of populations were already fully vaccinated. Overall, 723 individuals who completed the initial vaccination regime (fully vaccinated group) and an additional 18 who received a booster dose were identified—together, they represented 20.8% of all the COVID-19 patients hospitalized during the same period in the same healthcare institutions (0.5% in the case of a group that received a booster dose). Although laboratory and clinical parameters did not differ between both groups, patients who received a booster tended to have lower CRP, IL-6, PCT, and d-dimer levels and they required oxygen therapy less frequently. The most common early COVID-19 symptoms in the studied group were fatigue, cough, fever (>38 °C), and dyspnea. Individuals with no detectable anti-spike IgG antibodies constituted 13%; the odds of being a humoral non-responder to the vaccine were increased in patients aged >70 years. Fully vaccinated patients hospitalized after more than 180 days from the last vaccine dose were significantly older and they were predominantly represented by individuals over 70 years and with comorbidities, particularly cardiovascular disease. Contrary to mRNA vaccines, most patients vaccinated with adenoviral vector vaccines were infected within six months. A total of 102 fatal cases (14% of all deaths among vaccinated individuals; 0.7% in the case of a group that received a booster dose) were recorded, representing 17.6% of all the COVID-19 fatalities recorded in June−December 2021 in the considered healthcare units. The odds of death were significantly increased in men, individuals aged >70 years, patients with comorbidities, and those identified as humoral non-responders to vaccination; in fully vaccinated patients the odds were also increased when the second vaccine dose was given >180 days before the first COVID-19 symptoms. The mortality rate in immunocompromised subjects was 19%. The results indicate that compared to vaccinated individuals, severe COVID-19 and deaths in the unvaccinated group were significantly more prevalent during the B.1.617.2-dominated wave in Poland; and, it highlight the protective role of a booster dose, particularly for more vulnerable individuals.
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Affiliation(s)
- Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), 60-806 Poznań, Poland
| | - Monika Pazgan-Simon
- 1st Infectious Diseases Ward, Gromkowski Regional Specialist Hospital, 50-149 Wroclaw, Poland;
- Department of Infectious Diseases and Hepatology, Wrocław Medical University, 51-149 Wrocław, Poland;
| | - Juliusz Kamerys
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, 90-549 Łódź, Poland; (J.K.); (A.P.)
| | - Anna Moniuszko-Malinowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, 15-089 Białystok, Poland; (A.M.-M.); (P.C.)
| | - Katarzyna Sikorska
- Department of Tropical Medicine and Epidemiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | - Joanna Wernik
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Toruń, Poland; (J.W.); (M.P.)
| | - Dorota Zarębska-Michaluk
- Department of Infectious Diseases, Jan Kochanowski University, 25-369 Kielce, Poland; (D.Z.-M.); (M.B.)
| | - Łukasz Supronowicz
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-089 Białystok, Poland; (Ł.S.); (R.F.)
| | - Barbara Sobala-Szczygieł
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, 40-055 Katowice, Poland; (B.S.-S.); (J.J.)
| | - Agata Skrzat-Klapaczyńska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-K.); (J.K.)
| | - Krzysztof Simon
- Department of Infectious Diseases and Hepatology, Wrocław Medical University, 51-149 Wrocław, Poland;
| | - Anna Piekarska
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, 90-549 Łódź, Poland; (J.K.); (A.P.)
| | - Piotr Czupryna
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, 15-089 Białystok, Poland; (A.M.-M.); (P.C.)
| | - Małgorzata Pawłowska
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Toruń, Poland; (J.W.); (M.P.)
| | - Michał Brzdęk
- Department of Infectious Diseases, Jan Kochanowski University, 25-369 Kielce, Poland; (D.Z.-M.); (M.B.)
| | - Jerzy Jaroszewicz
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, 40-055 Katowice, Poland; (B.S.-S.); (J.J.)
| | - Justyna Kowalska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.S.-K.); (J.K.)
| | - Marcin Renke
- Division of Occupational, Metabolic and Internal Diseases, Institute of Maritime and Tropical Medicine, Faculty of Health Sciences, Medical University of Gdansk, 81-519 Gdynia, Poland;
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-089 Białystok, Poland; (Ł.S.); (R.F.)
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16
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Does Hospitalization Change the Perception of COVID-19 Vaccines among Unvaccinated Patients? Vaccines (Basel) 2022; 10:vaccines10030476. [PMID: 35335108 PMCID: PMC8950102 DOI: 10.3390/vaccines10030476] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 12/21/2022] Open
Abstract
The COVID-19 vaccination has been the subject of unprecedented misinformation, false news, and public concerns. This study presents a unique analysis comprising persons who were not vaccinated and became ill. It investigates reasons for not vaccinating and evaluates how the personal experience of COVID-19 affected further attitudes and decisions related to health. The study included 730 consecutive unvaccinated patients hospitalized in 12 centers in Poland during the autumn 2021 pandemic wave. The most frequent reason behind the refusal to receive the vaccine was concern over the adverse effects, disbelief that the vaccine was sufficiently tested, and one’s conviction that COVID-19 will not affect a patient. Online information, friends, spouse, children/grandchildren, and other family members were most often the source of discouragement from vaccination. Most individuals regretted their decision not to receive a vaccine (66.0%), declared to promote COVID-19 vaccination after discharge (64.0%), and to receive a COVID-19 vaccine in the time recommended for convalescents (69.5%). Individuals expressing no regrets of vaccine refusal more frequently revealed conspiracy beliefs. The study shows that personal experience with severe COVID-19 can influence the perception of vaccination, but approximately one-third of unvaccinated hospitalized patients still appear to express vaccine hesitancy.
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17
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Sikora D, Rzymski P. COVID-19 Vaccination and Rates of Infections, Hospitalizations, ICU Admissions, and Deaths in the European Economic Area during Autumn 2021 Wave of SARS-CoV-2. Vaccines (Basel) 2022; 10:437. [PMID: 35335069 PMCID: PMC8955952 DOI: 10.3390/vaccines10030437] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 01/14/2023] Open
Abstract
The COVID-19 vaccination campaigns were met with a varying level of vaccine hesitancy in Europe. We analyzed the potential relationships between COVID-19 vaccine coverage in different countries of the European Economic Area and rates of infection, hospitalizations, admissions to intensive care units (ICU), and deaths during the autumn 2021 SARS-CoV-2 wave (September-December). Significant negative correlations between infection rates and the percentage of fully vaccinated individuals were found during September, October, and November, but not December. The loss of this protective effect in December is likely due to the emergence of the omicron (B.1.1.529) variant, better adapted to evade vaccine-induced humoral immunity. For every considered month, the negative linear associations between the vaccine coverage and mean number of hospitalizations (r= -0.61 to -0.88), the mean number of ICU admissions (r= -0.62 to -0.81), and death rate (r= -0.64 to -0.84) were observed. The results highlight that vaccines provided significant benefits during autumn 2021. The vaccination of unvaccinated individuals should remain the primary strategy to decrease the hospital overloads, severe consequences of COVID-19, and deaths.
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Affiliation(s)
- Dominika Sikora
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland;
- Doctoral School, Poznan University of Medical Sciences, Fredry St. 10, 61-701 Poznań, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland;
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), 60-806 Poznań, Poland
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18
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Flisiak R, Rzymski P, Zarębska-Michaluk D, Rogalska M, Rorat M, Czupryna P, Lorenc B, Ciechanowski P, Kozielewicz D, Piekarska A, Pokorska-Śpiewak M, Sikorska K, Tudrujek M, Bolewska B, Angielski G, Kowalska J, Podlasin R, Mazur W, Oczko-Grzesik B, Zaleska I, Szymczak A, Frańczak-Chmura P, Sobolewska-Pilarczyk M, Kłos K, Figlerowicz M, Leszczyński P, Kucharek I, Grabowski H. Demographic and Clinical Overview of Hospitalized COVID-19 Patients during the First 17 Months of the Pandemic in Poland. J Clin Med 2021; 11:jcm11010117. [PMID: 35011858 PMCID: PMC8745464 DOI: 10.3390/jcm11010117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
Long-term analyses of demographical and clinical characteristics of COVID-19 patients can provide a better overview of the clinical course of the disease. They can also help understand whether changes in infection symptomatology, disease severity, and outcome occur over time. We aimed to analyze the demographics, early symptoms of infection, laboratory parameters, and clinical manifestation of COVID-19 patients hospitalized during the first 17 months of the pandemic in Poland (March 2020-June 2021). The patients' demographical and clinical data (n = 5199) were extracted from the national SARSTer database encompassing 30 medical centers in Poland and statistically assessed. Patients aged 50-64 were most commonly hospitalized due to COVID-19 regardless of the pandemic period. There was no shift in the age of admitted patients and patients who died throughout the studied period. Men had higher C-reactive protein and interleukin-6 levels and required oxygenation and mechanical ventilation more often. No gender difference in fatality rate was seen, although the age of males who died was significantly lower. A share of patients with baseline SpO2 < 91%, presenting respiratory, systemic and gastrointestinal symptoms was higher in the later phase of a pandemic than in the first three months. Cough, dyspnea and fever were more often presented in men, while women had a higher frequency of anosmia, diarrhea, nausea and vomiting. This study shows some shifts in SARS-CoV-2 pathogenicity between March 2020 and July 2021 in the Polish cohort of hospitalized patients and documents various gender-differences in this regard. The results represent a reference point for further analyses conducted under the dominance of different SARS-CoV-2 variants.
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Affiliation(s)
- Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-089 Bialystok, Poland;
- Correspondence: (R.F.); (P.R.); (D.Z.-M.)
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), 60-806 Poznan, Poland
- Correspondence: (R.F.); (P.R.); (D.Z.-M.)
| | - Dorota Zarębska-Michaluk
- Department of Infectious Diseases, Jan Kochanowski University, 25-369 Kielce, Poland
- Correspondence: (R.F.); (P.R.); (D.Z.-M.)
| | - Magdalena Rogalska
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-089 Bialystok, Poland;
| | - Marta Rorat
- Department of Forensic Medicine, Wrocław Medical University, 50-367 Wroclaw, Poland;
- First Infectious Diseases Ward, Gromkowski Regional Specialist Hospital in Wrocław, 51-149 Wroclaw, Poland
| | - Piotr Czupryna
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, 15-089 Bialystok, Poland;
| | - Beata Lorenc
- Pomeranian Center of Infectious Diseases, Department of Infectious Diseases, 80-210 Gdansk, Poland;
| | - Przemysław Ciechanowski
- Department of Paediatrics and Infectious Diseases, Regional Hospital in Szczecin, 71-455 Szczecin, Poland;
| | - Dorota Kozielewicz
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland; (D.K.); (M.S.-P.)
| | - Anna Piekarska
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, 90-549 Lodz, Poland;
| | - Maria Pokorska-Śpiewak
- Department of Children’s Infectious Diseases, Medical University of Warsaw, 01-201 Warsaw, Poland;
| | - Katarzyna Sikorska
- Department of Tropical Medicine and Epidemiology, Medical University of Gdańsk, 80-210 Gdansk, Poland;
| | - Magdalena Tudrujek
- Department of Infectious Diseases and Hepatology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Beata Bolewska
- Department of Infectious Diseases, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | | | - Justyna Kowalska
- Department of Adults’ Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Regina Podlasin
- Regional Hospital of Infectious Diseases in Warsaw, 01-301 Warsaw, Poland;
| | - Włodzimierz Mazur
- Clinical Department of Infectious Diseases in Chorzów, Medical University of Silesia, 41-500 Katowice, Poland;
| | - Barbara Oczko-Grzesik
- Department of Infectious Diseases and Hepatology, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Izabela Zaleska
- Department of Paediatrics and Infectious Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Aleksandra Szymczak
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiencies, Wroclaw Medical University, 51-149 Wrocław, Poland;
| | - Paulina Frańczak-Chmura
- Department of Children’s Infectious Diseases, Provincial Jan Boży Hospital, 20-089 Lublin, Poland;
| | - Małgorzata Sobolewska-Pilarczyk
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Torun, Poland; (D.K.); (M.S.-P.)
| | - Krzysztof Kłos
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, 04-141 Warsaw, Poland;
| | - Magdalena Figlerowicz
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, 60-572 Poznan, Poland;
| | - Piotr Leszczyński
- Department of Rheumatology, Rehabilitation and Internal Medicine, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Izabela Kucharek
- 2nd Department of Paediatrics, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland;
| | - Hubert Grabowski
- General, Endocrine and Transplant Surgery Department, Medical University of Gdańsk, 80-214 Gdansk, Poland;
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19
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Hwang J, Han YJ, Yon DK, Lee SW, Kim BK, Lee SB, Lee MH, Park SH, Koyanagi A, Jacob L, Tizaoui K, Kim SU, Shin JI, Smith L. Clinical significance of hepatosplenic thrombosis in vaccine-induced immune thrombotic thrombocytopenia after ChAdOx1 nCoV-19 vaccination. Int J Infect Dis 2021; 116:114-121. [PMID: 34958931 DOI: 10.1016/j.ijid.2021.12.352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/18/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare, serious complication after adenoviral COVID-19 vaccine administration that can involve various organ systems. We aimed to investigate the clinical significance of hepatosplenic thrombosis in patients with VITT. METHODS We searched PubMed ePubs, Scopus, Embase, and Web of Science databases for studies published until April 28, 2021 involving patients with VITT after ChAdOx1 nCoV-19 vaccination. Demographic and clinical characteristics including laboratory measurements were collected and compared. RESULTS Four case series and three case reports involving 48 cases of VITT were included. Hepatosplenic thrombosis was present in eight cases (17%). Patients with hepatosplenic thrombosis had lower platelet counts (13,000 vs. 29,500/μL, p=0.016) and higher D-dimer levels (140.0 vs. 57.3 times upper limit of normal range, p=0.028). Multiple-site thrombosis was also associated with hepatosplenic thrombosis (88% vs. 15%, p<0.001). CONCLUSIONS This is the first study comparing clinical profiles of patients with VITT according to the presence of hepatosplenic thrombosis. Patients with hepatosplenic thrombosis had more severe presentations with lower platelet counts, higher D-dimer levels, and higher rate of multiple-site thromboses. Further studies with larger sample sizes are required to establish definitive evidence regarding the significance of hepatosplenic thrombosis in VITT.
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Affiliation(s)
- Jimin Hwang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Young Joo Han
- Hospital medicine center, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Dong Keon Yon
- Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea; Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea; Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Beom Kyung Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea
| | - Se Bee Lee
- Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Min Ho Lee
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Park
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundacio Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain; ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Louis Jacob
- Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundacio Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain; Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Kalthoum Tizaoui
- Department of Basic Sciences, Medicine Faculty of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Seung Up Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Liver Center, Severance Hospital, Seoul, Republic of Korea.
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
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20
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Sessa F, Salerno M, Esposito M, Di Nunno N, Zamboni P, Pomara C. Autopsy Findings and Causality Relationship between Death and COVID-19 Vaccination: A Systematic Review. J Clin Med 2021; 10:jcm10245876. [PMID: 34945172 PMCID: PMC8709364 DOI: 10.3390/jcm10245876] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 01/02/2023] Open
Abstract
The current challenge worldwide is the administration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. Considering that the COVID-19 vaccination represents the best possibility to resolve this pandemic, this systematic review aims to clarify the major aspects of fatal adverse effects related to COVID-19 vaccines, with the goal of advancing our knowledge, supporting decisions, or suggesting changes in policies at local, regional, and global levels. Moreover, this review aims to provide key recommendations to improve awareness of vaccine safety. All studies published up to 2 December 2021 were searched using the following keywords: “COVID-19 Vaccine”, “SARS-CoV-2 Vaccine”, “COVID-19 Vaccination”, “SARS-CoV-2 Vaccination”, and “Autopsy” or “Post-mortem”. We included 17 papers published with fatal cases with post-mortem investigations. A total of 38 cases were analyzed: 22 cases were related to ChAdOx1 nCoV-19 administration, 10 cases to BNT162b2, 4 cases to mRNA-1273, and 2 cases to Ad26.COV2.S. Based on these data, autopsy is very useful to define the main characteristics of the so-called vaccine-induced immune thrombotic thrombocytopenia (VITT) after ChAdOx1 nCoV-19 vaccination: recurrent findings were intracranial hemorrhage and diffused microthrombi located in multiple areas. Moreover, it is fundamental to provide evidence about myocarditis related to the BNT162B2 vaccine. Finally, based on the discussed data, we suggest several key recommendations to improve awareness of vaccine safety.
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Affiliation(s)
- Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.S.); (M.E.)
| | - Massimiliano Esposito
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.S.); (M.E.)
| | - Nunzio Di Nunno
- Department of History, Society and Studies on Humanity, University of Salento, 73100 Lecce, Italy;
| | - Paolo Zamboni
- Vascular Diseases Center, Hub Center for Venous and Lymphatic Diseases Regione Emilia-Romagna, Sant’Anna University Hospital of Ferrara, 44121 Ferrara, Italy;
| | - Cristoforo Pomara
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.S.); (M.E.)
- Correspondence: ; Tel.: +39-095-3782-153 or +39-333-2466-148
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21
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Flisiak R, Pawłowska M, Rogalska-Płońska M, Bociąga-Jasik M, Kłos K, Piekarska A, Zarębska-Michaluk D. Effect of COVID-19 on Anti-S Antibody Response in Healthcare Workers Six Months Post-Vaccination. Vaccines (Basel) 2021; 9:vaccines9111325. [PMID: 34835257 PMCID: PMC8618383 DOI: 10.3390/vaccines9111325] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 10/30/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
The current study aimed to determine to what extent prior COVID-19 infection affects the response of specific antibodies following vaccination. The study involved 173 healthcare professionals who completed the two-dose vaccination course with BNT162b2, including 40 who previously experienced clinical COVID-19. The levels of anti-SARS-CoV-2 S1S2 IgG (anti-S) and, in some cases, anti-SARS-CoV-S-RBD IgG (anti-S-RBD) were determined six months after complete vaccination. A level exceeding the cut-off values for both anti-S and anti-S-RBD was observed in 100% of subjects, but after setting the analysis to 5- and 10-fold cut-off levels, the percentage of subjects meeting this criterion was significantly higher for anti-S-RBD. The 100-fold cut-off level was achieved by only 21% and 16% for anti-S and anti-S-RBD, respectively. Anti-S and anti-S-RBD levels above ten times the positive cut-off were respectively observed in 91% and 100% individuals with a history of COVID-19, while among those without COVID-19, these values were 64% and 90%, respectively. Significantly higher incidence of values above 10 and 100 times the cut-off became apparent among people with a history of COVID-19. In conclusion, vaccination against COVID-19 following infection with the disease provides higher levels of specific antibodies 6 months after vaccination than those of individuals without a history of the disease, which supports the use of a booster dose, particularly for those who have not experienced SARS-CoV-2 infection.
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Affiliation(s)
- Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-540 Bałystok, Poland;
- Correspondence: ; Tel.: +48-85-7416921
| | - Małgorzata Pawłowska
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 85-067 Bydgoszcz, Poland;
| | - Magdalena Rogalska-Płońska
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-540 Bałystok, Poland;
| | - Monika Bociąga-Jasik
- Department of Infectious and Tropical Diseases, Medical College, Jagiellonian University, 31-007 Krakow, Poland;
| | - Krzysztof Kłos
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, 04-141 Warsaw, Poland;
| | - Anna Piekarska
- Department of Infectious Diseases and Hepatology, Medical University of Łódź, 90-419 Łódź, Poland;
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22
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Kanduc D. From Genetics to Epigenetics: Top 4 Aspects for Improved SARS-CoV-2 Vaccine Designs as Paradigmatic Examples. Glob Med Genet 2021; 9:14-17. [PMID: 35169778 PMCID: PMC8837413 DOI: 10.1055/s-0041-1739495] [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: 09/14/2021] [Accepted: 09/29/2021] [Indexed: 11/03/2022] Open
Abstract
AbstractThis literature review described the genetic and biochemical factors that may have been overlooked in the formulation of vaccines and that most likely underlie possible issues with mass vaccination.
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Affiliation(s)
- Darja Kanduc
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Bari, Italy
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23
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Rzymski P, Camargo CA, Fal A, Flisiak R, Gwenzi W, Kelishadi R, Leemans A, Nieto JJ, Ozen A, Perc M, Poniedziałek B, Sedikides C, Sellke F, Skirmuntt EC, Stashchak A, Rezaei N. COVID-19 Vaccine Boosters: The Good, the Bad, and the Ugly. Vaccines (Basel) 2021; 9:1299. [PMID: 34835230 PMCID: PMC8623745 DOI: 10.3390/vaccines9111299] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 02/06/2023] Open
Abstract
Pursuing vaccinations against COVID-19 brings hope to limit the spread of SARS-CoV-2 and remains the most rational decision under pandemic conditions. However, it does not come without challenges, including temporary shortages in vaccine doses, significant vaccine inequity, and questions regarding the durability of vaccine-induced immunity that remain unanswered. Moreover, SARS-CoV-2 has undergone evolution with the emergence of its novel variants, characterized by enhanced transmissibility and ability to at least partially evade neutralizing antibodies. At the same time, serum antibody levels start to wane within a few months after vaccination, ultimately increasing the risk of breakthrough infections. This article discusses whether the administration of booster doses of COVID-19 vaccines is urgently needed to control the pandemic. We conclude that, at present, optimizing the immunity level of wealthy populations cannot come at the expense of low-income regions that suffer from vaccine unavailability. Although the efficiency of vaccination in protecting from infection may decrease over time, current data show that efficacy against severe disease, hospitalization, and death remains at a high level. If vaccine coverage continues at extremely low levels in various regions, including African countries, SARS-CoV-2 may sooner or later evolve into variants better adapted to evade natural and vaccine-induced immunity, ultimately bringing a global threat that, of course, includes wealthy populations. We offer key recommendations to increase vaccination rates in low-income countries. The pandemic is, by definition, a major epidemiological event and requires looking beyond one's immediate self-interest; otherwise, efforts to contain it will be futile.
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Affiliation(s)
- Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland;
- Universal Scientific Education and Research Network (USERN), https://usern.tums.ac.ir, Tehran 1417614411, Iran; (C.A.C.J.); (A.F.); (R.K.); (A.L.); (J.J.N.); (A.O.); (M.P.); (C.S.); (F.S.); (A.S.)
| | - Carlos A. Camargo
- Universal Scientific Education and Research Network (USERN), https://usern.tums.ac.ir, Tehran 1417614411, Iran; (C.A.C.J.); (A.F.); (R.K.); (A.L.); (J.J.N.); (A.O.); (M.P.); (C.S.); (F.S.); (A.S.)
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Andrzej Fal
- Universal Scientific Education and Research Network (USERN), https://usern.tums.ac.ir, Tehran 1417614411, Iran; (C.A.C.J.); (A.F.); (R.K.); (A.L.); (J.J.N.); (A.O.); (M.P.); (C.S.); (F.S.); (A.S.)
- Collegium Medicum, Warsaw Faculty of Medicine, Cardinal Stefan Wyszyński University, 01-938 Warsaw, Poland
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, 15-540 Białystok, Poland;
| | - Willis Gwenzi
- Biosystems and Environmental Engineering Research Group, Department of Agricultural and Biosystems Engineering, University of Zimbabwe, Mount Pleasant, Harare P.O. Box MP167, Zimbabwe;
| | - Roya Kelishadi
- Universal Scientific Education and Research Network (USERN), https://usern.tums.ac.ir, Tehran 1417614411, Iran; (C.A.C.J.); (A.F.); (R.K.); (A.L.); (J.J.N.); (A.O.); (M.P.); (C.S.); (F.S.); (A.S.)
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan 8174673441, Iran
| | - Alexander Leemans
- Universal Scientific Education and Research Network (USERN), https://usern.tums.ac.ir, Tehran 1417614411, Iran; (C.A.C.J.); (A.F.); (R.K.); (A.L.); (J.J.N.); (A.O.); (M.P.); (C.S.); (F.S.); (A.S.)
- PROVIDI Lab, Image Sciences Institute, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Juan J. Nieto
- Universal Scientific Education and Research Network (USERN), https://usern.tums.ac.ir, Tehran 1417614411, Iran; (C.A.C.J.); (A.F.); (R.K.); (A.L.); (J.J.N.); (A.O.); (M.P.); (C.S.); (F.S.); (A.S.)
- Instituto de Matemáticas, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Ahmet Ozen
- Universal Scientific Education and Research Network (USERN), https://usern.tums.ac.ir, Tehran 1417614411, Iran; (C.A.C.J.); (A.F.); (R.K.); (A.L.); (J.J.N.); (A.O.); (M.P.); (C.S.); (F.S.); (A.S.)
- Department of Pediatric Allergy and Immunology, Marmara University School of Medicine, 34854 Istanbul, Turkey
| | - Matjaž Perc
- Universal Scientific Education and Research Network (USERN), https://usern.tums.ac.ir, Tehran 1417614411, Iran; (C.A.C.J.); (A.F.); (R.K.); (A.L.); (J.J.N.); (A.O.); (M.P.); (C.S.); (F.S.); (A.S.)
- Faculty of Natural Sciences and Mathematics, University of Maribor, 2000 Maribor, Slovenia
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 404332, Taiwan
| | - Barbara Poniedziałek
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland;
- Universal Scientific Education and Research Network (USERN), https://usern.tums.ac.ir, Tehran 1417614411, Iran; (C.A.C.J.); (A.F.); (R.K.); (A.L.); (J.J.N.); (A.O.); (M.P.); (C.S.); (F.S.); (A.S.)
| | - Constantine Sedikides
- Universal Scientific Education and Research Network (USERN), https://usern.tums.ac.ir, Tehran 1417614411, Iran; (C.A.C.J.); (A.F.); (R.K.); (A.L.); (J.J.N.); (A.O.); (M.P.); (C.S.); (F.S.); (A.S.)
- Center for Research on Self and Identity, School of Psychology, University of Southampton, Southampton SO17 1BJ, UK
| | - Frank Sellke
- Universal Scientific Education and Research Network (USERN), https://usern.tums.ac.ir, Tehran 1417614411, Iran; (C.A.C.J.); (A.F.); (R.K.); (A.L.); (J.J.N.); (A.O.); (M.P.); (C.S.); (F.S.); (A.S.)
- Alpert Medical School of Brown University, Division of Cardiothoracic Surgery, Rhode Island Hospital, Providence, RI 02905, USA
| | - Emilia C. Skirmuntt
- Peter Medawar Building for Pathogen Research, Department of Zoology, University of Oxford, Oxford OX1 3SY, UK;
| | - Anzhela Stashchak
- Universal Scientific Education and Research Network (USERN), https://usern.tums.ac.ir, Tehran 1417614411, Iran; (C.A.C.J.); (A.F.); (R.K.); (A.L.); (J.J.N.); (A.O.); (M.P.); (C.S.); (F.S.); (A.S.)
- International Relations Office, Kharkiv National Medical University, 61000 Kharkiv, Ukraine
| | - Nima Rezaei
- Universal Scientific Education and Research Network (USERN), https://usern.tums.ac.ir, Tehran 1417614411, Iran; (C.A.C.J.); (A.F.); (R.K.); (A.L.); (J.J.N.); (A.O.); (M.P.); (C.S.); (F.S.); (A.S.)
- Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran 1417614411, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran 1417614411, Iran
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24
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Rzymski P, Poniedziałek B, Fal A. Willingness to Receive the Booster COVID-19 Vaccine Dose in Poland. Vaccines (Basel) 2021; 9:1286. [PMID: 34835217 PMCID: PMC8624071 DOI: 10.3390/vaccines9111286] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/18/2021] [Accepted: 11/03/2021] [Indexed: 12/29/2022] Open
Abstract
COVID-19 vaccinations are essential to mitigate the pandemic and prevent severe SARS-CoV-2 infections. However, the serum antibody levels in vaccinated individuals gradually decrease over time, while SARS-CoV-2 is undergoing an evolution toward more transmissible variants, such as B.1.617.2, ultimately increasing the risk of breakthrough infections and further virus spread. This cross-sectional online study of adult Poles (n = 2427) was conducted in September 2021 (before a general recommendation to administer a booster COVID-19 vaccine dose in Poland was issued) to assess the attitude of individuals who completed the current vaccination regime toward a potential booster dose of the COVID-19 vaccine and identify potential factors that may influence it. Overall, 71% of participants declared willingness to receive a booster COVID-19 dose, with a low median level of fear of receiving it of 1.0 (measured by the 10-point Likert-type scale), which was increased particularly in those having a worse experience (in terms of severity of side effects and associated fear) with past COVID-19 vaccination. The lowest frequency of willingness to receive a booster dose (26.7%) was seen in the group previously vaccinated with Ad26.COV2.S. The majority of individuals vaccinated previously with mRNA vaccines wished to receive the same vaccine, while in the case of AZD1222, such accordance was observed only in 9.1%. The main reasons against accepting a booster COVID-19 dose included the side effects experienced after previous doses, the opinion that further vaccination is unnecessary, and safety uncertainties. Women, older individuals (≥50 years), subjects with obesity, chronic diseases, and pre-vaccination and post-vaccination SARS-CoV-2 infections, and those with a history of vaccination against influenza were significantly more frequently willing to receive a booster COVID-19 dose. Moreover, the majority of immunosuppressed individuals (88%) were willing to receive an additional dose. The results emphasize some hesitancy toward potential further COVID-19 vaccination in the studied group of Poles and indicate the main groups to be targeted with effective science communication regarding the booster doses.
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Affiliation(s)
- Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland;
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), 60-806 Poznań, Poland
| | - Barbara Poniedziałek
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznań, Poland;
| | - Andrzej Fal
- Collegium Medicum, Warsaw Faculty of Medicine, Cardinal Stefan Wyszyński University, 01-938 Warsaw, Poland;
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25
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Hsu L, Grüne B, Buess M, Joisten C, Klobucnik J, Nießen J, Patten D, Wolff A, Wiesmüller GA, Kossow A, Hurraß J. COVID-19 Breakthrough Infections and Transmission Risk: Real-World Data Analyses from Germany's Largest Public Health Department (Cologne). Vaccines (Basel) 2021; 9:1267. [PMID: 34835198 PMCID: PMC8624814 DOI: 10.3390/vaccines9111267] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND METHODS Vaccination is currently considered the most successful strategy for combating the SARS-CoV-2 virus. According to short-term clinical trials, protection against infection is estimated to reach up to 95% after complete vaccination (≥14 days after receipt of all recommended COVID-19 vaccine doses). Nevertheless, infections despite vaccination, so-called breakthrough infections, are documented. Even though they are more likely to have a milder or even asymptomatic course, the assessment of further transmission is highly relevant for successful containment. Therefore, we calculated the real-world transmission risk from fully vaccinated patients (vaccination group, VG) to their close contacts (CP) compared with the risk from unvaccinated reference persons matched according to age, sex, and virus type (control group = CG) utilizing data from Cologne's health department. RESULTS A total of 357 breakthrough infections occurred among Cologne residents between 27 December 2020 (the date of the first vaccination in Cologne) and 6 August 2021. Of the 979 CPs in VG, 99 (10.1%) became infected. In CG, 303 of 802 CPs (37.8%) became infected. Factors promoting transmission included non-vaccinated status (β = 0.237; p < 0.001), male sex (β = 0.079; p = 0.049), the presence of symptoms (β = -0.125; p = 0.005), and lower cycle threshold value (β = -0.125; p = 0.032). This model explained 14.0% of the variance (corr. R2). CONCLUSION The number of transmissions from unvaccinated controls was three times higher than from fully vaccinated patients. These real-world data underscore the importance of vaccination in enabling the relaxation of stringent and restrictive general pandemic control measures.
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Affiliation(s)
- Lea Hsu
- Public Health Department Cologne, Infektions- und Umwelthygiene, 50667 Köln, Germany; (B.G.); (M.B.); (C.J.); (J.K.); (J.N.); (D.P.); (A.W.); (G.A.W.); (A.K.); (J.H.)
- Institute for Occupational Medicine and Social Medicine, University Hospital, Medical Faculty, RWTH Aachen University, 52056 Aachen, Germany
| | - Barbara Grüne
- Public Health Department Cologne, Infektions- und Umwelthygiene, 50667 Köln, Germany; (B.G.); (M.B.); (C.J.); (J.K.); (J.N.); (D.P.); (A.W.); (G.A.W.); (A.K.); (J.H.)
| | - Michael Buess
- Public Health Department Cologne, Infektions- und Umwelthygiene, 50667 Köln, Germany; (B.G.); (M.B.); (C.J.); (J.K.); (J.N.); (D.P.); (A.W.); (G.A.W.); (A.K.); (J.H.)
| | - Christine Joisten
- Public Health Department Cologne, Infektions- und Umwelthygiene, 50667 Köln, Germany; (B.G.); (M.B.); (C.J.); (J.K.); (J.N.); (D.P.); (A.W.); (G.A.W.); (A.K.); (J.H.)
- Department for Physical Activity in Public Health, Institute of Movement and Neurosciences, Am Sportpark Müngersdorf 6, German Sport University Cologne, 50933 Cologne, Germany
| | - Jan Klobucnik
- Public Health Department Cologne, Infektions- und Umwelthygiene, 50667 Köln, Germany; (B.G.); (M.B.); (C.J.); (J.K.); (J.N.); (D.P.); (A.W.); (G.A.W.); (A.K.); (J.H.)
| | - Johannes Nießen
- Public Health Department Cologne, Infektions- und Umwelthygiene, 50667 Köln, Germany; (B.G.); (M.B.); (C.J.); (J.K.); (J.N.); (D.P.); (A.W.); (G.A.W.); (A.K.); (J.H.)
| | - David Patten
- Public Health Department Cologne, Infektions- und Umwelthygiene, 50667 Köln, Germany; (B.G.); (M.B.); (C.J.); (J.K.); (J.N.); (D.P.); (A.W.); (G.A.W.); (A.K.); (J.H.)
| | - Anna Wolff
- Public Health Department Cologne, Infektions- und Umwelthygiene, 50667 Köln, Germany; (B.G.); (M.B.); (C.J.); (J.K.); (J.N.); (D.P.); (A.W.); (G.A.W.); (A.K.); (J.H.)
| | - Gerhard A. Wiesmüller
- Public Health Department Cologne, Infektions- und Umwelthygiene, 50667 Köln, Germany; (B.G.); (M.B.); (C.J.); (J.K.); (J.N.); (D.P.); (A.W.); (G.A.W.); (A.K.); (J.H.)
- Institute for Occupational Medicine and Social Medicine, University Hospital, Medical Faculty, RWTH Aachen University, 52056 Aachen, Germany
| | - Annelene Kossow
- Public Health Department Cologne, Infektions- und Umwelthygiene, 50667 Köln, Germany; (B.G.); (M.B.); (C.J.); (J.K.); (J.N.); (D.P.); (A.W.); (G.A.W.); (A.K.); (J.H.)
- Institute of Hygiene, University Hospital Muenster, 48149 Münster, Germany
| | - Julia Hurraß
- Public Health Department Cologne, Infektions- und Umwelthygiene, 50667 Köln, Germany; (B.G.); (M.B.); (C.J.); (J.K.); (J.N.); (D.P.); (A.W.); (G.A.W.); (A.K.); (J.H.)
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26
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Clusters of SARS-CoV-2 Lineage B.1.1.7 Infection after Vaccination with Adenovirus-Vectored and Inactivated Vaccines. Viruses 2021; 13:v13112127. [PMID: 34834934 PMCID: PMC8623206 DOI: 10.3390/v13112127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023] Open
Abstract
A SARS-CoV-2 B.1.1.7 variant of concern (VOC) has been associated with increased transmissibility, hospitalization, and mortality. This study aimed to explore the factors associated with B.1.1.7 VOC infection in the context of vaccination. On March 2021, we detected SARS-CoV-2 RNA in nasopharyngeal samples from 14 of 22 individuals vaccinated with a single-dose of ChAdOx1 (outbreak A, n = 26), and 22 of 42 of individuals with two doses of the CoronaVac vaccine (outbreak B, n = 52) for breakthrough infection rates for ChAdOx1 of 63.6% and 52.4% for CoronaVac. The outbreaks were caused by two independent clusters of the B.1.1.7 VOC. The serum of PCR-positive symptomatic SARS-CoV-2-infected individuals had ~1.8-3.4-fold more neutralizing capacity against B.1.1.7 compared to the serum of asymptomatic individuals. These data based on exploratory analysis suggest that the B.1.1.7 variant can infect individuals partially immunized with a single dose of an adenovirus-vectored vaccine or fully immunized with two doses of an inactivated vaccine, although the vaccines were able to reduce the risk of severe disease and death caused by this VOC, even in the elderly.
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Mhawish H, Mady A, Alaklobi F, Aletreby W, Asad T, Alodat M, Alharthy A, Abdulrahman B, Almahwi S, Memish ZA. Comparison of severity of immunized versus non-immunized COVID-19 patients admitted to ICU: A prospective observational study. Ann Med Surg (Lond) 2021; 71:102951. [PMID: 34667593 PMCID: PMC8518130 DOI: 10.1016/j.amsu.2021.102951] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/20/2022] Open
Abstract
Background Vaccines against COVID-19 show high efficacy, yet, infection is still being detected among immunized patients, although with blunted severity. The purpose of this study was to assess the severity of COVID-19 infection among immunized versus non-immunized COVID-19 patients admitted to ICU. Method A prospective observational cohort study, including all COVID-19 patients admitted to intensive care unit between January 1st, 2021 and June 30th, 2021 were eligible for inclusion. A comparison of severity upon hospitalization of immunized versus non-immunized patients on a 7-level ordinal scale was conducted, using ordinal logistic regression. Results 592 patients were enrolled, 524 (88.5%) non-immunized, 63 (10.6%) partially immunized, and 5 (0.9%) fully immunized, partially and fully immunized patients were grouped together. Majority of immunized patients (86.7%) were symptomatic before 21 days of immunization. Non-immunized group had fewer patients in the lower severity categories, while more patients in the higher severity categories compared to immunized group. At least one dose of immunization was associated with reduction of odds of moving up severity scale (OR = 0.2 [95% CI: 0.15–0.4]; p < 0.001) in a well fitted ordinal logistic regression model. At least one dose of immunization was associated with lower adjusted odds of 30 day all-cause mortality (OR = 0.45 [95% CI: 0.23–0.89]; p = 0.02). Non-immunized group had higher mortality rate (43.9% versus 29.4% [95% CI: 1.5 to 25.8]; p = 0.02). Conclusion Most COVID-19 patients admitted to ICU were non-immunized, most of the partially immunized patients got infected before immunity could develop, and fully immunized patients were likely non-responders. At least one dose of immunization significantly decreases severity of the disease across all ordinal severity categories, and is significantly associated with lower 30 day all-cause mortality. Accordingly, immunization status may have to be considered when deciding on disposition of COVID-19 patients at the point of triage. Vaccines against COVID-19 show high efficacy in preventing hospitalization and death. In our report most COVID-19 patients admitted to ICU were non-immunized. At least one dose of immunization significantly decreases severity of the disease. Partially immunized patients get infected before immunity could develop. Fully immunized patients were likely non-responders.
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Affiliation(s)
- Huda Mhawish
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ahmed Mady
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia.,Anesthesia Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Faisal Alaklobi
- Pediatrics Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - Waleed Aletreby
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Tasmiya Asad
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alodat
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | | | | | - Saleh Almahwi
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ziad A Memish
- Research & Innovation Centre King Saud Medical City, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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28
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Kolobukhina LV, Burgasova OA, Kruzhkova IS, Bakalin VV, Generalova LV, Shagaev AV, Ogarkova DA, Nikiforova MA, Vasina DV, Guschin VA, Smetanina SV. Assessment of COVID-19 clinical course in patients vaccinated with Spitnik V, SARS-CoV-2 S protein RBD domain variation and serum virus neutralizing activity. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2021. [DOI: 10.24075/brsmu.2021.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The COVID-19-associated mortality remains high. Studying the features of the COVID-19 course in vaccinated patients, who have got ill on different dates after vaccination, compared to unvaccinated individuals is relevant. The study was aimed to assess clinical and immunological features of the COVID-19 course, as well as to assess humoral immunity (virus neutralizing activity, VNA) and SARS-CoV-2 S protein RBD domain variation in the groups of patients, previously vaccinated with Sputnik V, and unvaccinated patients. A total of 251 patients with confirmed diagnosis of COVID-19 were enrolled, of them 116 individuals were previously vaccinated with one or two Sputnik V vaccine components, and 135 patients were not vaccinated (comparison group). Individuals over 50 years of age prevailed (82.8%). The patients, who received two vaccine components, had mild to moderate COVID-19 (92.1%). In the group of unvaccinated patients, 11 individuals received treatment in the ICU, 10 of them died. The viral load was significantly lower in vaccinated patients. Mutations of SARS-CoV-2, such as S477N, S477N+A522S, E484K and E484K+S494P, were identified both in vaccinated and unvaccinated patients. Assessment of the neutralizing activity of sera revealed no significant differences in VNA against different variants of SARS-CoV-2 mutations. The data obtained demonstrate that the lack of vaccination is an aggravating factor and is capable of increasing the risk of severe course and death in patients with COVID-19.
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Affiliation(s)
- LV Kolobukhina
- Gamaleya National Center of Epidemiology and Microbiology, Moscow, Russia
| | - OA Burgasova
- Gamaleya National Center of Epidemiology and Microbiology, Moscow, Russia
| | - IS Kruzhkova
- Gamaleya National Center of Epidemiology and Microbiology, Moscow, Russia
| | - VV Bakalin
- Peoples' Friendship University of Russia, Moscow, Russia
| | - LV Generalova
- Peoples' Friendship University of Russia, Moscow, Russia
| | - AV Shagaev
- Infectious Clinical Hospital № 1, Moscow, Russia
| | - DA Ogarkova
- Gamaleya National Center of Epidemiology and Microbiology, Moscow, Russia
| | - MA Nikiforova
- Gamaleya National Center of Epidemiology and Microbiology, Moscow, Russia
| | - DV Vasina
- Gamaleya National Center of Epidemiology and Microbiology, Moscow, Russia
| | - VA Guschin
- Gamaleya National Center of Epidemiology and Microbiology, Moscow, Russia
| | - SV Smetanina
- Infectious Clinical Hospital № 1, Moscow, Russia
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