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Waseel F, Streftaris G, Rudrusamy B, Dass SC. Assessing the dynamics and impact of COVID-19 vaccination on disease spread: A data-driven approach. Infect Dis Model 2024; 9:527-556. [PMID: 38525308 PMCID: PMC10958481 DOI: 10.1016/j.idm.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
The COVID-19 pandemic has significantly impacted global health, social, and economic situations since its emergence in December 2019. The primary focus of this study is to propose a distinct vaccination policy and assess its impact on controlling COVID-19 transmission in Malaysia using a Bayesian data-driven approach, concentrating on the year 2021. We employ a compartmental Susceptible-Exposed-Infected-Recovered-Vaccinated (SEIRV) model, incorporating a time-varying transmission rate and a data-driven method for its estimation through an Exploratory Data Analysis (EDA) approach. While no vaccine guarantees total immunity against the disease, and vaccine immunity wanes over time, it is critical to include and accurately estimate vaccine efficacy, as well as a constant vaccine immunity decay or wane factor, to better simulate the dynamics of vaccine-induced protection over time. Based on the distribution and effectiveness of vaccines, we integrated a data-driven estimation of vaccine efficacy, calculated at 75% for Malaysia, underscoring the model's realism and relevance to the specific context of the country. The Bayesian inference framework is used to assimilate various data sources and account for underlying uncertainties in model parameters. The model is fitted to real-world data from Malaysia to analyze disease spread trends and evaluate the effectiveness of our proposed vaccination policy. Our findings reveal that this distinct vaccination policy, which emphasizes an accelerated vaccination rate during the initial stages of the program, is highly effective in mitigating the spread of COVID-19 and substantially reducing the pandemic peak and new infections. The study found that vaccinating 57-66% of the population (as opposed to 76% in the real data) with a better vaccination policy such as proposed here is able to significantly reduce the number of new infections and ultimately reduce the costs associated with new infections. The study contributes to the development of a robust and informative representation of COVID-19 transmission and vaccination, offering valuable insights for policymakers on the potential benefits and limitations of different vaccination policies, particularly highlighting the importance of a well-planned and efficient vaccination rollout strategy. While the methodology used in this study is specifically applied to national data from Malaysia, its successful application to local regions within Malaysia, such as Selangor and Johor, indicates its adaptability and potential for broader application. This demonstrates the model's adaptability for policy assessment and improvement across various demographic and epidemiological landscapes, implying its usefulness for similar datasets from various geographical regions.
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Affiliation(s)
- Farhad Waseel
- School of Mathematical and Computer Sciences, Heriot-Watt University Malaysia, Putrajaya, Malaysia
- Faculty of Mathematics, Kabul University, Kabul, Afghanistan
| | - George Streftaris
- School of Mathematical and Computer Sciences, Heriot-Watt University, Edinburgh, United Kingdom
- Maxwell Institute for Mathematical Sciences, United Kingdom
| | - Bhuvendhraa Rudrusamy
- School of Engineering and Physical Sciences, Heriot-Watt University Malaysia, Putrajaya, Malaysia
| | - Sarat C. Dass
- School of Mathematical and Computer Sciences, Heriot-Watt University Malaysia, Putrajaya, Malaysia
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2
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Khoo CMJ, Dea EZQ, Law LY, Wong SST, Ng KY, Bakhtiar A. Acceptability of COVID-19 booster vaccine in malaysia: a cross-sectional study. Sci Rep 2024; 14:8421. [PMID: 38600166 PMCID: PMC11006945 DOI: 10.1038/s41598-024-59195-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/08/2024] [Indexed: 04/12/2024] Open
Abstract
Despite the high efficacy and safety demonstrated in clinical trials, COVID-19 booster vaccination rates in Malaysia remain below 50% among the general public. This study explores the factors influencing public acceptance of the COVID-19 booster vaccine among the Malaysian population. The questionnaire included variables on sociodemographics, knowledge, and the Health Belief Model (HBM) constructs. Based on the Chi-squared test of contingencies, a t-test and multivariate logistic regression analysis on 411 collected responses, the findings revealed that older participants, individuals of Chinese ethnicity, and those with higher education levels and incomes were more willing to accept booster vaccinations. The analysis further identified perceived susceptibility, perceived severity and perceived barriers as significant predictors influencing booster vaccination acceptance rates. Healthcare policymakers may consider targeting interventions to diminish the obstacles associated with booster vaccinations. These intervention strategies include implementing health intervention programmes, such as public health awareness initiatives, to raise awareness of the risks and severity of COVID-19, ultimately encouraging higher uptake of booster vaccines.
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Affiliation(s)
- Cheryl Minn Jee Khoo
- School of Pharmacy, Monash University Malaysia, 47500, Bandar Sunway, Selangor, Malaysia
| | - Eve Zhi Qing Dea
- School of Pharmacy, Monash University Malaysia, 47500, Bandar Sunway, Selangor, Malaysia
| | - Li Yeow Law
- School of Pharmacy, Monash University Malaysia, 47500, Bandar Sunway, Selangor, Malaysia
| | - Sharon Siew Tong Wong
- School of Pharmacy, Monash University Malaysia, 47500, Bandar Sunway, Selangor, Malaysia
| | - Khuen Yen Ng
- School of Pharmacy, Monash University Malaysia, 47500, Bandar Sunway, Selangor, Malaysia
| | - Athirah Bakhtiar
- School of Pharmacy, Monash University Malaysia, 47500, Bandar Sunway, Selangor, Malaysia.
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Jayaraj VJ, Husin M, Suah JL, Tok PSK, Omar A, Rampal S, Sivasampu S. Effectiveness of COVID-19 vaccines among children 6-11 years against hospitalization during Omicron predominance in Malaysia. Sci Rep 2024; 14:5690. [PMID: 38454077 PMCID: PMC10920657 DOI: 10.1038/s41598-024-55899-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/28/2024] [Indexed: 03/09/2024] Open
Abstract
There is currently limited data on the effectiveness of COVID-19 vaccines for children aged 6-11 years in Malaysia. This study aims to determine vaccine effectiveness (VE) against COVID-19-related hospitalization after receipt of one- and two-doses of BNT162b2 mRNA (Comirnaty-Pfizer/BioNTech) vaccine over a duration of almost 1 year in the predominantly Omicron period of BA.4/BA.5 and X.B.B sub lineages. This study linked administrative databases between May 2022 and March 2023 to evaluate real-world vaccine effectiveness (VE) for the BNT162b2 mRNA (Comirnaty-Pfizer/BioNTech) vaccine against COVID-19-related hospitalization in the Omicron pre-dominant period with BA.4/BA.5 and X.B.B sub lineages. During the Omicron-predominant period, the cumulative hospitalization rate was almost two times higher for unvaccinated children (9.6 per million population) compared to vaccinated children (6 per million population). The estimated VE against COVID-19 hospitalization for one dose of BNT162b2 was 27% (95% CI - 1%, 47%) and 38% (95% CI 27%, 48%) for two doses. The estimated VE against hospitalization remained stable when stratified by time. VE for the first 90 days was estimated to be 45% (95% CI 33, 55%), followed by 47% (95% CI 34, 56%) between 90 and 180 days, and 36% (95% CI 22, 45%) between 180 and 360 days. Recent infection within 6 months does not appear to modify the impact of vaccination on the risk of hospitalization, subject to the caveat of potential underestimation. In our pediatric population, BNT162b2 provided moderate-non-diminishing protection against COVID-19 hospitalization over almost 1 year of Omicron predominance.
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Affiliation(s)
- Vivek Jason Jayaraj
- Sector for Biostatistics & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia.
| | - Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Jing Lian Suah
- Data, Analytics and Research, Central Bank of Malaysia, Kuala Lumpur, Malaysia
| | - Peter Seah Keng Tok
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Azahadi Omar
- Sector for Biostatistics & Data Repository, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Sanjay Rampal
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Epidemiology and Evidence-Based Practice, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
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Ab Rahman N, Lim MT, Lee FY, Wo WK, Yeoh HS, Peariasamy KM, Sivasampu S. Thrombocytopenia and venous thromboembolic events after BNT162b2, CoronaVac, ChAdOx1 vaccines and SARS-CoV-2 infection: a self-controlled case series study. Sci Rep 2023; 13:20471. [PMID: 37993548 PMCID: PMC10665324 DOI: 10.1038/s41598-023-47486-x] [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: 10/18/2022] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
This study assessed the association between COVID-19 vaccines, SARS-CoV-2 infection and the risk of thrombocytopenia and venous thromboembolism (VTE). This self-controlled case series study used hospital records between 1st February 2021 and 28th February 2022 linked to the national immunisation registry and COVID-19 surveillance data in Malaysia. Conditional Poisson regression was used to estimate incidence rate ratios (IRR) of events in the risk period (day 1-21 post-exposure) relative to control period with the corresponding 95% confidence interval (CI) adjusted for calendar period. We found no significant increased risk of thrombocytopenia in 1-21 days following BNT162b2, CoronaVac and ChAdOx1 vaccines while the risk was increased following SARS-CoV-2 infection (IRR 15.52, 95% CI 13.38-18.00). Similarly, vaccination with BNT162b2, CoronaVac, or ChAdOx1 was not associated with an increased risk of VTE during the 1-21 days risk period. SARS-CoV-2 infection was associated with increased risk of VTE (IRR 39.84, 95% CI 27.45-32.44). Our findings showed low event rates of thrombocytopenia and VTE following booster vaccination with comparable safety profiles between those who received homologous and heterologous booster combinations. Our findings showed the risk of thrombocytopenia and VTE was not increased after COVID-19 vaccination while the risks were substantially higher after SARS-CoV-2 infection.
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Affiliation(s)
- Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia.
| | - Ming Tsuey Lim
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
| | - Fei Yee Lee
- Clinical Research Centre, Selayang Hospital, Ministry of Health, Kepong, Selangor, Malaysia
| | - Wee Kee Wo
- National Pharmaceutical Regulatory Agency, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Hee Sheong Yeoh
- National Pharmaceutical Regulatory Agency, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
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Reynolds L, Dewey C, Asfour G, Little M. Vaccine efficacy against SARS-CoV-2 for Pfizer BioNTech, Moderna, and AstraZeneca vaccines: a systematic review. Front Public Health 2023; 11:1229716. [PMID: 37942238 PMCID: PMC10628441 DOI: 10.3389/fpubh.2023.1229716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023] Open
Abstract
The purpose of this systematic review was to report on the vaccine efficacy (VE) of three SARS-CoV-2 vaccines approved by Health Canada: Pfizer BioNTech, Moderna, and AstraZeneca. Four databases were searched for primary publications on population-level VE. Ninety-two publications matched the inclusion criteria, and the extracted data were separated by vaccine type: mRNA vaccines (Pfizer and Moderna) and the AstraZeneca vaccine. The median VE for PCR-positive patients and various levels of clinical disease was determined for the first and second doses of both vaccine types against multiple SARS-CoV-2 variants. The median VE for PCR-positive infections against unidentified variants from an mRNA vaccine was 64.5 and 89%, respectively, after one or two doses. The median VE for PCR-positive infections against unidentified variants from the AstraZeneca vaccine was 53.4 and 69.6%, respectively, after one or two doses. The median VE for two doses of mRNA for asymptomatic, symptomatic, and severe infection against unidentified variants was 85.5, 93.2, and 92.2%, respectively. The median VE for two doses of AstraZeneca for asymptomatic, symptomatic, and severe infection against unidentified variants was 69.7, 71, and 90.2%, respectively. Vaccine efficacy numerically increased from the first to the second dose, increased from the first 2 weeks to the second 2 weeks post-vaccination for both doses, but decreased after 4 months from the second dose. Vaccine efficacy did not differ by person's age.
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Affiliation(s)
- Lia Reynolds
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Cate Dewey
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Ghaid Asfour
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Matthew Little
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
- School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, Victoria, BC, Canada
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Zhang X, Xia J, Jin L, Wu Y, Zheng X, Cao X, Meng X, Li J, Zhu F. Effectiveness of homologous or heterologous immunization regimens against SARS-CoV-2 after two doses of inactivated COVID-19 vaccine: A systematic review and meta-analysis. Hum Vaccin Immunother 2023; 19:2221146. [PMID: 37344370 PMCID: PMC10288895 DOI: 10.1080/21645515.2023.2221146] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/19/2023] [Accepted: 05/31/2023] [Indexed: 06/23/2023] Open
Abstract
We aimed to evaluate the effectiveness or efficacy of heterologous or homologous COVID-19 vaccine regimens against COVID-19-related outcomes after primary immunization with two doses of CoronaVac or Sinopharm COVID-19 vaccines. PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched up to 31 October 2022. The primary measure was vaccine effectiveness against COVID-19 infection with homologous or heterologous booster. The results showed heterologous and homologous booster significantly improved effectiveness against COVID-19 infection compared to primary immunization. The effectiveness against COVID-19 infection was 89.19% (95%CI 78.49, 99.89) for heterologous mRNA vaccine booster, 87.00% (95%CI 82.14, 91.85) for non-replicating vector vaccine booster, 69.99% (95%CI 52.16, 87.82) for homologous booster, and 51.48% (95%CI 41.75, 61.21) for two doses of inactivated vaccine. Homologous and heterologous regimens were also effective against SARS-CoV-2 variants, and more evidence is still needed to confirm our findings.
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Affiliation(s)
- Xiaoyin Zhang
- School of Public Health, Southeast University, Nanjing, P.R. China
| | - Jiayue Xia
- School of Public Health, Southeast University, Nanjing, P.R. China
| | - Lairun Jin
- School of Public Health, Southeast University, Nanjing, P.R. China
| | - Yanfei Wu
- School of Public Health, Southeast University, Nanjing, P.R. China
| | - Xiuyu Zheng
- Research & Development Center, CanSino Biologics Inc, Tianjin, P. R. China
| | - Xiang Cao
- School of Public Health, Southeast University, Nanjing, P.R. China
| | - Xingchen Meng
- School of Public Health, Southeast University, Nanjing, P.R. China
| | - Jingxin Li
- School of Public Health, Southeast University, Nanjing, P.R. China
- National Health Commission (NHC) Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, P.R. China
- Institute of Global Health and Emergency Pharmacy, China Pharmaceutical University, Nanjing, P. R. China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fengcai Zhu
- School of Public Health, Southeast University, Nanjing, P.R. China
- National Health Commission (NHC) Key Laboratory of Enteric Pathogenic Microbiology, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, P.R. China
- Institute of Global Health and Emergency Pharmacy, China Pharmaceutical University, Nanjing, P. R. China
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
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Lee YS, Jamaluddin J, Ho BK. Characteristics and factors associated with severity of COVID-19 infections in primary care. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2023; 18:42. [PMID: 37593088 PMCID: PMC10431198 DOI: 10.51866/oa.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Introduction Primary care service plays a vital role in early clinical assessment of patients with COVID-19 in Malaysia. This study aimed to evaluate the potential risk factors of COVID-19 severity at presentation to primary care facilities in the post-vaccination period. Method Clinical records from the Selangkah system of all patients with COVID-19 aged above 18 years seen at COVID-19 assessment centres located in 10 government health clinics in Gombak district, Selangor, from 1 October to 31 December 2021 with complete documentation and outcomes were retrieved. Demographics, comorbidities, clinical features and vaccination statuses and types were retrospectively evaluated. The variables were compared between mild and severe diseases. Univariate and multivariable logistic regressions were used to identify the factors affecting disease severity. Results A total of 4406 patients (median age=37 years, men=51.2%) were analysed. Approximately 97.1% of the cases were mild, while 2.9% were severe. Fever, difficulty breathing, lethargy, throat irritation/runny nose, oxygen saturation of <95%, respiratory rate of >20 breaths per minute, CoronaVac vaccination and hypertension were the determinants of severity (P<0.05). Conclusion The high proportion (97.1%) of mild cases in this study compared with an earlier report (81.8%) during the pre-vaccination period may suggest the impact of vaccine, as 84.9% of this cohort was fully vaccinated. Our study also demonstrated a significant difference in COVID-19 severity between the vaccine types. The identified clinical features and comorbidities could assist primary care doctors in stratifying patients with COVID-19 judiciously in terms of hospital referral or home quarantine.
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Affiliation(s)
- Yeow Siong Lee
- MBBS (IMU), MMed (Family Medicine) (UM), Klinik Kesihatan Selayang Baru, Jalan Sungai Tua, Batu Caves, Selangor Darul Ehsan, Malaysia
| | - Jazlan Jamaluddin
- MD (Moscow), MMed (Family Medicine) (UiTM), Klinik Kesihatan Sauk, Jalan Besar Lenggong, Sauk, Kuala Kangsar, Perak, Malaysia.
| | - Bee Kiau Ho
- MBBS (UM), MMed (Family Medicine) (UM), Klinik Kesihatan Bandar Botanic, Blok A, Jalan Langat, Bandar Botanic, Klang, Selangor, Malaysia
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Law M, Ho SS, Tsang GK, Ho CM, Kwan CM, Yan VKC, Yiu HHE, Lai FTT, Wong ICK, Chan EWY. Efficacy and effectiveness of inactivated vaccines against symptomatic COVID-19, severe COVID-19, and COVID-19 clinical outcomes in the general population: a systematic review and meta-analysis. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100788. [PMID: 37360863 PMCID: PMC10199328 DOI: 10.1016/j.lanwpc.2023.100788] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/04/2023] [Accepted: 04/26/2023] [Indexed: 06/28/2023]
Abstract
Background Inactivated, whole-virion vaccines have been used extensively in the SARS-CoV-2 pandemic. Its efficacy and effectiveness across regions have not been systematically evaluated. Efficacy refers to how well a vaccine performs in a controlled environment. Effectiveness refers to how well it performs in real world settings. Methods This systematic review and meta-analysis reviewed published, peer-reviewed evidence on all WHO-approved inactivated vaccines and evaluated their efficacy and effectiveness against SARS-CoV-2 infection, symptomatic infection, severe clinical outcomes, and severe COVID-19. We searched Pubmed (including MEDLINE), EMBASE (via OVID), Web of Science Core Collection, Web of Science Chinese Science Citation Database, and Clinicaltrials.gov. Findings The final pool included 28 studies representing over 32 million individuals reporting efficacy or effectiveness estimates of complete vaccination using any approved inactivated vaccine between January 1, 2019 and June 27, 2022. Evidence was found for efficacy and effectiveness against symptomatic infection (OR 0.21, 95% CI 0.16-0.27, I2 = 28% and OR 0.32, 95% CI 0.16-0.64, I2 = 98%, respectively) and infection (OR 0.53, 95% CI 0.49-0.57, I2 = 90% and OR 0.31, 95% CI 0.24-0.41, I2 = 0%, respectively) for early SARS-CoV-2 variants of concern (VoCs) (Alpha, Delta), and for waning of vaccine effectiveness with more recent VoCs (Gamma, Omicron). Effectiveness remained robust against COVID-related ICU admission (OR 0.21, 95% CI 0.04-1.08, I2 = 99%) and death (OR 0.08, 95% CI 0.00-2.02, I2 = 96%), although effectiveness estimates against hospitalization (OR 0.44, 95% CI 0.37-0.53, I2 = 0%) were inconsistent. Interpretation This study showed evidence of efficacy and effectiveness of inactivated vaccines for all outcomes, although inconsistent reporting of key study parameters, high heterogeneity of observational studies, and the small number of studies of particular designs for most outcomes undermined the reliability of the findings. Findings highlight the need for additional research to address these limitations so that more definitive conclusions can be drawn to inform SARS-CoV-2 vaccine development and vaccination policies. Funding Health and Medical Research Fund on COVID-19, Health Bureau of the Government of the Hong Kong SAR.
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Affiliation(s)
- Martin Law
- Li Ka Shing Faculty of Medicine, Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong SAR, China
| | - Sam S.H. Ho
- Li Ka Shing Faculty of Medicine, Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong SAR, China
| | - Gigi K.C. Tsang
- Li Ka Shing Faculty of Medicine, Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong SAR, China
| | - Clarissa M.Y. Ho
- Li Ka Shing Faculty of Medicine, Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong SAR, China
| | - Christine M. Kwan
- Li Ka Shing Faculty of Medicine, Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Hong Kong SAR, China
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong SAR, China
| | - Vincent Ka Chun Yan
- Li Ka Shing Faculty of Medicine, Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong SAR, China
| | - Hei Hang Edmund Yiu
- Li Ka Shing Faculty of Medicine, Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong SAR, China
| | - Francisco Tsz Tsun Lai
- Li Ka Shing Faculty of Medicine, Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Hong Kong SAR, China
| | - Ian Chi Kei Wong
- Li Ka Shing Faculty of Medicine, Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Hong Kong SAR, China
- Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom
- Aston Pharmacy School, Aston University, Birmingham, United Kingdom
| | - Esther Wai Yin Chan
- Li Ka Shing Faculty of Medicine, Department of Pharmacology and Pharmacy, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Hong Kong SAR, China
- Department of Pharmacy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- The University of Hong Kong Shenzhen Institute of Research and Innovation, Shenzhen, China
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Marzo RR, Chakraborty R, Soh SY, Thew HZ, Chong C, Siau CS, Abdul Wahab KB, Binti Ariffin IA, Chauhan S, Brackstone K, Padhi BK, Heidler P. Factors influencing parents' hesitancy to vaccinate their children aged 5-11 years old against COVID-19: results from a cross-sectional study in Malaysia. Front Public Health 2023; 11:1091015. [PMID: 37261237 PMCID: PMC10228831 DOI: 10.3389/fpubh.2023.1091015] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 04/11/2023] [Indexed: 06/02/2023] Open
Abstract
Introduction Vaccination programs have been rolled out across the globe to contain and mitigate the spread of the COVID-19 infection. Until recently, such programs were limited to adults and the older population, thereby limiting children from getting vaccinated. Recently, the Malaysian government rolled out vaccination for children aged 5-11 years. However, there are certain factors that might affect vaccination uptake among children. This study explores factors influencing parents' hesitancy to vaccinate children in Malaysia. Method A nationwide online cross-sectional convenience sampling survey from April 21, 2022 to June 3, 2022 was conducted. The study used descriptive statistics to inform about vaccine hesitancy among parents. Cross-tabulation was performed to calculate the frequency and percentage of vaccine hesitancy, quality of life, e-health literacy, and the 5C psychological antecedents of vaccination among parents with children 5-11 years in Malaysia. Graphical methods were used to portray the levels of e-health literacy and levels of 5C psychological antecedents of vaccination. The study used both bi-variate and multivariate analysis to understand the relationship between vaccine hesitancy and the socio-demo-economic factors, quality of life, e-health literacy and 5C psychological antecedents. Results Of 382 participants, almost one-third (33%) of participants reported vaccine hesitancy for their children. For 5C's psychological antecedents of vaccination, around one quarter (26.96%) reported disagreement for confidence in vaccination, almost half (52.36%) reported disagreement for vaccination complacency, three-fifths (60.99%) reported vaccination constraint, one quarter (25.92%) reported calculation antecedent, and almost one-third reported disagreement over collective responsibility antecedent (25.92%). Chi-square test revealed that gender, employment status, and parents' COVID-19 vaccination status were significantly associated (p<0.05) with vaccine hesitancy among parents. Assessing the influence of transactional e-health literacy, only the communication component contained a significant association (p<0.05). Among the 5C psychological antecedents, confidence, calculation, and collective responsibility were significantly associated (p<0.05) with vaccine hesitancy. Parents with secondary [OR: 8.80; CI: 2.44-31.79, (p<0.05)], post-secondary [OR: 5.21; CI: 2.10-13.41, (p<0.05)], and tertiary education [OR: 6.77; CI: 2.25-20.35, (p<0.05)] had significantly higher likelihood of vaccine hesitancy than those with primary education. Conclusion Highly educated parents are more skeptical and are more likely to perceive the vaccine as unsafe and ineffective for their children. It is critical to disseminate the required information about the vaccine safety to the educated group.
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Affiliation(s)
- Roy Rillera Marzo
- Department of Community Medicine, International Medical School, Management and Science University, Selangor, Malaysia
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | | | - Shean Yih Soh
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Putra Malaysia University, Serdang, Malaysia
| | - Hui Zhu Thew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Putra Malaysia University, Serdang, Malaysia
| | - Collins Chong
- Department of Anaesthesia and Intensive Care, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Ching Sin Siau
- Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Khairuddin Bin Abdul Wahab
- Department of Community Medicine, International Medical School, Management and Science University, Selangor, Malaysia
| | - Indang Ariati Binti Ariffin
- Department of Community Medicine, International Medical School, Management and Science University, Selangor, Malaysia
| | - Shekhar Chauhan
- International Institute for Population Sciences (IIPS), Mumbai, India
| | - Ken Brackstone
- Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Bijaya Kumar Padhi
- Asian Institute of Public Health, Bhubaneswar, India
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Petra Heidler
- Institute International Trade and Sustainable Economy, IMC University of Applied Sciences Krems, Krems an der Donau, Austria
- Department of Health Sciences, St. Pölten University of Applied Sciences, St. Pölten, Austria
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10
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Spinardi J, Dantas AC, Carballo C, Thakkar K, Akoury NA, Kyaw MH, Del Carmen Morales Castillo G, Srivastava A, Sáfadi MAP. Narrative Review of the Evolution of COVID-19 Vaccination Recommendations in Countries in Latin America, Africa and the Middle East, and Asia. Infect Dis Ther 2023; 12:1237-1264. [PMID: 37097556 PMCID: PMC10127189 DOI: 10.1007/s40121-023-00804-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/03/2023] [Indexed: 04/26/2023] Open
Abstract
The rapid rollout of vaccines to combat the coronavirus disease 2019 (COVID-19) pandemic over the past 2 years has resulted in the use of various vaccine platforms and regional differences in COVID-19 vaccine implementation strategies. The aim of this narrative review was to summarize evolving COVID-19 vaccine recommendations in countries in Latin America, Asia, and Africa and the Middle East across various vaccine platforms, age groups, and specific subpopulations. Nuances in primary and booster vaccination schedules were evaluated, and the preliminary impact of such diverse vaccination strategies are discussed, including key vaccine effectiveness data in the era of Omicron-lineage variants. Primary vaccination rates for included Latin American countries were 71-94% for adults and between 41% and 98% for adolescents and children; rates for first booster in adults were 36-85%. Primary vaccination rates for adults in the included Asian countries ranged from 64% in the Philippines to 98% in Malaysia, with corresponding booster rates varying from 9% in India to 78% in Singapore; for adolescents and children, primary vaccination rates ranged from 29% in the Philippines to 93% in Malaysia. Across included African and Middle Eastern countries, primary vaccination rates in adults varied widely from 32% in South Africa to 99% in the United Arab Emirates; booster rates ranged from 5% in South Africa to 60% in Bahrain. Evidence from the regions studied indicates preference of using an mRNA vaccine as a booster on the basis of safety and effectiveness of observed real-world data, especially during circulation of Omicron lineages. Vaccination against COVID-19 remains of paramount importance to reduce the burden of disease; strategies to overcome vaccine inequity, fatigue, hesitancy, and misinformation and to ensure adequate access and supply are also important.
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Affiliation(s)
- Júlia Spinardi
- Vaccine Medical and Scientific Affairs, Pfizer, Rua Alexandre Dumas, 1860, São Paulo, 04717904, Brazil.
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
| | | | | | - Karan Thakkar
- Vaccines Medical Affairs, Pfizer, Singapore, Singapore
| | | | - Moe Hein Kyaw
- Vaccines Clinical Epidemiologist Emerging Markets, Pfizer Inc, Collegeville, PA, USA
| | | | | | - Marco Aurélio P Sáfadi
- Department of Pediatrics, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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11
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Xu S, Li J, Wang H, Wang F, Yin Z, Wang Z. Real-world effectiveness and factors associated with effectiveness of inactivated SARS-CoV-2 vaccines: a systematic review and meta-regression analysis. BMC Med 2023; 21:160. [PMID: 37106390 PMCID: PMC10134725 DOI: 10.1186/s12916-023-02861-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The two inactivated SARS-CoV-2 vaccines, CoronaVac and BBIBP-CorV, have been widely used to control the COVID-19 pandemic. The influence of multiple factors on inactivated vaccine effectiveness (VE) during long-term use and against variants is not well understood. METHODS We selected published or preprinted articles from PubMed, Embase, Scopus, Web of Science, medRxiv, BioRxiv, and the WHO COVID-19 database by 31 August 2022. We included observational studies that assessed the VE of completed primary series or homologous booster against SARS-CoV-2 infection or severe COVID-19. We used DerSimonian and Laird random-effects models to calculate pooled estimates and conducted multiple meta-regression with an information theoretic approach based on Akaike's Information Criterion to select the model and identify the factors associated with VE. RESULTS Fifty-one eligible studies with 151 estimates were included. For prevention of infection, VE associated with study region, variants, and time since vaccination; VE was significantly decreased against Omicron compared to Alpha (P = 0.021), primary series VE was 52.8% (95% CI, 43.3 to 60.7%) against Delta and 16.4% (95% CI, 9.5 to 22.8%) against Omicron, and booster dose VE was 65.2% (95% CI, 48.3 to 76.6%) against Delta and 20.3% (95% CI, 10.5 to 28.0%) against Omicron; primary VE decreased significantly after 180 days (P = 0.022). For the prevention of severe COVID-19, VE associated with vaccine doses, age, study region, variants, study design, and study population type; booster VE increased significantly (P = 0.001) compared to primary; though VE decreased significantly against Gamma (P = 0.034), Delta (P = 0.001), and Omicron (P = 0.001) compared to Alpha, primary and booster VEs were all above 60% against each variant. CONCLUSIONS Inactivated vaccine protection against SARS-CoV-2 infection was moderate, decreased significantly after 6 months following primary vaccination, and was restored by booster vaccination. VE against severe COVID-19 was greatest after boosting and did not decrease over time, sustained for over 6 months after the primary series, and more evidence is needed to assess the duration of booster VE. VE varied by variants, most notably against Omicron. It is necessary to ensure booster vaccination of everyone eligible for SARS-CoV-2 vaccines and continue monitoring virus evolution and VE. TRIAL REGISTRATION PROSPERO, CRD42022353272.
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Affiliation(s)
- Shiyao Xu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Jincheng Li
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Hongyuan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Fuzhen Wang
- Chinese Center for Disease Control and Prevention, National Immunization Programme, Beijing, China
| | - Zundong Yin
- Chinese Center for Disease Control and Prevention, National Immunization Programme, Beijing, China.
| | - Zhifeng Wang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China.
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12
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COVID-19 Vaccination Prioritization Strategies in Malaysia: A Retrospective Analysis of Early Evidence. Vaccines (Basel) 2022; 11:vaccines11010048. [PMID: 36679893 PMCID: PMC9861551 DOI: 10.3390/vaccines11010048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) that can cause extreme acute respiratory syndrome has posed a catastrophic threat to public health. The vaccines had indeed restored optimism and, after more than two years of battling the pandemic, there is renewed hope for the transition to endemicity. At the start of vaccination efforts, when supply shortages of vaccines were inevitable, every nation determined the high-risk population groups to be given priority for the COVID-19 vaccines. In this paper, the characteristics of the initial COVID-19 vaccine recipients in Malaysia are described. In line with the policies of many other countries, Malaysia firstly inoculated frontline healthcare workers, and subsequently the list of front liners grew to include defense and security personnel and those involved in the provision of essential services. People with disabilities or those with special needs and several underlying medical conditions that increased their risk of developing severe COVID-related illnesses were included in the priority categories. These included patients with severe lung disease, chronic heart disease, chronic kidney disease, chronic liver disease, neurological disease, diabetes mellitus and obesity in adults, splenic dysfunction, and severe mental illness. With little information and under circumstances of great uncertainty, the Health Ministry of a middle-income country had developed a vaccination priority-list based on the disease's epidemiology and clinical data, vaccine type, operational considerations, and risk evaluation. Early evidence was presented and suggested that the full vaccination with any of the three predominant vaccines (AZD1222, BNT162b2, and CoronaVac) in the country had been highly effective in preventing COVID-19 infections, COVID-19-related ICU admissions, and death. As many SARS-CoV-2 variants of concern (VoC), such as the Omicron BA.2/4/5, are emerging, future vaccination strategies may necessitate the need to change the immunogen of the vaccine, as well as considerations for when to give high-risk groups booster injections. These considerations are valuable for future planning by policymakers and healthcare providers to make vaccination policy and decisions, especially for the inclusion of the COVID-19 vaccines into national immunization programs.
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13
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Yang SL, Mat Ripen A, Leong CT, Lee JV, Yen CH, Chand AK, Koh K, Abdul Rahim NAB, Gokilavanan V, Mohamed NNEB, Sevalingam RKA, Sulaiman N, Ab Razak AKB, Mohd Nor NHB, Pong MK, Tai KY, Toh V, Woon YL, Peariasamy KM. COVID-19 breakthrough infections and humoral immune response among BNT162b2 vaccinated healthcare workers in Malaysia. Emerg Microbes Infect 2022; 11:1262-1271. [PMID: 35412409 PMCID: PMC9067955 DOI: 10.1080/22221751.2022.2065936] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/10/2022] [Indexed: 12/12/2022]
Abstract
The evaluation of breakthrough infection and humoral immunity responses are important outcomes for vaccination policy for healthcare staff. This prospective cohort study collected blood samples at 5-time points; before primary vaccine doses, and at 2, 10 and 24 weeks after BNT162b2 vaccination from 551 HCWs, between March and October 2021. We investigated the association between anti-spike-1 protein receptor-binding domain (anti-S1-RBD) antibody geometric mean titre (GMT) and breakthrough infections. Two weeks post-vaccination, the GMT of anti-S1-RBD antibodies was measured at almost maximum detectable value (3115 BAU/ml [95% CI, 3051-3180]); it decreased to 1486 BAU/ml (95% CI, 1371-1610) at 10 weeks; and to 315 BAU/ml (95% CI, 283-349) at 24 weeks. Prior COVID-19 infection and age significantly affected the antibody titres. Fifty-six participants, none of whom were COVID-19 convalescents, had breakthrough infections between 10 and 24 weeks post-vaccination. Before breakthrough infections, the GMT was not different between the breakthrough and non-breakthrough individuals. After infection, the GMT was significantly higher in individuals with breakthrough infections (2038 BAU/ml [95%CI, 1547-2685]), specifically in symptomatic breakthroughs, compared to those without infection (254 BAU/ml [95%CI, 233-278]). A notable surge in breakthrough infections among healthcare workers coincided with the emergence of the Delta variant and when BNT162b2-elicited antibody responses waned in 10-24 weeks (i.e. approximately 3-6 months). Post-breakthrough, the antibody response was boosted in individuals with symptomatic presentations, but not asymptomatic individuals. The study finding supports administering booster vaccination for healthcare staff, including those who recovered from asymptomatic breakthrough infection.
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Affiliation(s)
- Su Lan Yang
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Adiratna Mat Ripen
- Allergy & Immunology Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Chin Tho Leong
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Jen Ven Lee
- Clinical Research Centre, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Chia How Yen
- Clinical Research Centre, Hospital Queen Elizabeth II, Ministry of Health Malaysia, Kota Kinabalu, Malaysia
| | - Avinash Kumar Chand
- Occupational Health Department, Hospital Queen Elizabeth, Ministry of Health Malaysia, Kota Kinabalu, Malaysia
| | - Karina Koh
- Clinical Research Centre, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | | | - Varaalakshmy Gokilavanan
- Clinical Research Centre, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | | | - Raj Kumar A/L. Sevalingam
- Clinical Research Centre, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Nadirah Sulaiman
- Clinical Research Centre, Hospital Queen Elizabeth, Ministry of Health Malaysia, Kota Kinabalu, Malaysia
| | - Ahmad Kamil bin Ab Razak
- Occupational Health Department, Hospital Queen Elizabeth, Ministry of Health Malaysia, Kota Kinabalu, Malaysia
| | | | - Mei Kuan Pong
- Occupational Health Department, Hospital Queen Elizabeth, Ministry of Health Malaysia, Kota Kinabalu, Malaysia
| | - Ket Yan Tai
- Clinical Research Centre, Hospital Queen Elizabeth, Ministry of Health Malaysia, Kota Kinabalu, Malaysia
| | - Valerie Toh
- Clinical Research Centre, Hospital Queen Elizabeth, Ministry of Health Malaysia, Kota Kinabalu, Malaysia
| | - Yuan Liang Woon
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Kalaiarasu M. Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
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14
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Tanriover MD, Aydin OA, Guner R, Yildiz O, Celik I, Doganay HL, Kose S, Akhan S, Akalin EH, Sezer Z, Ozdarendeli A, Unal S. Efficacy, Immunogenicity, and Safety of the Two-Dose Schedules of TURKOVAC versus CoronaVac in Healthy Subjects: A Randomized, Observer-Blinded, Non-Inferiority Phase III Trial. Vaccines (Basel) 2022; 10:1865. [PMID: 36366373 PMCID: PMC9698857 DOI: 10.3390/vaccines10111865] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 09/29/2023] Open
Abstract
We present the interim results of the efficacy, immunogenicity, and safety of the two-dose schedules of TURKOVAC versus CoronaVac. This was a randomized, observer-blinded, non-inferiority trial (NCT04942405). Volunteers were 18-55 years old and randomized at a 1:1 ratio to receive either TURKOVAC or CoronaVac at Day 0 and Day 28, both of which are 3 μg/0.5 mL of inactivated severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) adsorbed to aluminum hydroxide. The primary efficacy outcome was the prevention of polymerase chain reaction (PCR)-confirmed symptomatic coronavirus disease 2019 (COVID-19) at least 14 days after the second dose in the modified per-protocol (mPP) group. Safety analyses were performed in the modified intention-to-treat (mITT) group. Between 22 June 2021 and 7 January 2022, 1290 participants were randomized. The mITT group consisted of 915 participants, and the mPP group consisted of 732 participants. During a median follow-up of 90 (IQR 86-90) days, the relative risk reduction with TURKOVAC compared to CoronaVac was 41.03% (95% CI 12.95-60.06) for preventing PCR-confirmed symptomatic COVID-19. The incidences of adverse events (AEs) overall were 58.8% in TURKOVAC and 49.7% in CoronaVac arms (p = 0.006), with no fatalities or grade four AEs. TURKOVAC was non-inferior to CoronaVac in terms of efficacy and demonstrated a good safety and tolerability profile.
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Affiliation(s)
- Mine Durusu Tanriover
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, 06230 Ankara, Türkiye
- Vaccine Institute, Hacettepe University, 06230 Ankara, Türkiye
| | - Ozlem Altuntas Aydin
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Başaksehir Cam and Sakura City Hospital, 34480 Istanbul, Türkiye
| | - Rahmet Guner
- Infectious Diseases and Clinical Microbiology Clinic, Ankara Yildirim Beyazit University, Ankara City Hospital, 06800 Ankara, Türkiye
| | - Orhan Yildiz
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University Faculty of Medicine, 38030 Kayseri, Türkiye
| | - Ilhami Celik
- Department of Infectious Diseases and Clinical Microbiology, Kayseri City Training and Research Hospital, 38080 Kayseri, Türkiye
| | - Hamdi Levent Doganay
- Department of Gastroenterology, Medical Park Pendik Hospital, 34899 Istanbul, Türkiye
- Department of Internal Medicine, Bahcesehir University School of Medicine, 34734 Istanbul, Türkiye
| | - Sukran Kose
- Infectious Diseases Clinic, University of Health Sciences, Izmir Tepecik Training and Research Hospital, 35020 Izmir, Türkiye
| | - Sila Akhan
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli University Faculty of Medicine, 41001 Kocaeli, Türkiye
| | - Emin Halis Akalin
- Department of Infectious Diseases and Clinical Microbiology, Bursa Uludag University Faculty of Medicine, 16059 Bursa, Türkiye
| | - Zafer Sezer
- Department of Medical Pharmacology, Erciyes University Faculty of Medicine, 38030 Kayseri, Türkiye
| | - Aykut Ozdarendeli
- Department of Microbiology, Erciyes University Faculty of Medicine, 38030 Kayseri, Türkiye
- Vaccine Research, Development and Application Centre (ERAGEM), Erciyes University, 38280 Kayseri, Türkiye
| | - Serhat Unal
- Vaccine Institute, Hacettepe University, 06230 Ankara, Türkiye
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, 06230 Ankara, Türkiye
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15
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Horváth JK, Ferenci T, Ferenczi A, Túri G, Röst G, Oroszi B. Real-Time Monitoring of the Effectiveness of Six COVID-19 Vaccines against Laboratory-Confirmed COVID-19 in Hungary in 2021 Using the Screening Method. Vaccines (Basel) 2022; 10:1824. [PMID: 36366334 PMCID: PMC9697606 DOI: 10.3390/vaccines10111824] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 08/15/2023] Open
Abstract
Several studies have reported the waning effectiveness of COVID-19 vaccines. This study aims to demonstrate the applicability of the screening method for estimating vaccine effectiveness (VE) in a pandemic. We report VE in Hungary, estimated with the screening method, in 2021, covering a period of Alpha and the Delta variant, including the booster dose roll-out. Hungary is in a unique position to use six different vaccines in the same population. All vaccines provided a high level of protection initially, which declined over time. While the picture is different in each age group, the waning of immunity is apparent for all vaccines, especially in the younger age groups and the Sinopharm, Sputnik-V, and AstraZeneca vaccines, which performed similarly. This is clearly reversed by booster doses, more prominent for those three vaccines, where the decline in protection is more evident. Overall, two vaccines, Pfizer/BioNTech and Moderna, tend to produce the best results in all age groups, even with waning immunity considered. Using the screening method in future pandemic waves is worthwhile, especially in countries struggling with a lack of resources or when there is a need to deliver VE results within a short timeframe due to urgent decision-making.
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Affiliation(s)
- Judit K. Horváth
- Epidemiology and Surveillance Centre, Semmelweis University, 1085 Budapest, Hungary
- Mathematical Modelling and Epidemiology Task Force, 1085 Budapest, Hungary
- National Laboratory for Health Security, 6720 Szeged, Hungary
| | - Tamás Ferenci
- Mathematical Modelling and Epidemiology Task Force, 1085 Budapest, Hungary
- National Laboratory for Health Security, 6720 Szeged, Hungary
- Physiological Controls Research Center, Óbuda University, 1034 Budapest, Hungary
- Department of Statistics, Corvinus University of Budapest, 1093 Budapest, Hungary
| | - Annamária Ferenczi
- Epidemiology and Surveillance Centre, Semmelweis University, 1085 Budapest, Hungary
- Mathematical Modelling and Epidemiology Task Force, 1085 Budapest, Hungary
- National Laboratory for Health Security, 6720 Szeged, Hungary
| | - Gergő Túri
- Epidemiology and Surveillance Centre, Semmelweis University, 1085 Budapest, Hungary
- Mathematical Modelling and Epidemiology Task Force, 1085 Budapest, Hungary
- National Laboratory for Health Security, 6720 Szeged, Hungary
| | - Gergely Röst
- Mathematical Modelling and Epidemiology Task Force, 1085 Budapest, Hungary
- National Laboratory for Health Security, 6720 Szeged, Hungary
- Bolyai Institute, University of Szeged, 6720 Szeged, Hungary
| | - Beatrix Oroszi
- Epidemiology and Surveillance Centre, Semmelweis University, 1085 Budapest, Hungary
- Mathematical Modelling and Epidemiology Task Force, 1085 Budapest, Hungary
- National Laboratory for Health Security, 6720 Szeged, Hungary
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16
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Abdul Aziz NI, Flanders S, Nungsari M. Social expectations and government incentives in Malaysia's COVID-19 vaccine uptake. PLoS One 2022; 17:e0275010. [PMID: 36156604 PMCID: PMC9512221 DOI: 10.1371/journal.pone.0275010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/08/2022] [Indexed: 11/19/2022] Open
Abstract
High vaccination rates are integral to reducing infection and severity rates of COVID-19 infections within a community. We examine the role of social expectations in COVID-19 vaccination take-ups and its interaction with potential government actions in Malaysia. We find that individuals' expectations of others in their social groups towards vaccination predicts those individuals' vaccination registrations. Using a vignette experiment, we examine the extent of normative expectations in normalizing pro-vaccination behavior beyond an individual's reference group. We find that unless moderated by a high level of public trust, individuals prefer punitive policies as a way to increase vaccination rates in their communities.
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Affiliation(s)
- N. Izzatina Abdul Aziz
- Institute of Malaysian and International Studies (IKMAS), National University of Malaysia, Bangi, Selangor, Malaysia
- ASEAN Research Center, Asia School of Business, Kuala Lumpur, Malaysia
| | - Sam Flanders
- ASEAN Research Center, Asia School of Business, Kuala Lumpur, Malaysia
- Asia School of Business, Kuala Lumpur, Malaysia
- MIT Sloan School of Management, Cambridge, MA, United States of America
| | - Melati Nungsari
- ASEAN Research Center, Asia School of Business, Kuala Lumpur, Malaysia
- Asia School of Business, Kuala Lumpur, Malaysia
- MIT Sloan School of Management, Cambridge, MA, United States of America
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17
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Yu CY, Wong SY, Liew NWC, Joseph N, Zakaria Z, Nurulfiza I, Soe HJ, Kairon R, Amin-Nordin S, Chee HY. Whole genome sequencing analysis of SARS-CoV-2 from Malaysia: From alpha to Omicron. Front Med (Lausanne) 2022; 9:1001022. [PMID: 36213636 PMCID: PMC9537942 DOI: 10.3389/fmed.2022.1001022] [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: 07/22/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
Countries around the world are gearing for the transition of the coronavirus disease 2019 (COVID-19) from pandemic to endemic phase but the emergence of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants could lead to a prolonged pandemic. SARS-CoV-2 has continued to evolve as it optimizes its adaptation to the human host and the successive waves of COVID-19 have been linked to the explosion of particular variant of concern. As the genetic diversity and epidemiological landscape of SARS-CoV-2 differ from country to country, this study aims to provide insights into the variants that are circulating in Malaysia. Whole genome sequencing was performed for 204 SARS-CoV-2 from COVID-19 cases and an additional 18,667 SARS-CoV-2 genome sequences were retrieved from the GISAID EpiCoV database for clade, lineage and genetic variation analyses. Complete genome sequences with high coverage were then used for phylogeny investigation and the resulting phylogenetic tree was constructed from 8,716 sequences. We found that the different waves of COVID-19 in Malaysia were dominated by different clades with the L and O clade for first and second wave, respectively, whereas the progressive replacement by G, GH, and GK of the GRA clade were observed in the subsequence waves. Continuous monitoring of the genetic diversity of SARS-CoV-2 is important to identify the emergence and dominance of new variant in different locality so that the appropriate countermeasures can be taken to effectively contain the spread of SARS-CoV-2.
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Affiliation(s)
- Choo Yee Yu
- Laboratory of Vaccine and Biomolecules, Institute of Bioscience, Universiti Putra Malaysia, Serdang, Malaysia
| | - Sie Yeng Wong
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nancy Woan Charn Liew
- Laboratory of Vaccine and Biomolecules, Institute of Bioscience, Universiti Putra Malaysia, Serdang, Malaysia
| | - Narcisse Joseph
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Zunita Zakaria
- Institute of Bioscience, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Malaysia
| | - Isa Nurulfiza
- Laboratory of Vaccine and Biomolecules, Institute of Bioscience, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Cell and Molecular Biology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | | | | | - Syafinaz Amin-Nordin
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Hui Yee Chee
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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18
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Lim AH, Ab Rahman N, Ong SM, Paraja J, Rashid R, Parmar IS, Dahlan SN, Tan ZSS, Bohari I, Peariasamy KM, Sivasampu S. Evaluation of BNT162b2 vaccine effectiveness in Malaysia: test negative case-control study. Vaccine 2022; 40:5675-5682. [PMID: 36030123 PMCID: PMC9399819 DOI: 10.1016/j.vaccine.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/13/2022] [Accepted: 08/15/2022] [Indexed: 12/01/2022]
Abstract
There is a notable lack of vaccine effectiveness studies using test-negative case-controlled approach in low- and middle-income countries which have different logistic, demographic and socio-economic conditions from high-income countries. We aimed to estimate the effectiveness of BNT162b2 vaccine against COVID-19 infection over time, intensive care unit admission, severe or critical disease and death due to COVID-19. This study was conducted in the resident population of Labuan aged ≥18 years who had been tested for SARS-CoV-2 by Reverse-Transcriptase Polymerase Chain Reaction between 1 March 2021 and 31 October 2021. We used a test-negative case-control design where 2644 pairs of cases and controls were matched by age, sex, testing date, nationality and testing reason. Analysis was stratified by age group to estimate age effect (<60 years and ≥60 years). Of 22217 individuals tested by Reverse-Transcriptase Polymerase Chain Reaction, 5100 were positive for SARS-CoV-2 and aged 18 years and above. Overall vaccine effectiveness ≥ 14 days after the second dose was 65.2% (95% CI: 59.8–69.9%) against COVID-19 infection, 92.5% (95% CI: 72.3–98.8%) against intensive care unit admission, and 96.5% (95% CI: 82.3–99.8%) against COVID-19 deaths. Among infected individuals, vaccine effectiveness was 79.2% (95% CI: 42.3–94.1%) in preventing severe or critical disease due to COVID-19. Vaccine effectiveness for ≥60 years was 72.3% (95% CI: 53.4–83.9%) in fully vaccinated individuals, higher than 64.8% (95% CI: 49.3–59.1%) for those <60 years. Two doses of BNT162b2 were highly effective against COVID-19 infection, severe or critical disease, intensive care unit admission and death due to COVID-19. This study addresses a gap in literature on BNT162b2 vaccine effectiveness in low- and middle-income populations and demonstrates the feasibility of such a study design in a resource limited setting while supporting evidence of waning immunity.
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Affiliation(s)
- Audrey Huili Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia.
| | - Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Su Miin Ong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | | | - Rahmah Rashid
- Labuan State Health Department, Ministry of Health, Malaysia
| | | | | | | | - Ismuni Bohari
- Labuan State Health Department, Ministry of Health, Malaysia
| | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
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19
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Low EV, Tok PSK, Husin M, Suah JL, Tng BH, Thevananthan T, Appannan MR, Yahaya H, Mohd Zin S, Muhamad Zin F, Sivasampu S, Peariasamy KM. Assessment of Heterologous and Homologous Boosting With Inactivated COVID-19 Vaccine at 3 Months Compared With Homologous Boosting of BNT162b2 at 6 Months. JAMA Netw Open 2022; 5:e2226046. [PMID: 35947381 PMCID: PMC9366545 DOI: 10.1001/jamanetworkopen.2022.26046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Evidence for the timing of booster vaccination after completion of BNT162b2 and CoronaVac primary vaccination is crucial to guide policy recommendations. OBJECTIVE To compare the odds of symptomatic SARS-CoV-2 infection and COVID-19-related outcomes after heterologous and homologous boosting of CoronaVac at 3-month intervals and homologous boosting of BNT162b2 at 6-month intervals, with BNT162b2 primary series (2 doses) as the reference group. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used national data for Malaysia. Participants included all individuals aged 18 years and older who received a complete primary series of CoronaVac or BNT162b2 vaccine and were eligible for a booster dose between November 21, 2021, and December 28, 2021. Data were analyzed from November 21, 2021, to January 7, 2022. EXPOSURES Receipt of a booster vs no booster and categorized into primary series BNT162b2 (2 doses of BNT162b2), primary series CoronaVac (2 doses of CoronaVac), 3 doses of BNT162b2, primary series CoronaVac plus a BNT162b2 booster, and 3 doses of CoronaVac. MAIN OUTCOMES AND MEASURES The primary outcome was symptomatic SARS-CoV-2 infection. The secondary outcomes were COVID-19-related intensive care unit admission and death. All outcomes were observed from the day an individual was considered fully boosted (≥14 days after booster dose). RESULTS Our cohort included 13 840 240 individuals (mean [SD] age, 39.9 [15.5] years; 7 040 298 [50.9%] men; 4 451 180 individuals [32.2%] with ≥1 comorbidities), of whom 5 081 641 individuals (36.7%) had received a booster dose. Using the primary series BNT162b2 recipients as reference, the adjusted odds against symptomatic SAR-CoV-2 infection were lower for individuals who received the primary series CoronaVac plus a BNT162b2 (adjusted odds ratio [aOR], 0.06 [95% CI, 0.05-0.06]), 3 doses of CoronaVac (aOR, 0.08 [95% CI, 0.06-0.10]), or 3 doses of BNT162b2 (aOR, 0.01 [95% CI, 0.00-0.01]). Receipt of heterologous booster (primary series of CoronaVac plus a BNT162b2 booster) was associated with lower odds of SARS-CoV-2 infection (aOR, 0.17 [95% CI, 0.17-0.18]) compared with homologous booster (3 doses of CoronaVac) for individuals aged 60 years and older (aOR, 0.19 [95% CI, 0.19-0.20]). CONCLUSIONS AND RELEVANCE In this cohort study, for individuals who received the CoronaVac primary series and a booster dose of BNT162b2 or CoronaVac at 3 months, the observed odds of symptomatic SARS-CoV-2 infection were similar to individuals who received the BNT162b2 primary series plus a third dose of BNT162b2 at 6 months. Heterologous booster is recommended for individuals aged 60 years or older who received the CoronaVac primary series, given the lower observed odds against symptomatic SARS-CoV-2 infection among those who received a BNT1612b2 booster.
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Affiliation(s)
- Ee Vien Low
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Peter Seah Keng Tok
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Jing Lian Suah
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Boon Hwa Tng
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | | | | | - Hazlina Yahaya
- Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Shahanizan Mohd Zin
- Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Faizah Muhamad Zin
- Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | - Kalaiarasu M. Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
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20
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Ab Rahman N, Lim MT, Lee FY, Ong SM, Peariasamy KM, Sivasampu S. A Case-Based Monitoring Approach to Evaluate Safety of COVID-19 Vaccines in a Partially Integrated Health Information System: A Study Protocol. Front Pharmacol 2022; 13:834940. [PMID: 35910370 PMCID: PMC9328743 DOI: 10.3389/fphar.2022.834940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
In response to Coronavirus disease 2019 (COVID-19) global pandemic, various COVID-19 vaccines were rapidly administered under emergency use authorization. Rare outcomes associated with COVID-19 vaccines might be less likely to be captured in clinical trials, leading to a knowledge gap in real-world vaccine safety. In contrast with high-income countries, many low-to-middle income countries have limited capacity to conduct active surveillance, owing to the absence of large and fully-integrated health information databases. This paper describes the study protocol, which aims to investigate risk of prespecified adverse events of special interests following COVID-19 vaccination in a partially integrated health information system with non-shareable electronic health records. The SAFECOVAC study is a longitudinal, observational retrospective study of active safety surveillance using case-based monitoring approach. This involves linkage of several administrative databases and hospitalization data monitoring to identify adverse events of special interests following administration of COVID-19 vaccines in Malaysia. The source population comprises of all individuals who received at least one dose of COVID-19 vaccine. Self-controlled design and vaccinated case-coverage design will be employed to assess risk of adverse events of special interests and determine the association with vaccine exposure. Data on vaccination records will be obtained from the national COVID-19 vaccination register to identify the vaccination platforms, doses and the timing of vaccinations. The outcome of this study is hospitalization for the adverse events of special interests between March 2021 and June 2022. The outcomes will be obtained through linkage with hospital admission database and national pharmacovigilance database. Findings will provide analysis of real-world data which can inform deliberations by government and public health decision makers relative to the refinement of COVID-19 vaccination recommendations.
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Affiliation(s)
- Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
- *Correspondence: Norazida Ab Rahman,
| | - Ming Tsuey Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Fei Yee Lee
- Clinical Research Centre, Selayang Hospital, Ministry of Health, Selangor, Malaysia
| | - Su Miin Ong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Kalaiarasu M. Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
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21
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Chuenkitmongkol S, Solante R, Burhan E, Chariyalertsak S, Chiu NC, Do-Van D, Husin M, Hwang KP, Kiertiburanakul S, Kulkarni PS, Lee PI, Lobo RC, Nghia CH, Ong-Lim A, Sivasampu S, Suah JL, Tok PSK, Thwaites G. Expert Review on global real-world vaccine effectiveness against SARS-CoV-2. Expert Rev Vaccines 2022; 21:1255-1268. [PMID: 35748494 DOI: 10.1080/14760584.2022.2092472] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION COVID-19 vaccines have been highly effective in reducing morbidity and mortality during the pandemic. While primary series vaccination rates are generally high in Southeast Asian (SEA) countries, various factors have limited the rollout and impact of booster doses. AREAS COVERED We reviewed 79 studies in the publicly available International Vaccine Access Center (IVAC) VIEW-hub platform on vaccine effectiveness (VE) after primary immunizations with two-dose schedules. VE data were reported for SARS-CoV-2 infection, COVID-19-related hospitalizations and deaths, and stratified across variants of concern (VOC), age, study design and prior SARS-CoV-2 infection for mRNA vaccines (BNT162b2, mRNA-1273 and combinations of both), vector vaccines (AstraZeneca, AZD1222 "Vaxzevria") and inactivated virus vaccines (CoronaVac). EXPERT OPINION The most-studied COVID-19 vaccines provide consistently high (>90%) protection against serious clinical outcomes like hospitalizations and deaths, regardless of variant. Additionally, this protection appears equivalent for mRNA vaccines and vector vaccines like AZD1222, as supported by our analysis of local Asian and relevant international data, and by insights from SEA experts. Given the continued impact of COVID-19 hospitalizations and deaths on healthcare systems worldwide, encouraging vaccination strategies that can reduce this burden is more relevant than attempting to prevent broader but milder infections with specific variants, including Omicron.
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Affiliation(s)
| | | | - Erlina Burhan
- Faculty of Medicine Universitas Indonesia, RSUP Persahabatan, Jakarta, Indonesia
| | | | | | - Dung Do-Van
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Kao-Pin Hwang
- China Medical University Children's Hospital, Taichung, Taiwan
| | | | | | - Ping-Ing Lee
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | | | - Anna Ong-Lim
- College of Medicine - Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Jing Lian Suah
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Peter Seah Keng Tok
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam, and The Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
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22
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Ab Rahman N, Lim MT, Lee FY, Lee SC, Ramli A, Saharudin SN, King TL, Anak Jam EB, Ayub NA, Sevalingam RK, Bahari R, Ibrahim NN, Mahmud F, Sivasampu S, Peariasamy KM. Risk of serious adverse events after the BNT162b2, CoronaVac, and ChAdOx1 vaccines in Malaysia: A self-controlled case series study. Vaccine 2022; 40:4394-4402. [PMID: 35667917 PMCID: PMC9163997 DOI: 10.1016/j.vaccine.2022.05.075] [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: 03/14/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 10/25/2022]
Abstract
BACKGROUND Rapid deployment of COVID-19 vaccines is challenging for safety surveillance, especially on adverse events of special interest (AESIs) that were not identified during the pre-licensure studies. This study evaluated the risk of hospitalisations for predefined diagnoses among the vaccinated population in Malaysia. METHODS Hospital admissions for selected diagnoses between 1 February 2021 and 30 September 2021 were linked to the national COVID-19 immunisation register. We conducted self-controlled case-series study by identifying individuals who received COVID-19 vaccine and diagnosis of thrombocytopenia, venous thromboembolism, myocardial infarction, myocarditis/pericarditis, arrhythmia, stroke, Bell's Palsy, and convulsion/seizure. The incidence of events was assessed in risk period of 21 days postvaccination relative to the control period. We used conditional Poisson regression to calculate the incidence rate ratio (IRR) and 95% confidence interval (CI) with adjustment for calendar period. RESULTS There was no increase in the risk for myocarditis/pericarditis, Bell's Palsy, stroke, and myocardial infarction in the 21 days following either dose of BNT162b2, CoronaVac, and ChAdOx1 vaccines. A small increased risk of venous thromboembolism (IRR 1.24; 95% CI 1.02, 1.49), arrhythmia (IRR 1.16, 95% CI 1.07, 1.26), and convulsion/seizure (IRR 1.26; 95% CI 1.07, 1.48) was observed among BNT162b2 recipients. No association between CoronaVac vaccine was found with all events except arrhythmia (IRR 1.15; 95% CI 1.01, 1.30). ChAdOx1 vaccine showed significant association for thrombocytopenia (IRR 2.67; 95% CI 1.21, 5.89) and venous thromboembolism (IRR 2.22; 95% CI 1.17, 4.21). CONCLUSION This study shows acceptable safety profiles of COVID-19 vaccines among recipients of BNT162b2, CoronaVac, and ChAdOx1 vaccines. This information can be used together with effectiveness data for risk-benefit analysis of the vaccination program. Further surveillance with more data is required to assess AESIs following COVID-19 vaccination in short- and long-term.
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Affiliation(s)
- Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Selangor, Malaysia.
| | - Ming Tsuey Lim
- Institute for Clinical Research, National Institutes of Health, Selangor, Malaysia
| | - Fei Yee Lee
- Institute for Clinical Research, National Institutes of Health, Selangor, Malaysia
| | - Sing Chet Lee
- National Pharmaceutical Regulatory Agency, Selangor, Malaysia
| | - Azuana Ramli
- National Pharmaceutical Regulatory Agency, Selangor, Malaysia
| | | | - Teck Long King
- Clinical Research Centre, Sarawak General Hospital, Sarawak, Malaysia
| | | | - Nor Aliya Ayub
- Clinical Research Centre, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | | | - Rashidah Bahari
- Clinical Research Centre, Putrajaya Hospital, Putrajaya, Malaysia
| | | | - Fatihah Mahmud
- Clinical Research Centre, Tengku Ampuan Afzan Hospital, Pahang, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Selangor, Malaysia
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23
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Husin M, Tok PSK, Suah JL, Thevananthan T, Tng BH, Peariasamy KM, Sivasampu S. Real-world effectiveness of BNT162b2 vaccine against SARS-CoV-2 infection among adolescents (12 to 17-year-olds) in Malaysia. Int J Infect Dis 2022; 121:55-57. [PMID: 35500793 PMCID: PMC9055416 DOI: 10.1016/j.ijid.2022.04.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES In this study, we aimed to investigate vaccine effectiveness (VE) against SARS-CoV-2 infections among adolescents aged 12 to 17 years in Malaysia and examine potential VE differences after full vaccination. METHODS We consolidated data on COVID-19 testing, vaccination, and outcomes for all public school-going adolescents in Malaysia from September 1, 2021, to December 31, 2021, and estimated the VE against SARS-CoV-2 infections during this period. Cases were defined as positive tests, either by reverse transcriptase- PCR (RT-PCR) or rapid antigen (RTK-Ag) testing, while controls were negative tests. Secondarily, we restricted the analysis to all tests performed in December 2021 and compared VE by month of full vaccination. RESULTS A total of 175,880 eligible tests (53.4% or 93,995 RT-PCR tests) were included. After full vaccination with BNT162b2, VE against SARS-CoV-2 infections was 65.7% (95% confidence interval [CI] 64.4, 66.9) over the study period. When restricted to tests in December 2021, VEs for those fully vaccinated in September 2021, October 2021, and November 2021 were comparable (60.6% [95% CI 23.7, 81.5], 56.9% [95% CI 51.1, 62.0], and 65.7% [95% CI 59.8, 70.7] respectively). CONCLUSIONS Among adolescents, full vaccination with BNT162b2 offered considerable protection against SARS-CoV-2 infections over at least three months without substantial evidence of waning.
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Affiliation(s)
- Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Malaysia.
| | - Peter Seah Keng Tok
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Malaysia.
| | - Jing Lian Suah
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Malaysia
| | - Thevesh Thevananthan
- Disease Control Division, Ministry of Health Malaysia, Putrajaya, 62590, Malaysia
| | - Boon Hwa Tng
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Malaysia
| | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, 40170, Malaysia
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24
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Suah JL, Husin M, Keng PS, Hwa B, Thevananthan T, Low EV, Appannan MR, Zin FM, Zin SM, Yahaya H, Peariasamy KM, Sivasampu S. Waning COVID-19 Vaccine Effectiveness for BNT162b2 and CoronaVac in Malaysia: An Observational Study. Int J Infect Dis 2022; 119:69-76. [PMID: 35331933 PMCID: PMC8938298 DOI: 10.1016/j.ijid.2022.03.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES We aimed to investigate and compare waning vaccine effectiveness (VE) against COVID-19 infection, COVID-19 related ICU admission and COVID-19 related death for BNT162b2 and CoronaVac vaccines. METHODS We consolidated national data on COVID-19 vaccination and outcomes, and used cases from 1 to 30 September 2021 to compare VE between the 'early' (fully vaccinated in April to June 2021) and 'late' (July to August 2021) groups. We estimated VE against COVID-19 infection with a negative binomial regression, and VE against ICU admission and death among confirmed COVID-19 cases with a logistic regression. RESULTS For BNT162b2, VE against COVID-19 infections declined from 90•8% (95% CI 89•4, 92•1) in the 'late' group to 79•3% (95% CI 76•1, 82•1) in the 'early' group. VE for BNT162b2 against ICU admission and death were stable. For CoronaVac, VE waned against COVID-19 infections from 74•5% (95% CI 70•6, 78•0) to 30•4% (95% CI 18•8, 40•3). Effectiveness against ICU admission waned from 56•0% (95% CI 51•2, 60•2) to 28•7% (95% CI 12•2, 42•1). CoronaVac's effectiveness against death remained stable. CONCLUSION VE against COVID-19 infection waned after three to five months of full vaccination for both BNT162b2 and CoronaVac vaccines in Malaysia. For CoronaVac, protection against ICU admission also declined.
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Affiliation(s)
- Jing Lian Suah
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia.
| | - Masliyana Husin
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia.
| | - Peter Seah Keng
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia
| | - Boon Hwa
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia
| | - Thevesh Thevananthan
- Disease Control Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia
| | - Ee Vien Low
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia
| | | | - Faizah Muhamad Zin
- Medical Development Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia
| | - Shahanizan Mohd Zin
- Medical Development Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia
| | - Hazlina Yahaya
- Disease Control Division, Ministry of Health Malaysia, Putrajaya 62590, Malaysia
| | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam 40170, Malaysia
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25
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Abdul Taib NA, Raja DB, Teo AKJ, Kamarulzaman A, William T, HS AS, Mokhtar SA, Ting CY, Yap WA, Chan MYK, Amir LE. Comparison of vaccine efficacy must be based on good clinical data–Authors’ reply. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 20:100413. [PMID: 35233553 PMCID: PMC8882058 DOI: 10.1016/j.lanwpc.2022.100413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nur Asheila Abdul Taib
- AINQA Health Sdn. Bhd., Lot 7.01 B & C, Menara BRDB,285 Jalan Maarof, Bukit Bandaraya, Kuala Lumpur 59000, Malaysia
- Corresponding author.
| | - Dhesi Baha Raja
- AINQA Health Sdn. Bhd., Lot 7.01 B & C, Menara BRDB,285 Jalan Maarof, Bukit Bandaraya, Kuala Lumpur 59000, Malaysia
| | - Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Adeeba Kamarulzaman
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Timothy William
- Gleneagles Hospital, Kota Kinabalu, Sabah, Malaysia
- Infectious Diseases Society Kota Kinabalu Sabah-Menzies School of Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Queen Elizabeth Hospital-Clinical Research Centre, Ministry of Health, Kota Kinabalu, Malaysia
| | - Arvinder-Singh HS
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Malaysia
| | - Siti Aisah Mokhtar
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - Choo-Yee Ting
- Faculty of Computing and Informatics, Multimedia University, Malaysia
| | | | - Michelle Yoon Kim Chan
- AINQA Health Sdn. Bhd., Lot 7.01 B & C, Menara BRDB,285 Jalan Maarof, Bukit Bandaraya, Kuala Lumpur 59000, Malaysia
| | - Lidwina Edwin Amir
- AINQA Health Sdn. Bhd., Lot 7.01 B & C, Menara BRDB,285 Jalan Maarof, Bukit Bandaraya, Kuala Lumpur 59000, Malaysia
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26
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Cocchio S, Zabeo F, Facchin G, Piva N, Furlan P, Nicoletti M, Saia M, Tonon M, Mongillo M, Russo F, Baldo V. The Effectiveness of a Diverse COVID-19 Vaccine Portfolio and Its Impact on the Persistence of Positivity and Length of Hospital Stays: The Veneto Region's Experience. Vaccines (Basel) 2022; 10:vaccines10010107. [PMID: 35062767 PMCID: PMC8777781 DOI: 10.3390/vaccines10010107] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
The vaccination campaign for the Veneto region (northeastern Italy) started on 27 December 2020. As of early December 2021, 75.1% of the whole Veneto population has been fully vaccinated. Vaccine efficacy has been demonstrated in many clinical trials, but reports on real-world contexts are still necessary. We conducted a retrospective cohort study on 2,233,399 residents in the Veneto region to assess the reduction in the COVID-19 burden, taking different outcomes into consideration. First, we adopted a non-brand-specific approach borrowed from survival analysis to estimate the effectiveness of vaccination against SARS-CoV-2 in preventing infections, hospitalizations, and deaths. We used t-tests and multivariate regressions to examine vaccine impact on breakthrough infections, in terms of the persistence of positivity and the length of hospital stays. Evidence emerging from this study suggests that unvaccinated individuals are significantly more likely to become infected, need hospitalization, and are at a higher risk of death from COVID-19 than those given at least one dose of vaccine. Cox models indicate that the effectiveness of full vaccination is 88% against infection, 94% against hospitalization, and 95% against death. Multivariate regressions suggest that vaccination is significantly correlated with a shorter period of positivity and shorter hospital stays, with each step toward completion of the vaccination cycle coinciding with a reduction of 3.3 days in the persistence of positivity and 2.3 days in the length of hospital stay.
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Affiliation(s)
- Silvia Cocchio
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Federico Zabeo
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Giacomo Facchin
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Nicolò Piva
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Patrizia Furlan
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Michele Nicoletti
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
| | - Mario Saia
- Azienda Zero of Veneto Region, 35100 Padua, Italy;
| | - Michele Tonon
- Regional Directorate of Prevention, Food Safety, Veterinary, Public Health—Regione del Veneto, 30123 Venezia, Italy; (M.T.); (M.M.); (F.R.)
| | - Michele Mongillo
- Regional Directorate of Prevention, Food Safety, Veterinary, Public Health—Regione del Veneto, 30123 Venezia, Italy; (M.T.); (M.M.); (F.R.)
| | - Francesca Russo
- Regional Directorate of Prevention, Food Safety, Veterinary, Public Health—Regione del Veneto, 30123 Venezia, Italy; (M.T.); (M.M.); (F.R.)
| | - Vincenzo Baldo
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy; (S.C.); (F.Z.); (G.F.); (N.P.); (P.F.); (M.N.)
- Correspondence: ; Tel.: +39-049-8275381
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