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Yao L, Chemaitelly H, Goldman E, Gudina EK, Khalil A, Ahmed R, James AB, Roca A, Fallah MP, Macnab A, Cho WC, Eikelboom J, Qamar FN, Kremsner P, Oliu-Barton M, Sisa I, Tadesse BT, Marks F, Wang L, Kim JH, Meng X, Wang Y, Fly AD, Wang CY, Day SW, Howard SC, Graff JC, Maida M, Ray K, Franco-Paredes C, Mashe T, Ngongo N, Kaseya J, Ndembi N, Hu Y, Bottazzi ME, Hotez PJ, Ishii KJ, Wang G, Sun D, Aleya L, Gu W. Time to establish an international vaccine candidate pool for potential highly infectious respiratory disease: a community's view. EClinicalMedicine 2023; 64:102222. [PMID: 37811488 PMCID: PMC10550631 DOI: 10.1016/j.eclinm.2023.102222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/26/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
In counteracting highly infectious and disruptive respiratory diseases such as COVID-19, vaccination remains the primary and safest way to prevent disease, reduce the severity of illness, and save lives. Unfortunately, vaccination is often not the first intervention deployed for a new pandemic, as it takes time to develop and test vaccines, and confirmation of safety requires a period of observation after vaccination to detect potential late-onset vaccine-associated adverse events. In the meantime, nonpharmacologic public health interventions such as mask-wearing and social distancing can provide some degree of protection. As climate change, with its environmental impacts on pathogen evolution and international mobility continue to rise, highly infectious respiratory diseases will likely emerge more frequently and their impact is expected to be substantial. How quickly a safe and efficacious vaccine can be deployed against rising infectious respiratory diseases may be the most important challenge that humanity will face in the near future. While some organizations are engaged in addressing the World Health Organization's "blueprint for priority diseases", the lack of worldwide preparedness, and the uncertainty around universal vaccine availability, remain major concerns. We therefore propose the establishment of an international candidate vaccine pool repository for potential respiratory diseases, supported by multiple stakeholders and countries that contribute facilities, technologies, and other medical and financial resources. The types and categories of candidate vaccines can be determined based on information from previous pandemics and epidemics. Each participant country or region can focus on developing one or a few vaccine types or categories, together covering most if not all possible potential infectious diseases. The safety of these vaccines can be tested using animal models. Information for effective candidates that can be potentially applied to humans will then be shared across all participants. When a new pandemic arises, these pre-selected and tested vaccines can be quickly tested in RCTs for human populations.
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Affiliation(s)
- Lan Yao
- Department of Nutrition and Health Science, College of Health, Ball State University, Muncie, IN 47306, USA
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Centre, Memphis, TN 38163, USA
| | - Hiam Chemaitelly
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Emanuel Goldman
- Department of Microbiology, Biochemistry and Molecular Genetics, New Jersey Medical School, Rutgers University, Newark, NJ 07103, USA
| | - Esayas Kebede Gudina
- Department of Internal Medicine, Jimma University Institute of Health, Jimma, Ethiopia
| | - Asma Khalil
- Fetal Medicine Unit, St George’s Hospital, St George’s University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Rahaman Ahmed
- Cell Biology and Genetics Department, University of Lagos, Lagos 101017, Nigeria
- Centre for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Lagos 100001, Nigeria
| | - Ayorinde Babatunde James
- Department of Biochemistry and Nutrition, Nigerian Institute of Medical Research, Yaba, Lagos State, Nigeria
| | - Anna Roca
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara 273, The Gambia
| | - Mosoka Papa Fallah
- Refuge Place International, Monrovia, Liberia
- Centre for Emerging Infectious Diseases Policy and Research, Boston University, Boston, MA, USA
- Africa Centre for Disease Control, Addis Ababa, Ethiopia
| | - Andrew Macnab
- The Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, South Africa
| | - William C. Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong, China
| | - John Eikelboom
- Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Farah Naz Qamar
- Department of Pediatrics and Child Health, Aga Khan University Hospital, National Stadium Rd, Karachi, Sindh 74800, Pakistan
| | - Peter Kremsner
- Institut für Tropenmedizin, Universität Tübingen, Germany
- Centre de Recherches Medicales de Lambarene, Gabon
| | - Miquel Oliu-Barton
- Université Paris Dauphine – PSL, Pl. du Maréchal de Lattre de Tassigny, Paris 75016, France
- Bruegel, Rue de la Charité 33, Brussels 1210, Belgium
| | - Ivan Sisa
- College of Health Sciences, Universidad San Francisco de Quito, Quito 170901, Ecuador
| | | | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
| | - Lishi Wang
- Department of Basic Medicine, Inner Mongolia Medical University, Jinshan Development Zone, Huhhot, China
| | - Jerome H. Kim
- International Vaccine Institute, Seoul, Republic of Korea
- Seoul National University, College of Natural Sciences, Seoul, Republic of Korea
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Alyce D. Fly
- Department of Nutrition and Health Science, College of Health, Ball State University, Muncie, IN 47306, USA
| | - Cong-Yi Wang
- NHC Key Laboratory of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, The Centre for Biomedical Research, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Sara W. Day
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Scott C. Howard
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - J. Carolyn Graff
- College of Nursing, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta 93100, Italy
| | - Kunal Ray
- School of Biological Science, Ramkrishna Mission Vivekananda Education & Research Institute, Narendrapur 700103, West Bengal, India
| | - Carlos Franco-Paredes
- Hospital Infantil de Mexico, Federico Gomez, Mexico
- Department of Microbiology, Immunology, and Pathology, Colorado State University, USA
| | - Tapfumanei Mashe
- One Health Office, Ministry of Health and Child Care, Harare, Zimbabwe
- World Health Organization, Harare, Zimbabwe
| | | | | | | | - Yu Hu
- Institute of Haematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China
- Hubei Clinical and Research Centre of Thrombosis and Hemostasis, Wuhan, China
| | - Maria Elena Bottazzi
- Department of Pediatrics, Texas Children's Hospital Centre for Vaccine Development, Baylor College of Medicine, Houston, TX, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Peter J. Hotez
- Department of Pediatrics, Texas Children's Hospital Centre for Vaccine Development, Baylor College of Medicine, Houston, TX, USA
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
- Molecular Virology & Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Ken J. Ishii
- Division of Vaccine Science, Department of Microbiology and Immunology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- International Vaccine Design Centre, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Centre for Vaccine Adjuvant Research, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Gang Wang
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dianjun Sun
- Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University; Key Laboratory of Etiologic Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health 23618104, 157 Baojian Road, Harbin, Heilongjiang 150081, China
| | - Lotfi Aleya
- Chrono-Environnement Laboratory, UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon Cedex F-25030, France
| | - Weikuan Gu
- Department of Orthopedic Surgery and BME-Campbell Clinic, University of Tennessee Health Science Centre, Memphis, TN 38163, USA
- Research Service, Memphis VA Medical Centre, 1030 Jefferson Avenue, Memphis, TN 38104, USA
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Meher T, Pradhan SK, Hatei SP, Majhi SC, Panda A, Mund SR, Mishra SK. Immunogenicity of ChAdOx1 (Covishield) Booster Dose in Healthcare Providers: A Pre-Post Study. Cureus 2023; 15:e46370. [PMID: 37920622 PMCID: PMC10619706 DOI: 10.7759/cureus.46370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Abstract
Background Worldwide, healthcare workers who face a higher risk of contracting coronavirus disease 2019 (COVID-19) were among the first to receive COVID-19 vaccinations. Following the initial two vaccine doses, health experts recommended a third booster shot to enhance protection against the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) virus. However, limited information about how this booster dose affects antibody levels is available. This study assesses the immune response triggered by the ChAdOx1 (Covishield) booster dose. Methods We conducted a before and after study among 132 healthcare providers at a tertiary care hospital in India who had already received their initial COVID-19 vaccine doses and agreed to participate. A booster shot was administered nine months following their second vaccine dose per the prevalent norms. We collected blood samples to measure immunoglobulin-G (IgG) levels against the spike protein's receptor-binding domain of the SARS-CoV-2 virus. These blood samples were taken both when they received the booster shot and one month after the booster. We determined IgG levels using a chemiluminescence microparticle immunoassay. Result Among the participants, approximately 54% were females. Regarding occupation, about 36% were doctors, 30% were students, 20% were nursing officers, and the remaining 14% held grade-4 positions. The median age of the participants was 32 years. About 74% had no history of underlying health conditions. Before the booster dose, 29% of the participants tested negative for antibodies. However, all participants developed antibodies following the booster shot, and there was a significant increase in antibody levels, which was statistically meaningful with a p-value of less than 0.0001. Conclusion In conclusion, the administration of a booster dose effectively induced seroconversion and significantly increased antibody levels among healthcare providers, enhancing their immunity against COVID-19, essential in the face of a waning immune response to primary series vaccination.
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Affiliation(s)
- Trupti Meher
- Community Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, IND
| | - Subrat K Pradhan
- Community Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, IND
| | - Shankar P Hatei
- Anesthesia and Critical Care, Shrirama Chandra Bhanja (SCB) Medical College and Hospital, Cuttack, IND
| | - Subash C Majhi
- Pediatrics, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, IND
| | - Aishwarya Panda
- Community Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, IND
| | - Smriti R Mund
- Anesthesiology, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, IND
| | - Sanjeeb K Mishra
- Community Medicine, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, IND
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Sannathimmappa M, Nambiar V, Aravindakshan R, Baig M, Hassan A, Mohammed Al-Balushi M. Effectiveness and adverse effects of astrazeneca and pfizer COVID-19 vaccines among medical students in Oman: A comparative study. BIOMEDICAL AND BIOTECHNOLOGY RESEARCH JOURNAL (BBRJ) 2023. [DOI: 10.4103/bbrj.bbrj_9_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
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Licensed liposomal vaccines and adjuvants in the antigen delivery system. BIOTECHNOLOGIA 2022; 103:409-423. [PMID: 36685697 PMCID: PMC9837556 DOI: 10.5114/bta.2022.120709] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/10/2022] [Accepted: 08/02/2022] [Indexed: 12/28/2022] Open
Abstract
Liposomes (LSs) are promising nanoparticles with unique properties such as controlled nanosize, large surface area, increased reactivity, and ability to undergo modification. Worldwide, licensed liposomal forms of antibiotics, hormones, antioxidants, cytostatics, ophthalmic drugs, etc., are available on the pharmaceutical market. This review focuses on the adjuvant properties of LSs in the production of vaccines (VACs). LS-VACs have the following advantages: antigens with low immunogenicity can become highly immunogenic; LSs can include both hydrophilic and hydrophobic antigens; LSs allow to achieve a prolonged specific action of antibodies; and LSs reduce the toxicity and pyrogenicity of encapsulated antigens and adjuvants. The immune response is influenced by the composition of the liposomal membrane, physicochemical characteristics of lipids, antigen localization in LSs, interaction of LSs with complement, and a number of proteins, which leads to opsonization. The major requirements for adjuvants are their ability to enhance the immune response, biodegradability, and elimination from the organism, and LSs fully meet these requirements. The effectiveness and safety of LSs as carriers in the antigen delivery system have been proven by the long-term clinical use of licensed vaccines against hepatitis A, influenza, herpes zoster, malaria, and COVID-19.
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Ioannidis JPA. Factors influencing estimated effectiveness of COVID-19 vaccines in non-randomised studies. BMJ Evid Based Med 2022; 27:324-329. [PMID: 35338091 PMCID: PMC9691814 DOI: 10.1136/bmjebm-2021-111901] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 12/15/2022]
Abstract
Non-randomised studies assessing COVID-19 vaccine effectiveness need to consider multiple factors that may generate spurious estimates due to bias or genuinely modify effectiveness. These include pre-existing immunity, vaccination misclassification, exposure differences, testing, disease risk factor confounding, hospital admission decision, treatment use differences, and death attribution. It is useful to separate whether the impact of each factor admission decision, treatment use differences, and death attribution. Steps and measures to consider for improving vaccine effectiveness estimation include registration of studies and of analysis plans; sharing of raw data and code; background collection of reliable information; blinded assessment of outcomes, e.g. death causes; using maximal/best information in properly-matched studies, multivariable analyses, propensity analyses, and other models; performing randomised trials, whenever possible, for suitable questions, e.g. booster doses or comparative effectiveness of different vaccination strategies; living meta-analyses of vaccine effectiveness; better communication with both relative and absolute metrics of risk reduction and presentation of uncertainty; and avoidance of exaggeration in communicating results to the general public.
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Affiliation(s)
- John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine and Department of Epidemiology and Population Health, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
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Tschiderer L, Seekircher L, Richter L, von Laer D, Lass-Flörl C, Forer L, Schönherr S, Krammer F, Embacher-Aichhorn S, Tilg H, Weiss G, Allerberger F, Willeit P. Ultra-rapid rollout vaccination with BNT162b2 to reduce SARS-CoV-2 infections in the general population. iScience 2022; 25:105380. [PMID: 36373097 PMCID: PMC9639213 DOI: 10.1016/j.isci.2022.105380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/30/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022] Open
Abstract
This study aimed to determine the impact of ultra-rapid rollout vaccination on incidence of SARS-CoV-2 infection. Vaccination with BNT162b2 was provided to 66.9% of eligible residents of the Schwaz district in Tyrol, Austria, within six days per dose (first dose: 11–16 March 2021, second dose: 8–13 April 2021). Of 11,955 individuals enrolled at nine vaccination centers (median age 44.6 years; 51.3% female), 71 had incident SARS-CoV-2 over a six-month follow-up. Incidence rates per 100,000 person-weeks were 92.3 (95% confidence interval [CI]: 70.8–120.2) at weeks 1–5 and 6.4 (3.9–10.4) at ≥6 weeks after dose 1. In these two periods, effectiveness of the vaccination campaign to reduce incident SARS-CoV-2 was 58.6% (50.8%–65.2%) and 91.1% (89.6%–92.3%) in study participants and 28.3% (23.1%–33.0%) and 64.0% (61.7%–66.1%) in the Schwaz district, compared with districts with slower vaccination rollout. Therefore, the vaccination campaign in the Schwaz district illustrates the impact of accelerated vaccination rollout in controlling the pandemic. This study accompanied an ultra-rapid rollout vaccination campaign in Austria 66.9% of eligible residents of the Schwaz district received BNT162b2 within 6 days Over six months, SARS-CoV-2 incidence rate was 22.8 per 100.000 person-weeks Effectiveness of the vaccination campaign was 91.1% at ≥6 weeks after the 1st dose
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Affiliation(s)
- Lena Tschiderer
- Institute of Health Economics, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Lisa Seekircher
- Institute of Health Economics, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Lukas Richter
- Institute of Infectious Disease Epidemiology, Austrian Agency for Health and Food Safety, 1220 Vienna, Austria
| | - Dorothee von Laer
- Institute of Virology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Cornelia Lass-Flörl
- Department of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Lukas Forer
- Institute of Genetic Epidemiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Sebastian Schönherr
- Institute of Genetic Epidemiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Florian Krammer
- Department of Microbiology and Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029-5674, USA
| | | | - Herbert Tilg
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Infectious Diseases, Immunology, Pneumology and Rheumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Franz Allerberger
- Institute of Infectious Disease Epidemiology, Austrian Agency for Health and Food Safety, 1220 Vienna, Austria
| | - Peter Willeit
- Institute of Health Economics, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- Corresponding author
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The Impact of Immune-Modifying Treatments for Skin Diseases on the Immune Response to COVID-19 Vaccines: a Narrative Review. CURRENT DERMATOLOGY REPORTS 2022; 11:263-288. [PMID: 36310766 PMCID: PMC9592867 DOI: 10.1007/s13671-022-00376-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/18/2022]
Abstract
Purpose of Review SARS-CoV-2 has had a devastating global effect, with vaccinations being paramount in the public health strategy against COVID-19. Vaccinations have uncoupled infection from adverse COVID-19 outcomes worldwide. While immune-modifying therapies are effective for the management of skin diseases such as psoriasis and atopic dermatitis, these medications also impair protective immune responses. There has been longstanding uncertainty and concern over the impact of immune-modifying therapies on the effectiveness of vaccines; for example, it is well recognised that methotrexate impairs humoral responses to both influenza and pneumococcal vaccines. This narrative review aims to discuss the evidence to date on the impact of immune-modifying therapies on the immune response to COVID-19 vaccines, with a focus on the first two vaccine doses. Recent Findings Individuals receiving immune-modifying therapy are more likely to have attenuated humoral responses to a single dose of COVID-19 vaccine compared to healthy controls; however, this may be improved by a complete course of vaccination. B cell targeted biologics such as rituximab markedly impair the humoral response to both the first and second COVID-19 vaccination. There remains a paucity of data on cellular immune responses, with the few available studies indicating lower responses to two vaccine doses in individuals receiving immune-modifying therapies compared to healthy controls, which may impact the durability of immune responses. Summary Inadequate humoral immune responses to a single dose of vaccine in the context of immune-modifying therapy are improved by a complete course of vaccination. Individuals receiving immune-modifying treatments should be encouraged to take up a complete vaccine course to mitigate their risk against COVID-19. Research in large patient populations on the longevity/kinetics of the complex humoral and cellular response to subsequent vaccine doses, including against newer variants of concern, is warranted, in addition to data on immune correlates of vaccine clinical effectiveness.
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Ding Y, Shen Y, Fan Y, Chen J, Xu Y, Wu D. The safety and short-term outcomes of allogeneic hematopoietic stem cell transplantation with donor vaccination for COVID-19. MedComm (Beijing) 2022; 3:e179. [PMID: 36226252 PMCID: PMC9534375 DOI: 10.1002/mco2.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Yihan Ding
- National Clinical Research Center for Hematologic DiseasesJiangsu Institute of HematologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina,Institute of Blood and Marrow TransplantationCollaborative Innovation Center of HematologySoochow UniversitySuzhouChina,Department of HematologyThe Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical UniversityHuai'anChina
| | - Yifan Shen
- National Clinical Research Center for Hematologic DiseasesJiangsu Institute of HematologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina,Institute of Blood and Marrow TransplantationCollaborative Innovation Center of HematologySoochow UniversitySuzhouChina
| | - Yi Fan
- National Clinical Research Center for Hematologic DiseasesJiangsu Institute of HematologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina,Institute of Blood and Marrow TransplantationCollaborative Innovation Center of HematologySoochow UniversitySuzhouChina
| | - Jia Chen
- National Clinical Research Center for Hematologic DiseasesJiangsu Institute of HematologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina,Institute of Blood and Marrow TransplantationCollaborative Innovation Center of HematologySoochow UniversitySuzhouChina
| | - Yang Xu
- National Clinical Research Center for Hematologic DiseasesJiangsu Institute of HematologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina,Institute of Blood and Marrow TransplantationCollaborative Innovation Center of HematologySoochow UniversitySuzhouChina
| | - Depei Wu
- National Clinical Research Center for Hematologic DiseasesJiangsu Institute of HematologyThe First Affiliated Hospital of Soochow UniversitySuzhouChina,Institute of Blood and Marrow TransplantationCollaborative Innovation Center of HematologySoochow UniversitySuzhouChina
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Estimating conditional vaccine effectiveness. Eur J Epidemiol 2022; 37:885-890. [PMID: 36155868 PMCID: PMC9510183 DOI: 10.1007/s10654-022-00911-3] [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: 04/11/2022] [Accepted: 08/31/2022] [Indexed: 11/26/2022]
Abstract
Vaccine effectiveness for COVID-19 is typically estimated for different outcomes that often are hierarchical in severity (e.g. any documented infection, symptomatic infection, hospitalization, death) and subsets of each other. Conditional effectiveness for a more severe outcome conditional on a less severe outcome is the protection offered against the severe outcome (e.g. death) among those who already sustained the less severe outcome (e.g. documented infection). The concept applies also to the protection offered by previous infection rather than vaccination. Formulas and a nomogram are provided here for calculating conditional effectiveness. Illustrative examples are presented from recent vaccine effectiveness studies, including situations where effectiveness for different outcomes changed at different pace over time. E(death | documented infection) is the percent decrease in the case fatality rate and E(death | infection) is the percent decrease in the infection fatality rate (IFR). Conditional effectiveness depends on many factors and should not be misinterpreted as a causal effect estimate. However, it may be used for better personalized communication of the benefits of vaccination, considering also IFR and epidemic activity in public health decision-making and communication.
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Grøsland M, Larsen VB, Telle K, Gjefsen HM. Has vaccination alleviated the strain on hospitals due to COVID-19? A combined difference-in-difference and simulation approach. BMC Health Serv Res 2022; 22:1183. [PMID: 36131346 PMCID: PMC9490737 DOI: 10.1186/s12913-022-08541-x] [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: 04/05/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Serious measures, including mass vaccination, have been taken to ensure sufficient hospital capacity during the COVID-19 pandemic. Due to high hospitalization risk in the oldest age groups, most countries prioritized elderly for vaccines. The aim of this study is to broaden the understanding of how vaccination in younger age groups relieved the strain on hospitals during the pandemic. Methods To determine the impact of vaccination on hospitalization, we relied on individual level data on health care use and vaccination from the Norwegian Emergency Preparedness Register Beredt C19. Using a pre-post design, we estimated the increase in hospitalization days from before to after confirmed COVID-19 for individuals aged 18-64 who were fully vaccinated (N=2 419) or unvaccinated (N=55 168) with comparison groups of vaccinated (N=4 818) and unvaccinated (N= 97 126) individuals without COVID-19. To evaluate whether vaccination itself contributed to a strain in hospitals, we use a similar design to study hospitalization rates before and after vaccination by comparing individuals vaccinated with the first dose (N=67 687) to unvaccinated individuals (N=130 769). These estimates were incorporated into a simulation of hospitalization days with different vaccine scenarios to show how the estimated results might have mattered for the hospitals and their capacity. Results Hospitalization days increased by 0.96 percentage point each day during the first week and 1.57 percentage points during the second week after testing positive for COVID-19 for unvaccinated individuals. The corresponding increase was 0.46 and 0.32 for vaccinated individuals, i.e., a substantial difference. The increase was significantly higher for those aged 45-64 than for those aged 18-25. We find no increase in hospitalization days due to vaccination. Simulation results show that vaccination reduced hospitalization days by 25 percent, mainly driven by age 45-64. Conclusion Our findings indicate that vaccination of individuals aged 18-64 did alleviate pressure on hospitals. Whereas there was a substantial relieve from vaccinating the 45-64 age group, there was no such contribution from vaccinating the 18-25 age group. Our study highlights how simulation models can be useful when evaluating alternative vaccine strategies. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08541-x.
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Affiliation(s)
- Mari Grøsland
- Norwegian Institute of Public Health, Cluster for Health Services Research, Postboks 222, Skøyen, N-0213, 0473, Oslo, Norway.
| | - Vilde Bergstad Larsen
- Norwegian Institute of Public Health, Cluster for Health Services Research, Postboks 222, Skøyen, N-0213, 0473, Oslo, Norway
| | - Kjetil Telle
- Norwegian Institute of Public Health, Cluster for Health Services Research, Postboks 222, Skøyen, N-0213, 0473, Oslo, Norway
| | - Hege Marie Gjefsen
- Norwegian Institute of Public Health, Cluster for Health Services Research, Postboks 222, Skøyen, N-0213, 0473, Oslo, Norway
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Higdon MM, Wahl B, Jones CB, Rosen JG, Truelove SA, Baidya A, Nande AA, ShamaeiZadeh PA, Walter KK, Feikin DR, Patel MK, Deloria Knoll M, Hill AL. A Systematic Review of Coronavirus Disease 2019 Vaccine Efficacy and Effectiveness Against Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Disease. Open Forum Infect Dis 2022; 9:ofac138. [PMID: 35611346 PMCID: PMC9047227 DOI: 10.1093/ofid/ofac138] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/17/2022] [Indexed: 01/13/2023] Open
Abstract
Billions of doses of coronavirus disease 2019 (COVID-19) vaccines have been administered globally, dramatically reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) incidence and severity in some settings. Many studies suggest vaccines provide a high degree of protection against infection and disease, but precise estimates vary and studies differ in design, outcomes measured, dosing regime, location, and circulating virus strains. In this study, we conduct a systematic review of COVID-19 vaccines through February 2022. We included efficacy data from Phase 3 clinical trials for 15 vaccines undergoing World Health Organization Emergency Use Listing evaluation and real-world effectiveness for 8 vaccines with observational studies meeting inclusion criteria. Vaccine metrics collected include protection against asymptomatic infection, any infection, symptomatic COVID-19, and severe outcomes including hospitalization and death, for partial or complete vaccination, and against variants of concern Alpha, Beta, Gamma, Delta, and Omicron. We additionally review the epidemiological principles behind the design and interpretation of vaccine efficacy and effectiveness studies, including important sources of heterogeneity.
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Affiliation(s)
- Melissa M Higdon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brian Wahl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carli B Jones
- Department of Pathology Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shaun A Truelove
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anurima Baidya
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anjalika A Nande
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Parisa A ShamaeiZadeh
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Karoline K Walter
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel R Feikin
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Minal K Patel
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Maria Deloria Knoll
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alison L Hill
- Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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COVID-19 Vaccine Effectiveness at a Referral Hospital in Northern Peru: A Retrospective Cohort Study. Vaccines (Basel) 2022; 10:vaccines10050812. [PMID: 35632567 PMCID: PMC9143947 DOI: 10.3390/vaccines10050812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 01/14/2023] Open
Abstract
COVID-19 vaccines have achieved a significant reduction in mortality, yet objective estimates are needed in specific settings. We aimed to determine the effectiveness of COVID-19 vaccination at a referral hospital in Lambayeque, Peru. We conducted a retrospective cohort study from February to September 2021. We included hospitalized patients with COVID-19, whose data were stored in NotiWeb, a patient data system of the Peruvian Ministry of Health. We applied a propensity score-weighting method according to baseline characteristics of patients, and estimated hazard ratios (HR) using Cox regression models. Of 1553 participants, the average age was 55 years (SD: 16.8), 907 (58%) were male, and 592 (38%) deceased at 28-day follow-up. Before hospital admission, 74 (4.8%) had been immunized with at least one vaccine dose. Effectiveness against death in vaccinated patients was 50% at 90-day follow-up (weighted HR 0.50, 95% CI 0.28–0.89). Our results support the effectiveness of COVID-19 vaccination against death and provide information after early immunization in Peru.
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COVID-19 Vaccine Effectiveness: A Review of the First 6 Months of COVID-19 Vaccine Availability (1 January–30 June 2021). Vaccines (Basel) 2022; 10:vaccines10030393. [PMID: 35335025 PMCID: PMC8951318 DOI: 10.3390/vaccines10030393] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/16/2022] [Accepted: 02/28/2022] [Indexed: 02/07/2023] Open
Abstract
Observational studies are needed to demonstrate real-world vaccine effectiveness (VE) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outcomes. Our objective was to conduct a review of published SARS-CoV-2 VE articles, supplemented by preprints, during the first 6 months of COVID-19 vaccine availability. This review compares the effectiveness of completing the primary COVID-19 vaccination series against multiple SARS-CoV-2 disease presentations and disease severity outcomes in three population groups (general population, frontline workers, and older adults). Four hundred and seventy-one published articles and 47 preprints were identified. After title and abstract screening and full article review, 50 studies (28 published articles, 22 preprints) were included. VE results were reported for five COVID-19 vaccines and four combinations of COVID-19 vaccines. VE results for BNT162b2 were reported in 70.6% of all studies. Seventeen studies reported variant specific VE estimates; Alpha was the most common. This comprehensive review demonstrates that COVID-19 vaccination is an important tool for preventing COVID-19 morbidity and mortality among fully vaccinated persons aged 16 years and older and serves as an important baseline from which to follow future trends in COVID-19 evolution and effectiveness of new and updated vaccines.
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Tanislav C, Rosenbauer J, Zingel R, Kostev K. No increased incidence of venous thrombosis or pulmonary embolism after SARS-CoV-2 vaccination in Germany. Public Health 2022; 207:14-18. [PMID: 35461122 PMCID: PMC8923878 DOI: 10.1016/j.puhe.2022.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/26/2022]
Abstract
Objectives Vaccination is one of the most effective measures to combat the COVID-19 pandemic. The main reason for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination hesitancy is the potential side-effects. This study aimed to investigate the incidence of venous thrombosis and pulmonary embolism in patients who received SARS-CoV-2 vaccination. Study design This was a retrospective cohort study. Methods Individuals aged ≥18 years who received an initial vaccination for COVID-19 in one of 1134 general practices in Germany between April and June 2021 were included in the study. Vaccinated patients were matched to unvaccinated individuals by age, sex, index month (April to June 2020 [unvaccinated cohort] or April to June 2021 [vaccinated cohort]) and diagnoses that may be associated with an increased incidence of thrombosis documented within 12 months before the index date. The incidences of thrombosis and non-fatal pulmonary embolism as a function of COVID-19 vaccination were analysed. Results The present study included 326,833 individuals who were vaccinated against COVID-19 and 326,833 matched unvaccinated individuals. During the follow-up period, 406 vaccinated patients and 342 individuals in the control group received a diagnosis of thrombosis or non-fatal pulmonary embolism. This resulted in an incidence rate of 11.9 vs 11.3 cases per 1000 patient-years for vaccinated vs unvaccinated individuals, respectively, and a non-significant overall incidence rate ratio (IRR: 1.06; 95% confidence interval [CI]: 0.93–1.22). The highest IRR was observed in the 41–60 years age group (IRR: 1.30; 95% CI: 0.98–1.73), and the lowest IRR was seen in the 18–40 years age group (IRR: 0.6; 95% CI: 0.0–1.05); however, none of the individual age group incidence rates was significant. Conclusions The results indicate that the occurrence of thrombosis or pulmonary embolism after COVID-19 vaccination is a coincidental finding rather than a consequence of vaccination.
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