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Poukka E, van Roekel C, Turunen T, Baum U, Kramer R, Begier E, Presser L, Teirlinck A, Heikkinen T, Knol M, Nohynek H. Effectiveness of Vaccines and Monoclonal Antibodies Against Respiratory Syncytial Virus: Generic Protocol for Register-Based Cohort Study. J Infect Dis 2024; 229:S84-S91. [PMID: 37930815 DOI: 10.1093/infdis/jiad484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023] Open
Abstract
Several immunization products are currently being developed against respiratory syncytial virus (RSV) for children, pregnant females, and older adults, and some products have already received authorization. Therefore, studies to monitor the effectiveness of these products are needed in the following years. To assist researchers to conduct postmarketing studies, we developed a generic protocol for register-based cohort studies to evaluate immunization product effectiveness against RSV-specific and nonspecific outcomes. To conduct a study on the basis of this generic protocol, the researchers can use any relevant databases or healthcare registers that are available at the study site.
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Affiliation(s)
- Eero Poukka
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare
- Department of Public Health, Faculty of Medicine, University of Helsinki, Finland
| | - Caren van Roekel
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Topi Turunen
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare
| | - Ulrike Baum
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare
| | | | | | - Lance Presser
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Anne Teirlinck
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Finland
| | - Mirjam Knol
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Hanna Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare
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van Roekel C, Poukka E, Turunen T, Nohynek H, Presser L, Meijer A, Heikkinen T, Kramer R, Begier E, Teirlinck AC, Knol MJ. Effectiveness of Immunization Products Against Medically Attended Respiratory Syncytial Virus Infection: Generic Protocol for a Test-Negative Case-Control Study. J Infect Dis 2024; 229:S92-S99. [PMID: 37935046 DOI: 10.1093/infdis/jiad483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
Monitoring the real-life effectiveness of respiratory syncytial virus (RSV) products is of major public health importance. This generic protocol for a test-negative design study aims to address currently envisioned approaches for RSV prevention (monoclonal antibodies and vaccines) to study effectiveness of these products among target groups: children, older adults, and pregnant women. The generic protocol approach was chosen to allow for flexibility in adapting the protocol to a specific setting. This protocol includes severe acute respiratory infection (SARI) and acute respiratory infection (ARI), both due to RSV, as end points. These end points can be applied to studies in hospitals, primarily targeting patients with more severe disease, but also to studies in general practitioner clinics targeting ARI.
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Affiliation(s)
- Caren van Roekel
- Centre for Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
| | - Eero Poukka
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Topi Turunen
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Lance Presser
- Centre for Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
| | - Adam Meijer
- Centre for Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
| | - Terho Heikkinen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | | | | | - Anne C Teirlinck
- Centre for Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
| | - Mirjam J Knol
- Centre for Infectious Disease Control, National Institute for Public Health and Environment, Bilthoven, the Netherlands
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Hussein I, Vänskä S, Sivelä J, Leino T, Nohynek H. Factors associated with parental Human Papillomavirus (HPV) vaccination intention of daughter: A national survey in Finland. Vaccine 2024; 42:701-712. [PMID: 38172018 DOI: 10.1016/j.vaccine.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Human papillomavirus (HPV) vaccines are offered free of charge in Finland to 10-12-year-old children. Nationally about 80% of girls are vaccinated, with regional differences in first dose coverage varying from 62% to 82% in girls born in 2011. This study examined the factors associated with HPV vaccination intention. Furthermore, we assessed the realisation of HPV vaccination among the daughters of the participating parents. METHODS A web-based survey was conducted for randomly selected parents of girls (N = 6 465) aged 10 to 14 years of age. Data was collected in February and March 2022 in five Finnish high and low coverage municipalities. The national vaccination register was employed to assess realisation of vaccination. RESULTS Participation rate was 13.7% (n = 883 parents). Almost all parents were aware of the association between HPV and cervical cancer, but only one fifth was aware of other diseases associated with HPV. Adherence to the national vaccination programme, parents' mother tongue, and trusting in official information were associated with positive vaccination intention. The most often reported reason for non-vaccination was fear of adverse effects (22%). Overall, parental attitudes towards HPV vaccination were positive, with 83% of parents indicating their daughter had received or will receive the vaccination. Vaccination realisation was subsequently examined and 88% of the daughters were vaccinated. CONCLUSIONS Despite low knowledge of HPV-related diseases overall, majority of parents held a positive intention to vaccinate their daughter. Realisation of intention was high in our study, higher than the national uptake. Foreign-origin parents had lower intention to vaccinate their daughters. As information on HPV and its vaccine is available in 11 languages, there is a need to re-think accessibility. In-depth interviews are needed to better explore the reasons behind non-vaccination.
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Affiliation(s)
- Idil Hussein
- Infectious Disease Control and Vaccinations, Department of Health Security, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland; Doctoral Programme in Population Health, Faculty of Medicine, University of Helsinki, Finland.
| | - Simopekka Vänskä
- Infectious Disease Control and Vaccinations, Department of Health Security, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
| | - Jonas Sivelä
- Infectious Disease Control and Vaccinations, Department of Health Security, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
| | - Tuija Leino
- Infectious Disease Control and Vaccinations, Department of Health Security, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
| | - Hanna Nohynek
- Infectious Disease Control and Vaccinations, Department of Health Security, Finnish Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
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Peña S, Zhou Z, Kestilä L, Galanti MR, Shaaban AN, Caspersen IH, Magnus P, Geraldo P, Rojas-Saunero P, Parikka S, Nohynek H, Karvonen S. Tobacco Use and Uptake of COVID-19 Vaccinations in Finland: A Population-Based Study. Nicotine Tob Res 2024:ntad234. [PMID: 38196092 DOI: 10.1093/ntr/ntad234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/18/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION People who smoke are at higher risk of Coronavirus Disease-2019 (COVID-19) hospitalizations and deaths and might benefit greatly from high COVID-19 vaccination coverage. Studies on tobacco use and COVID-19 vaccine uptake in the general population are lacking. AIMS AND METHODS We conducted a cohort study utilizing linked data from 42 935 participants from two national surveys in Finland (FinSote 2018 and 2020). Exposures were smoking and smokeless tobacco (snus) use. The primary outcome was the uptake of two COVID-19 vaccine doses. Secondary outcomes were the uptake of one COVID-19 vaccine dose; three COVID-19 vaccine doses; time between the first and second dose; and time between the second and third dose. We examined the association between tobacco use and COVID-19 vaccine uptake and between-dose spacing in Finland. RESULTS People who smoke had a 7% lower risk of receiving two COVID-19 vaccine doses (95% confidence interval [CI] = 0.91; 0.96) and a 14% lower risk of receiving three doses (95% CI = 0.78; 0.94) compared to never smokers. People who smoked occasionally had a lower risk of receiving three vaccine doses. People who currently used snus had a 28% lower uptake of three doses (95% CI = 0.56; 0.93) compared to never users but we did not find evidence of an association for one or two doses. We did not find evidence of an association between tobacco use and spacing between COVID-19 vaccine doses. CONCLUSIONS People who smoke tobacco products daily, occasionally, and use snus had a lower uptake of COVID-19 vaccines. Our findings support a growing body of literature on lower vaccination uptake among people who use tobacco products. IMPLICATIONS People who smoke or use snus might be a crucial target group of public health efforts to increase COVID-19 vaccinations and plan future vaccination campaigns. CLINICAL TRIALS REGISTRATION NUMBER NCT05479383.
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Affiliation(s)
- Sebastián Peña
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Zhi Zhou
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Laura Kestilä
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Maria Rosaria Galanti
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Ahmed Nabil Shaaban
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Pablo Geraldo
- Department of Sociology and Department of Statistics, University of California Los Angeles, Los Angeles, CA, USA
| | - Paloma Rojas-Saunero
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Suvi Parikka
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Hanna Nohynek
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Sakari Karvonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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Broberg EK, Nohynek H. Respiratory syncytial virus infections - recent developments providing promising new tools for disease prevention. Euro Surveill 2023; 28:2300686. [PMID: 38062943 PMCID: PMC10831406 DOI: 10.2807/1560-7917.es.2023.28.49.2300686] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Eeva K Broberg
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Hanna Nohynek
- Finnish institute for health and welfare, Helsinki, Finland
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Hussein I, Vänskä S, Sivelä J, Leino T, Nohynek H. Factors associated with parental intention to vaccinate their child against influenza, Finland, February to March, 2022: a web-based survey. Euro Surveill 2023; 28:2200828. [PMID: 38062946 PMCID: PMC10831410 DOI: 10.2807/1560-7917.es.2023.28.49.2200828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 08/04/2023] [Indexed: 12/18/2023] Open
Abstract
BackgroundInfluenza vaccination for children aged 6 months to 6 years is included in the national vaccination programme in Finland. Although all vaccines in the programme are free of charge, national coverage of influenza vaccination among children under 3 years and 3-6 years during 2020/21 was 43% and 35% respectively, with regional differences.AimTo assess factors underlying parental vaccination intention in order to increase influenza vaccine uptake among children.MethodsWe conducted a web-based survey among parents (n = 17,844) of randomly selected eligible children (aged 6 months-6 years) in February-March 2022 in five Finnish municipalities from regions of high and low coverage. Logistic regressions were used to determine associations between vaccination intention and e.g. sociodemographic factors, attitudes and knowledge. Linkage to the national vaccination register was used to confirm realisation of vaccination intention after the study.ResultsParticipation rate was 13% (n = 2,322 parents). Influenza knowledge, trust in official information, responding parent's education level, adherence to the vaccination programme, number of children and changes in attitudes towards vaccination since COVID-19 were all associated with intention to vaccinate. Vaccination intention for children was 64%, and realised vaccination 51%.ConclusionDespite the low participation rate, both vaccinated and unvaccinated children were represented. Influenza vaccine uptake is not dependent on a single factor. Our results identified the need for open dialogue between parents and healthcare professionals, as the lack of vaccine being offered by healthcare professionals was the most reported reason for not vaccinating.
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Affiliation(s)
- Idil Hussein
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Doctoral Programme in Population Health, Faculty of Medicine, University of Helsinki, Finland
| | - Simopekka Vänskä
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Jonas Sivelä
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tuija Leino
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Hanna Nohynek
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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Stuurman AL, Carmona A, Biccler J, Descamps A, Levi M, Baum U, Mira-Iglesias A, Bellino S, Hoang U, de Lusignan S, Bonaiuti R, Lina B, Rizzo C, Nohynek H, Díez-Domingo J. Brand-specific estimates of influenza vaccine effectiveness for the 2021-2022 season in Europe: results from the DRIVE multi-stakeholder study platform. Front Public Health 2023; 11:1195409. [PMID: 37546295 PMCID: PMC10399959 DOI: 10.3389/fpubh.2023.1195409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Development of Robust and Innovative Vaccine Effectiveness (DRIVE) was a European public-private partnership (PPP) that aimed to provide annual, brand-specific estimates of influenza vaccine effectiveness (IVE) for regulatory and public health purposes. DRIVE was launched in 2017 under the umbrella of the Innovative Medicines Initiative (IMI) and conducted IVE studies from its pilot season in 2017-2018 to its final season in 2021-2022. Methods In 2021-2022, DRIVE conducted four primary care-based test-negative design (TND) studies (Austria, Italy, Iceland, and England; involving >1,000 general practitioners), nine hospital-based TND studies (France, Iceland, Italy, Romania, and Spain, for a total of 21 hospitals), and one population-based cohort study in Finland. In the TND studies, patients with influenza-like illness (primary care) or severe acute respiratory infection (hospital) were enrolled, and laboratory tested for influenza using RT-PCR. Study contributor-specific IVE was calculated using logistic regression, adjusting for age, sex, and calendar time, and pooled by meta-analysis. Results In 2021-2022, pooled confounder-adjusted influenza vaccine effectiveness (IVE) estimates against laboratory-confirmed influenza (LCI) overall and per type and subtype/lineage was produced, albeit with wide confidence intervals (CI). The limited circulation of influenza in Europe did not allow the network to reach the optimal sample size to produce precise IVE estimates for all the brands included. The most significant IVE estimates were 76% (95% CI 23%-93%) for any vaccine and 81% (22%-95%) for Vaxigrip Tetra in adults ≥65 years old and 64% (25%-83%) for Fluenz Tetra in children (TND primary care setting), 85% (12%-97%) for any vaccine in adults 18-64 years (TND hospital setting), and 38% (1%-62%) in children 6 months-6 years (population-based cohort, mixed setting). Discussion Over five seasons, DRIVE collected data on >35,000 patients, more than 60 variables, and 13 influenza vaccines. DRIVE demonstrated that estimating brand-specific IVE across Europe is possible, but achieving sufficient sample size to obtain precise estimates for all relevant stratifications remains a challenge. Finally, DRIVE's network of study contributors and lessons learned have greatly contributed to the development of the COVID-19 vaccine effectiveness platform COVIDRIVE.
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Affiliation(s)
| | - Antonio Carmona
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (Fisabio), Valencia, Spain
- Biomedical Research Consortium in Epidemiology and Public Health (CIBER-ESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Jorne Biccler
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Alexandre Descamps
- Inserm CIC 1417, Assistance Publique Hopitaux de Paris (APHP), CIC Cochin-Pasteur, Paris, France
| | - Miriam Levi
- UFC Epidemiologia, Dipartimento di Prevenzione, Azienda USL Toscana Centro, Firenze, Italy
| | - Ulrike Baum
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ainara Mira-Iglesias
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (Fisabio), Valencia, Spain
- Biomedical Research Consortium in Epidemiology and Public Health (CIBER-ESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Stefania Bellino
- Department of Infectious Diseases, Istituto Superiore Di Sanità (ISS), Rome, Italy
| | - Uy Hoang
- Oxford-Royal College of General Practitioners Research and Surveillance Centre, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Simon de Lusignan
- Oxford-Royal College of General Practitioners Research and Surveillance Centre, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Roberto Bonaiuti
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Firenze, Italy
| | - Bruno Lina
- VirPath Research Laboratory, International Center for Infectiology Research, University Claude Bernard Lyon, Lyon, France
| | - Caterina Rizzo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Hanna Nohynek
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (Fisabio), Valencia, Spain
- Biomedical Research Consortium in Epidemiology and Public Health (CIBER-ESP), Instituto de Salud Carlos III, Madrid, Spain
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Solastie A, Nieminen T, Ekström N, Nohynek H, Lehtonen L, Palmu AA, Melin M. Changes in SARS-CoV-2 seroprevalence and population immunity in Finland, 2020-2022. Emerg Microbes Infect 2023:2222849. [PMID: 37289188 DOI: 10.1080/22221751.2023.2222849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Studying the prevalence of SARS-CoV-2 specific antibodies (seroprevalence) allows for assessing the impact of epidemic containment measures and vaccinations and estimating the number of infections regardless of viral testing. We assessed antibody-mediated immunity to SARS-CoV-2 induced by infections and vaccinations from April 2020 to December 2022 in Finland by measuring serum IgG to SARS-CoV-2 nucleoprotein (N-IgG) and spike glycoprotein from randomly selected 18-85-year-old subjects (n = 9794). N-IgG seroprevalence remained at <7% until the last quartile (Q) of 2021. After the emergence of the omicron variant, N-IgG seroprevalence increased rapidly and was 31% in Q1/2022 and 54% in Q4/2022. Seroprevalence was highest in the youngest age groups from Q2/2022 onwards. We did not observe regional differences in seroprevalence in 2022. We estimated that 51% of the Finnish 18-85-year-old population had antibody-mediated hybrid immunity induced by a combination of vaccinations and infections by the end of 2022. In conclusion, major shifts in the COVID-19 pandemic and resulting population immunity could be observed by serological testing.
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Affiliation(s)
- Anna Solastie
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuomo Nieminen
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Nina Ekström
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Nohynek
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Lasse Lehtonen
- HUS Diagnostic Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Arto A Palmu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Tampere, Finland. Current affiliation: FVR - Finnish Vaccine Research, Tampere, Finland
| | - Merit Melin
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
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9
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Hartonen T, Jermy B, Sõnajalg H, Vartiainen P, Krebs K, Vabalas A, Leino T, Nohynek H, Sivelä J, Mägi R, Daly M, Ollila HM, Milani L, Perola M, Ripatti S, Ganna A. Nationwide health, socio-economic and genetic predictors of COVID-19 vaccination status in Finland. Nat Hum Behav 2023:10.1038/s41562-023-01591-z. [PMID: 37081098 PMCID: PMC10365990 DOI: 10.1038/s41562-023-01591-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/22/2023] [Indexed: 04/22/2023]
Abstract
Understanding factors associated with COVID-19 vaccination can highlight issues in public health systems. Using machine learning, we considered the effects of 2,890 health, socio-economic and demographic factors in the entire Finnish population aged 30-80 and genome-wide information from 273,765 individuals. The strongest predictors of vaccination status were labour income and medication purchase history. Mental health conditions and having unvaccinated first-degree relatives were associated with reduced vaccination. A prediction model combining all predictors achieved good discrimination (area under the receiver operating characteristic curve, 0.801; 95% confidence interval, 0.799-0.803). The 1% of individuals with the highest predicted risk of not vaccinating had an observed vaccination rate of 18.8%, compared with 90.3% in the study population. We identified eight genetic loci associated with vaccination uptake and derived a polygenic score, which was a weak predictor in an independent subset. Our results suggest that individuals at higher risk of suffering the worst consequences of COVID-19 are also less likely to vaccinate.
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Affiliation(s)
- Tuomo Hartonen
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Bradley Jermy
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Hanna Sõnajalg
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Pekka Vartiainen
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Kristi Krebs
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Andrius Vabalas
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Tuija Leino
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jonas Sivelä
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Reedik Mägi
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Mark Daly
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital, Cambridge, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | - Hanna M Ollila
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Center of Genomic Medicine, Harvard Medical School, Boston, MA, USA
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Lili Milani
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Markus Perola
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital, Cambridge, MA, USA
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Andrea Ganna
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Massachusetts General Hospital, Cambridge, MA, USA.
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Teirlinck AC, Johannesen CK, Broberg EK, Penttinen P, Campbell H, Nair H, Reeves RM, Bøås H, Brytting M, Cai W, Carnahan A, Casalegno JS, Danis K, De Gascun C, Ellis J, Emborg HD, Gijon M, Guiomar R, Hirve SS, Jiřincová H, Nohynek H, Oliva JA, Osei-Yeboah R, Paget J, Pakarna G, Pebody R, Presser L, Rapp M, Reiche J, Rodrigues AP, Seppälä E, Socan M, Szymanski K, Trebbien R, Večeřová J, van der Werf S, Zambon M, Meijer A, Fischer TK. New perspectives on respiratory syncytial virus surveillance at the national level: lessons from the COVID-19 pandemic. Eur Respir J 2023; 61:2201569. [PMID: 37012081 PMCID: PMC10069872 DOI: 10.1183/13993003.01569-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/10/2023] [Indexed: 04/05/2023]
Abstract
The emergence of SARS-CoV-2 and the resulting coronavirus disease 2019 (COVID-19) pandemic has led to the reconsideration of surveillance strategies for respiratory syncytial virus (RSV) and other respiratory viruses. The COVID-19 pandemic and the non-pharmaceutical interventions for COVID-19 had a substantial impact on RSV transmission in many countries, with close to no transmission detected during parts of the usual season of 2020–2021. Subsequent relaxation of social restrictions has resulted in unusual out-of-season resurgences of RSV in several countries, causing a higher healthcare burden and often a higher proportion of hospitalisations than usual among children older than 1 year in age [1]. In case of an emerging infectious disease with pandemic potential, preparedness to scale up surveillance for the emerging disease while continuing the maintenance of surveillance activities of pre-existing seasonal diseases is necessary. Learning from the COVID-19 pandemic and considering the effects of this pandemic, we provide recommendations that can guide towards sustainable RSV surveillance with the potential to be integrated into the broader perspective of respiratory surveillance. https://bit.ly/40TsO0G
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Affiliation(s)
- Anne C Teirlinck
- National Institute for Public Health and the Environment (RIVM) - Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Caroline K Johannesen
- Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, and University of Copenhagen, Department of Public Health, Copenhagen, Denmark
| | - Eeva K Broberg
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Harish Nair
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Håkon Bøås
- Norwegian Institute of Public Health, Oslo, Norway
| | - Mia Brytting
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Wei Cai
- Robert Koch Institute, Berlin, Germany
| | | | - Jean-Sebastien Casalegno
- Centre National de Référence des virus des infections respiratoires dont la grippe, Hospices Civils de Lyon, Lyon, France
| | - Kostas Danis
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | | | | | | | - Raquel Guiomar
- National Institute of Health Ricardo Jorge, Lisbon, Portugal
| | | | | | - Hanna Nohynek
- Finnish National Institute for Health and Welfare, Helsinki, Finland
| | - Jesus Angel Oliva
- Instituto de Salud Carlos III Madrid, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - John Paget
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | | | - Richard Pebody
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Lance Presser
- National Institute for Public Health and the Environment (RIVM) - Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Marie Rapp
- Public Health Agency of Sweden, Stockholm, Sweden
| | | | | | | | - Maja Socan
- National Institute of Public Health, Ljubljana, Slovenia
| | - Karol Szymanski
- National Institute of Public Health NIH National Research Institute, Warsaw, Poland
| | | | | | | | | | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM) - Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Thea K Fischer
- Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, and University of Copenhagen, Department of Public Health, Copenhagen, Denmark
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Hovi P, Palmu AA, Nieminen TA, Artama M, Jokinen J, Ruokokoski E, Lassila R, Nohynek H, Kilpi T. Incidence of sinus thrombosis with thrombocytopenia-A nation-wide register study. PLoS One 2023; 18:e0282226. [PMID: 36827275 PMCID: PMC9956025 DOI: 10.1371/journal.pone.0282226] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
Safe vaccination is essential for mitigation of the COVID-19 pandemic. Two adenoviral vector vaccines, ChAdOx1 nCov-19 (AstraZeneca) and Ad26.COV2.S (Johnson&Johnson/Janssen) have shown to be effective and they are distributed globally, but reports on serious cerebral venous sinus thrombosis (CVST) associated with thrombocytopenia, have emerged. Our objective was to evaluate the background incidence of CVST with thrombocytopenia and to compare it to incidences following COVID-19 vaccines. We conducted a register-based nation-wide cohort study in Finland, including all 5.5 million individuals alive in Finland, 1 Jan 2020. COVID-19 vaccinations registered in the National Vaccination Register served as the exposure. We detected CVST admissions or hospital visits recorded in the hospital discharge register from Jan 1, 2020 through April 2, 2021. We confirmed the diagnosis of CVST and thrombocytopenia (platelet count <150,000 per cubic millimeter) using radiology reports and laboratory data. By Poisson regression, we compared the baseline incidences to the risks within four weeks after COVID-19 vaccinations. Out of the 167 CVST episodes identified in the registers, 117 were confirmed as CVST, 18 of which coincided with thrombocytopenia (baseline incidence 0.18 per 28 days per million persons). We found 2 episodes of CVST with thrombocytopenia within 28 days of the first ChAdOx1 nCov-19 vaccination (among 200,397 vaccinated, aged 16 or above). No cases were found following the first mRNA vaccine dose among 782,604 vaccinated. The background incidence of CVST combined with thrombocytopenia was minuscule compared to the incidence during the weeks following the ChAdOx1 nCov-19 vaccination. Accurate estimation of the baseline incidence is essential in the critical appraisal of the benefit-risk of any vaccination program.
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Affiliation(s)
- Petteri Hovi
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Pediatrics, Children’s Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- * E-mail:
| | - Arto A. Palmu
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuomo A. Nieminen
- Knowledge brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Miia Artama
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Health security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jukka Jokinen
- Knowledge brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Esa Ruokokoski
- Knowledge brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Riitta Lassila
- Health security, Finnish Institute for Health and Welfare, Helsinki, Finland
- Coagulation Disorders Unit, Department of Hematology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
- Research Program Unit in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hanna Nohynek
- Health security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Terhi Kilpi
- Management, Finnish Institute for Health and Welfare, Helsinki, Finland
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Lohiniva AL, Hussein I, Lehtinen JM, Sivelä J, Hyökki S, Nohynek H, Nuorti P, Lyytikäinen O. Qualitative Insights into Vaccine Uptake of Nursing Staff in Long-Term Care Facilities in Finland. Vaccines (Basel) 2023; 11:530. [PMID: 36992113 PMCID: PMC10056830 DOI: 10.3390/vaccines11030530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 03/31/2023] Open
Abstract
Vaccine hesitancy and refusal have undermined COVID-19 vaccination efforts of nursing staff. This study aimed to identify behavioral factors associated with COVID-19 vaccine uptake among unvaccinated nursing staff in long-term care facilities (LTCF) in Finland. Methodology: The study was based on the Theoretical Domains Framework. Data were collected through qualitative in-depth interviews among nursing staff and managers of LTCFs. The analysis was based on thematic analysis. We identified seven behavioral domains, with several themes, that reduced the staff's intention to get vaccinated: knowledge (information overload, inability to identify trustworthy information sources, lack of vaccine-specific and understandable scientific information), beliefs about consequences (incorrect perceptions about the vaccine effectiveness, and lack of trust in the safety of the vaccine), social influences (influence of family and friends), reinforcement (limited abilities of the management to encourage vaccination), beliefs about capabilities (pregnancy or desire to get pregnant), psychological factors (coping with changing opinion), and emotions (confusion, suspicion, disappointment, and fatigue). We also identified three behavioral domains that encouraged vaccine uptake: social influences (trust in health authorities), environmental context and resources (vaccination logistics), and work and professional role (professional pride). The study findings can help authorities to develop tailored vaccine promotion strategies for healthcare workers in LTCFs.
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Affiliation(s)
- Anna-Leena Lohiniva
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland
| | - Idil Hussein
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland
| | - Jaana-Marija Lehtinen
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland
| | - Jonas Sivelä
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland
| | - Suvi Hyökki
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland
| | - Pekka Nuorti
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Kalevankatu 4, 33520 Tampere, Finland
| | - Outi Lyytikäinen
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland
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13
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Nieminen TA, Kivekäs I, Artama M, Nohynek H, Kujansivu J, Hovi P. Sudden Hearing Loss Following Vaccination Against COVID-19. JAMA Otolaryngol Head Neck Surg 2023; 149:133-140. [PMID: 36520464 PMCID: PMC9857204 DOI: 10.1001/jamaoto.2022.4154] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Spontaneous adverse reaction reports of sudden hearing loss have been observed, and a population-based cohort study conducted in Israel showed an increase in the incidence of sudden sensorineural hearing loss (SSNHL) following vaccination with messenger RNA COVID-19 vaccine BNT162b2 (Pfizer-BioNTech). However, in this setting, the possibility of confounding remained. Objective To assess a potential association between COVID-19 vaccinations and SSNHL. Design, Setting, and Participants This register-based country-wide retrospective cohort study of 5.5 million Finnish residents was conducted from January 1, 2019, to April 20, 2022, and included all individuals who were identified from the population information system who were alive or born during the study period except individuals who had SSNHL during 2015 to 2018 according to specialized care derived diagnosis codes for SSNHL (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10] code H91.2) as a primary or secondary diagnosis. Exposures The a priori primary risk period was 0 to 54 days following each COVID-19 vaccination. The risk periods for different vaccine doses did not overlap so that a later vaccine exposure ended the previous risk period. The secondary risk period was from 55 days following each COVID-19 vaccination until a subsequent COVID-19 vaccination. A secondary analysis included a risk time from 0 to 54 days following a positive polymerase chain reaction test result for SARS-CoV-2. Main Outcomes and Measures The incidences of SSNHL following COVID-19 vaccination were compared with the incidences before the COVID-19 epidemic in Finland. The Poisson regression model included calendar time, age, sex, diabetes, cardiovascular disease, other chronic diseases, and the number of visits in primary health care. Results For the 5.5 million Finnish residents included in the study, the comparison time comprised 6.5 million person-years, the primary risk time of 1.7 million person-years, and the secondary risk time of 2.1 million person-years. Before the COVID-19 epidemic in Finland, 18.7/100 000 people received a diagnosis of SSNHL annually. The study data suggested no increased risk for SSNHL following any COVID-19 vaccination. In particular, adjusted incidence rate ratios with 95% confidence intervals for the BNT162b2 vaccine's 3 doses were 0.8 (95% CI, 0.6-1.0), 0.9 (95% CI, 0.6-1.2), and 1.0 (95% CI, 0.7-1.4), respectively. There was no association between SARS-CoV-2 infection and an increased incidence of SSNHL. Conclusions and Relevance The results of this cohort study show no evidence of an increased risk of SSNHL following COVID-19 vaccination. The study accounted for previous disease and other potential confounding factors. These results are based on diagnosis codes in specialized care but still need to be verified in settings that are capable of evaluating the degree of hearing loss.
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Affiliation(s)
| | - Ilkka Kivekäs
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland,Otorhinolaryngology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Hanna Nohynek
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jarno Kujansivu
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
| | - Petteri Hovi
- Finnish Institute for Health and Welfare, Helsinki, Finland
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14
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Bastola K, Nohynek H, Lilja E, Castaneda AE, Austero S, Kuusio H, Skogberg N. Incidence of SARS-CoV-2 Infection and Factors Associated With Complete COVID-19 Vaccine Uptake Among Migrant Origin Persons in Finland. Int J Public Health 2023; 68:1605547. [PMID: 37206095 PMCID: PMC10189547 DOI: 10.3389/ijph.2023.1605547] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/20/2023] [Indexed: 05/21/2023] Open
Abstract
Objective: We examined incidence of SARS-CoV-2 infection, COVID-19 vaccine uptake and factors associated with complete COVID-19 vaccine uptake among persons of migrant origin in Finland. Methods: Data on laboratory-confirmed SARS-CoV-2 infection and COVID-19 vaccine doses between March 2020 and November 2021 were linked to FinMonik register sample (n = 13,223) and MigCOVID (n = 3,668) survey data using unique personal identifier. Logistic regression was the main method of analyses. Results: Among FinMonik sample, complete COVID-19 vaccine uptake was lower among persons of Russia/former Soviet Union, Estonia, and rest of Africa and higher among persons of Southeast Asia, rest of Asia, and the Middle East/North Africa than among persons originating from Europe/North America/Oceania. Male sex, younger age, migration age (<18 years) and shorter length of residence were associated with lower vaccine uptake among FinMonik sample, whereas younger age, being economically inactive, poorer language skills, experiences of discrimination and psychological distress were associated with lower vaccine uptake among MigCOVID sub-sample. Conclusion: Our Findings point to a further need of tailored and targeted communication and community outreach strategies to increase vaccine uptake among persons of migrant origin.
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Díez-Domingo J, Torcel-Pagnon L, Carmona A, Launay O, Dos Santos G, Rizzo C, Haag M, Stuurman A, Nauta J, Vannacci A, de Lusignan S, Del Rey E, Levi M, Lina B, Bellino S, Nye S, Neels P, Nohynek H, Mahé C. The value of public-private collaborative real-world evidence platforms to monitor vaccine performance post authorization: DRIVE - a European initiative. Expert Rev Vaccines 2022; 21:1701-1710. [PMID: 36261918 DOI: 10.1080/14760584.2022.2137144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Fighting pandemics requires an established infrastructure for pandemic preparedness, with existing, sustainable platforms ready to be activated. This includes platforms for disease surveillance, virus circulation, and vaccine performance monitoring based on Real-World data, to complement clinical trial evidence. AREAS COVERED Because of its complexity, this can best be done by combining efforts between public and private sectors, developing a multi-stakeholder approach. Public-Private-Partnerships increasingly play a critical role in combating infectious diseases but are still looked at with hesitancy. The Development of Robust and Innovative Vaccine Effectiveness (DRIVE) project, which established a platform for measuring brand-specific influenza vaccine effectiveness in Europe, exemplifies how to build a collaborative platform with transparent governance, state-of-the-art methodology, and a large network of participating sites. Lessons learned from DRIVE have been cardinal to set up COVIDRIVE, a platform for brand-specific COVID-19 vaccine effectiveness monitoring. EXPERT OPINION The DRIVE partners propose that a debate on the benefits of Public-Private-Partnership-generated real-world evidence for vaccine effectiveness monitoring should be pursued to clarify roles and responsibilities, set up expectations, and decide the future environment for vaccine monitoring in Europe. In parallel, the driving factors behind PPP hesitancy should be studied.
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Affiliation(s)
- Javier Díez-Domingo
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (Fisabio), Valencia, Spain
| | | | - Antonio Carmona
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (Fisabio), Valencia, Spain
| | - Odile Launay
- Université Paris Descartes, Sorbonne Paris Cité, Inserm CIC 1417, Assistance Publique Hopitaux de Paris (APHP), CIC Cochin-Pasteur, Paris, France
| | | | - Caterina Rizzo
- Functional Area of Clinical Pathways and Epidemiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mendel Haag
- Center of Outcomes Research and Epidemiology, Medical Affairs, Seqirus, Amsterdam, The Netherlands
| | - Anke Stuurman
- P95 Epidemiology & Pharmacovigilance, Heverlee, Belgium
| | - Jos Nauta
- Abbott Healthcare Products B.V, CP Weesp, The Netherlands
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Firenze, Italy
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Elena Del Rey
- Synapse Research Management Partners SL (SYNAPSE), Madrid, Spain
| | - Miriam Levi
- Azienda USL Toscana Centro, Dipartimento di Prevenzione, Firenze, Italy
| | - Bruno Lina
- VirPath Research Laboratory, University Claude Bernard Lyon, Lyon, France
| | | | - Samantha Nye
- Confederation Of Meningitis Organisations Ltd (CoMO), Bristol, UK
| | - Pieter Neels
- International Association for Biological Standardization for Europe, Lyon, France
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Cédric Mahé
- Modeling, Epidemiology and Data Science, Sanofi, Lyon, France
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Ekström N, Haveri A, Solastie A, Virta C, Österlund P, Nohynek H, Nieminen T, Ivaska L, Tähtinen PA, Lempainen J, Jalkanen P, Julkunen I, Palmu AA, Melin M. Strong Neutralizing Antibody Responses to SARS-CoV-2 Variants Following a Single Vaccine Dose in Subjects With Previous SARS-CoV-2 Infection. Open Forum Infect Dis 2022; 9:ofac625. [PMID: 36519113 PMCID: PMC9745780 DOI: 10.1093/ofid/ofac625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/15/2022] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection primes the immune system; thus individuals who have recovered from infection have enhanced immune responses to subsequent vaccination (hybrid immunity). However, it remains unclear how well hybrid immunity induced by severe or mild infection can cross-neutralize emerging variants. We aimed to compare the strength and breadth of antibody responses in vaccinated recovered and uninfected subjects. METHODS We measured spike-specific immunoglobulin (Ig)G and neutralizing antibodies (NAbs) from vaccinated subjects including 320 with hybrid immunity and 20 without previous infection. From 29 subjects with a previous severe or mild infection, we also measured NAb responses against Alpha (B.1.1.7), Beta (B.1.351), Delta (B.1.617.2), and Omicron (B.1.1.529/BA.1) variants following vaccination. RESULTS A single vaccine dose induced 2-fold higher anti-spike IgG concentrations and up to 4-fold higher neutralizing potency of antibodies in subjects with a previous infection compared with vaccinated subjects without a previous infection. Hybrid immunity was more enhanced after a severe than a mild infection, with sequentially decreasing NAb titers against Alpha, Beta, Delta, and Omicron variants. We found similar IgG concentrations in subjects with a previous infection after 1 or 2 vaccine doses. CONCLUSIONS Hybrid immunity induced strong IgG responses, particularly after severe infection. However, the NAb titers were low against heterologous variants, especially against Omicron.
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Affiliation(s)
- Nina Ekström
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anu Haveri
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anna Solastie
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Camilla Virta
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pamela Österlund
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuomo Nieminen
- Data and Analytics Unit, Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Lauri Ivaska
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Paula A Tähtinen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
| | - Johanna Lempainen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland
- Clinical Microbiology, Turku University Hospital, Turku, Finland
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Pinja Jalkanen
- Infection and Immunity, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Ilkka Julkunen
- Clinical Microbiology, Turku University Hospital, Turku, Finland
- Infection and Immunity, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Arto A Palmu
- Interventions Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Tampere, Finland
| | - Merit Melin
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
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Duclos P, MacDonald NE, Dochez C, Thacker N, Steffen CA, Nohynek H, Lambert PH, Wharton M. Report of the 2nd workshop of the International Collaboration on advanced vaccinology training. Vaccine 2022; 40:6689-6699. [PMID: 36273989 DOI: 10.1016/j.vaccine.2022.09.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
At a workshop on 22-24 March 2022, leaders of 33 advanced vaccinology courses were invited to meet with partners to further the aims of the International Collaboration on Advanced Vaccinology Training (ICAVT) initiated in 2018 to assist courses in addressing challenges in priority areas and facilitate interactions and exchange of information. This included: an update to the landscape analysis of advanced vaccinology courses conducted in 2018, sharing experiences and good practices in the implementation of virtual training, reviewing the training needs of target audiences, informing courses of the principles, challenges, and added value of accreditation, discussing course evaluations and measurement of course impact, reviewing principles and support needed for quality cascade training, reviewing COVID-19 impact on training and identifying remaining related training needs, and identifying solutions to facilitate refresher courses and ways to facilitate networking of courses' alumni (particularly for virtual courses). The aims were to identify needs and impediments and implement necessary actions to facilitate sharing of information and resources between courses, to identify need for further developments of the e-Portal of the Collaboration (icavt.org) established to facilitate communication between the different courses and assist future course participants identify the most suitable course for them, and to discuss the formalization of the Collaboration. During the workshop, participants looked at several reports of surveys completed by courses and courses' alumni or partners. The COVID-19 pandemic impacted the delivery of some vaccinology courses leading to postponement, delivery online or hybrid training events. Lack of sustainable funding remained a major constraint for advanced vaccinology training and needs to be addressed. The Collaboration was consolidated with responsibilities and benefits for the members better defined. There was strong support for the Collaboration to continue with the organization of educational sessions at future workshops. The meeting re-enforced the view that there was much enthusiasm and commitment for the Global Collaboration and its core values.
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Affiliation(s)
- Philippe Duclos
- University of Geneva, Centre for Vaccinology, 1 Rue Michel Servet, 1211 Geneva 4, Switzerland.
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, IWK Health Centre, 5850/5980 University Ave, Halifax, Nova Scotia B3K 6R8, Canada
| | - Carine Dochez
- University of Antwerp, Network for Education and Support in Immunisation, Universiteitsplein 1, 2610 Antwerp, Belgium
| | | | | | - Hanna Nohynek
- National Institute for Health and Welfare Department of Vaccines and Immune Protection, 166 Mannerheimintie, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Paul-Henri Lambert
- University of Geneva, Centre for Vaccinology, 1 Rue Michel Servet, 1211 Geneva 4, Switzerland
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18
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Baum U, Poukka E, Leino T, Kilpi T, Nohynek H, Palmu AA. High vaccine effectiveness against severe COVID-19 in the elderly in Finland before and after the emergence of Omicron. BMC Infect Dis 2022; 22:816. [PMID: 36335289 PMCID: PMC9636823 DOI: 10.1186/s12879-022-07814-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
Background The elderly are highly vulnerable to severe COVID-19. Waning immunity and emergence of Omicron have caused concerns about reduced effectiveness of COVID-19 vaccines. The objective was to estimate vaccine effectiveness (VE) against severe COVID-19 among the elderly. Methods This nationwide, register-based cohort analysis included all residents aged 70 years and over in Finland. The follow-up started on December 27, 2020, and ended on March 31, 2022. The outcomes of interest were COVID-19-related hospitalization and intensive care unit (ICU) admission timely associated with SARS-CoV-2 infection. VE was estimated as one minus the hazard ratio comparing the vaccinated and unvaccinated and taking into account time since vaccination. Omicron-specific VE was evaluated as the effectiveness observed since January 1, 2022. Results The cohort included 896,220 individuals. Comirnaty (BioNTech/Pfizer) VE against COVID-19-related hospitalization was 93% (95% CI 89–95%) and 85% (95% CI 82–87%) 14–90 and 91–180 days after the second dose; VE increased to 95% (95% CI 94–96%) 14–60 days after the third dose. VE of other homologous and heterologous three dose series was similar. Protection against severe COVID-19 requiring ICU treatment was even better. Since January 1, 2022, Comirnaty VE was 98% (95% CI 92–99%) and 92% (95% CI 87–95%) 14–90 and 91–180 days after the second and 98% (95% CI 95–99%) 14–60 days after the third dose. Conclusions VE against severe COVID-19 is high among the elderly. It waned slightly after two doses, but a third restored the protection. VE against severe COVID-19 remained high even after the emergence of Omicron. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07814-4.
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Lewis HC, Marcato AJ, Meagher N, Valenciano M, Villanueva‐Cabezas J, Spirkoska V, Fielding JE, Karahalios A, Subissi L, Nardone A, Cheng B, Rajatonirina S, Okeibunor J, Aly EA, Barakat A, Jorgensen P, Azim T, Wijesinghe PR, Le L, Rodriguez A, Vicari A, Van Kerkhove MD, McVernon J, Pebody R, Price DJ, Bergeri I, Alemu MA, Alvi Y, Bukusi EA, Chung PS, Dambadarjaa D, Das AK, Dub T, Dulacha D, Ebrahim F, González‐Duarte MA, Guruge D, Heraud J, Heredia‐Melo DC, Herman‐Roloff A, Herring BL, Inbanathan FY, Islam F, Jeewandara KC, Kant S, Khan W, Lako R, Leite J, Malavige GN, Mandakh U, Mariam W, Mend T, Mize VA, Musa S, Nohynek H, Olu OO, Osorio‐Merchán MB, Pereyaslov D, Randremanana RV, de Dieu Randria MJ, Ransom J, Saxena S, Sharma P, Sreedevi A, Satheesh M, Subhashini KJ, Tippet‐Barr BA, Usha A, Wamala JF, Watare SH, Yadav K. Transmission of SARS-CoV-2 in standardised first few X cases and household transmission investigations: A systematic review and meta-analysis. Influenza Other Respir Viruses 2022; 16:803-819. [PMID: 36825117 PMCID: PMC9343340 DOI: 10.1111/irv.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022] Open
Abstract
We aimed to estimate the household secondary infection attack rate (hSAR) of SARS-CoV-2 in investigations aligned with the WHO Unity Studies Household Transmission Investigations (HHTI) protocol. We conducted a systematic review and meta-analysis according to PRISMA 2020 guidelines. We searched Medline, Embase, Web of Science, Scopus and medRxiv/bioRxiv for "Unity-aligned" First Few X cases (FFX) and HHTIs published 1 December 2019 to 26 July 2021. Standardised early results were shared by WHO Unity Studies collaborators (to 1 October 2021). We used a bespoke tool to assess investigation methodological quality. Values for hSAR and 95% confidence intervals (CIs) were extracted or calculated from crude data. Heterogeneity was assessed by visually inspecting overlap of CIs on forest plots and quantified in meta-analyses. Of 9988 records retrieved, 80 articles (64 from databases; 16 provided by Unity Studies collaborators) were retained in the systematic review; 62 were included in the primary meta-analysis. hSAR point estimates ranged from 2% to 90% (95% prediction interval: 3%-71%; I 2 = 99.7%); I 2 values remained >99% in subgroup analyses, indicating high, unexplained heterogeneity and leading to a decision not to report pooled hSAR estimates. FFX and HHTI remain critical epidemiological tools for early and ongoing characterisation of novel infectious pathogens. The large, unexplained variance in hSAR estimates emphasises the need to further support standardisation in planning, conduct and analysis, and for clear and comprehensive reporting of FFX and HHTIs in time and place, to guide evidence-based pandemic preparedness and response efforts for SARS-CoV-2, influenza and future novel respiratory viruses.
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Affiliation(s)
- Hannah C. Lewis
- World Health OrganizationGenevaSwitzerland,World Health Organization, Regional Office for AfricaBrazzavilleRepublic of Congo
| | - Adrian J. Marcato
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - Niamh Meagher
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | - Marta Valenciano
- World Health OrganizationGenevaSwitzerland,EpiconceptParisFrance
| | - Juan‐Pablo Villanueva‐Cabezas
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,The Nossal Institute for Global HealthThe University of MelbourneMelbourneAustralia
| | - Violeta Spirkoska
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Victorian Infectious Diseases Reference LaboratoryRoyal Melbourne Hospital, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - James E. Fielding
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia,Victorian Infectious Diseases Reference LaboratoryRoyal Melbourne Hospital, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | | | - Anthony Nardone
- World Health OrganizationGenevaSwitzerland,EpiconceptParisFrance
| | - Brianna Cheng
- World Health OrganizationGenevaSwitzerland,School of Population and Global HealthMcGill UniversityMontrealQuebecCanada
| | | | - Joseph Okeibunor
- World Health Organization, Regional Office for AfricaBrazzavilleRepublic of Congo
| | - Eman A. Aly
- World Health Organization, Regional Office for the Eastern MediterraneanCairoEgypt
| | - Amal Barakat
- World Health Organization, Regional Office for the Eastern MediterraneanCairoEgypt
| | | | - Tasnim Azim
- World Health Organization, Regional Office for South‐East AsiaNew DelhiIndia
| | | | - Linh‐Vi Le
- World Health Organization, Regional Office for the Western PacificManilaPhilippines
| | - Angel Rodriguez
- World Health Organization, Regional Office for the Americas (Pan American Health Organization)WashingtonDCUSA
| | - Andrea Vicari
- World Health Organization, Regional Office for the Americas (Pan American Health Organization)WashingtonDCUSA
| | | | - Jodie McVernon
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia,Murdoch Children's Research InstituteMelbourneAustralia
| | - Richard Pebody
- World Health Organization Regional Office for EuropeCopenhagenDenmark
| | - David J. Price
- Department of Infectious DiseasesThe University of Melbourne, at the Peter Doherty Institute for Infection and ImmunityMelbourneAustralia,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneAustralia
| | | | | | | | - Yasir Alvi
- Department of Community Medicine Hamdard Institute of Medical Sciences and Research New Delhi India
| | | | - Pui Shan Chung
- World Health Organization, Regional Office for the Western Pacific Manila Philippines
| | - Davaalkham Dambadarjaa
- School of Public Health Mongolian National University of Medical Sciences Ulaanbaatar Mongolia
| | - Ayan K. Das
- Department of Microbiology Hamdard Institute of Medical Science and Research New Delhi India
- Hakeem Abdul Hameed Centenary Hospital New Delhi India
| | - Timothée Dub
- Department of Health Security Finnish Institute for Health and Welfare Helsinki Finland
| | | | - Faiqa Ebrahim
- World Health Organization Country Office Addis Ababa Ethiopia
| | | | | | | | | | | | - Belinda L. Herring
- World Health Organization, Regional Office for Africa Brazzaville Republic of Congo
| | | | - Farzana Islam
- Hamdard Institute of Medical Sciences and Research (HIMSR) New Delhi India
| | - Kamal Chandima Jeewandara
- Allergy Immunology and Cell Biology Unit, Department of Immunology and Molecular Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura Nugegoda Sri Lanka
| | - Shashi Kant
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi India
| | - Wasiq Khan
- World Health Organization, Regional Office for the Eastern Mediterranean Cairo Egypt
| | | | - Juliana Leite
- World Health Organization, Regional Office for the Americas (Pan American Health Organization) Washington DC USA
| | | | - Undram Mandakh
- Mongolian National University of Medical Sciences Ulaanbaatar Mongolia
| | - Warisha Mariam
- Department of Community Medicine Maulana Azad Medical College New Delhi India
| | - Tsogt Mend
- National Center for Communicable Diseases Ulaanbaatar Mongolia
| | | | - Sanjin Musa
- Institute for Public Health of the Federation of Bosnia and Herzegovina Sarajevo Bosnia and Herzegovina
- Sarajevo School of Science and Technology Sarajevo Bosnia and Herzegovina
| | - Hanna Nohynek
- Department of Health Security Finnish Institute for Health and Welfare Helsinki Finland
| | | | | | | | | | | | - James Ransom
- Centers for Disease Control and Prevention Juba South Sudan
| | - Sonal Saxena
- Department of Microbiology Maulana Azad Medical College New Delhi India
| | - Pragya Sharma
- Department of Community Medicine Maulana Azad Medical College New Delhi India
| | - Aswathy Sreedevi
- Department of Community Medicine Amrita Institute of Medical Sciences Kochi Kerala India
| | - Mini Satheesh
- Kerala University of Health Sciences Kerala India
- Government Medical College Thiruvananthapuram Kerala India
| | - K. J. Subhashini
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi India
| | - Beth A. Tippet‐Barr
- U.S. Centers for Disease Control and Prevention Nairobi Kenya
- Nyanja Health Research Institute Salima Malawi
| | - Anuja Usha
- Regional Prevention of Epidemic and Infectious Disease Cell Government of Kerala Kerala India
| | | | | | - Kapil Yadav
- Centre for Community Medicine All India Institute of Medical Sciences New Delhi India
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Dub T, Solastie A, Hagberg L, Liedes O, Nohynek H, Haveri A, Virta C, Vara S, Lasander M, Ekström N, Österlund P, Lind K, Valtonen H, Hemmilä H, Ikonen N, Lukkarinen T, Palmu AA, Melin M. High secondary attack rate and persistence of SARS-CoV-2 antibodies in household transmission study participants, Finland 2020–2021. Front Med (Lausanne) 2022; 9:876532. [PMID: 35966873 PMCID: PMC9366099 DOI: 10.3389/fmed.2022.876532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Household transmission studies offer the opportunity to assess both secondary attack rate (SAR) and persistence of SARS-CoV-2 antibodies over time. Methods In Spring 2020, we invited confirmed COVID-19 cases and their household members to four visits, where we collected nasopharyngeal and serum samples over 28 days after index case onset. We calculated SAR based on the presence of SARS-CoV-2 neutralizing antibodies (NAb) and assessed the persistence of NAb and IgG antibodies (Ab) against SARS-CoV-2 spike glycoprotein and nucleoprotein. Results SAR was 45% (39/87), including 35 symptomatic secondary cases. During the initial 28-day follow-up, 62% (80/129) of participants developed NAb. Of those that seroconverted, 90% (63/70), 85% (63/74), and 78% (45/58) still had NAb to early B-lineage SARS-CoV-2 3, 6, and 12 months after the onset of the index case. Anti-spike IgG Ab persisted in 100% (69/69), 97% (72/74), and 93% (55/59) of seroconverted participants after 3, 6, and 12 months, while anti-nucleoprotein IgG Ab levels waned faster, persisting in 99% (68/69), 78% (58/74), and 55% (39/71) of participants, respectively. Conclusion Following detection of a COVID-19 case in a household, other members had a high risk of becoming infected. NAb to early B-lineage SARS-CoV-2 persisted for at least a year in most cases.
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Affiliation(s)
- Timothée Dub
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anna Solastie
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- *Correspondence: Anna Solastie,
| | - Lotta Hagberg
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Oona Liedes
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Hanna Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anu Haveri
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Camilla Virta
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Saimi Vara
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Mervi Lasander
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Nina Ekström
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Pamela Österlund
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Katja Lind
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
| | - Hanna Valtonen
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Heidi Hemmilä
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Centre for Military Medicine, Finnish Defence Forces, Helsinki, Finland
| | - Niina Ikonen
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Timo Lukkarinen
- Health Stations and Internal Medicine Clinic, Social and Health Care Sector, Helsinki, Finland
| | - Arto A. Palmu
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Tampere, Finland
| | - Merit Melin
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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Faden R, Cravioto A, Hombach J, Kaslow DC, Kochhar S, Nohynek H, Wilder-Smith A, Crane MA, Omer SB. Who to vaccinate first? A peek at decision-making in a pandemic. Nature 2022; 607:235-238. [PMID: 35821419 DOI: 10.1038/d41586-022-01899-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ekezie W, Awwad S, Krauchenberg A, Karara N, Dembiński Ł, Grossman Z, del Torso S, Dornbusch HJ, Neves A, Copley S, Mazur A, Hadjipanayis A, Grechukha Y, Nohynek H, Damnjanović K, Lazić M, Papaevangelou V, Lapii F, Stein-Zamir C, Rath B. Access to Vaccination among Disadvantaged, Isolated and Difficult-to-Reach Communities in the WHO European Region: A Systematic Review. Vaccines (Basel) 2022; 10:vaccines10071038. [PMID: 35891201 PMCID: PMC9324407 DOI: 10.3390/vaccines10071038] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/30/2022] [Accepted: 06/14/2022] [Indexed: 01/27/2023] Open
Abstract
Vaccination has a significant impact on morbidity and mortality. High vaccination coverage rates are required to achieve herd protection against vaccine-preventable diseases. However, limited vaccine access and hesitancy among specific communities represent significant obstacles to this goal. This review provides an overview of critical factors associated with vaccination among disadvantaged groups in World Health Organisation European countries. Initial searches yielded 18,109 publications from four databases, and 104 studies from 19 out of 53 countries reporting 22 vaccine-preventable diseases were included. Nine groups representing the populations of interest were identified, and most of the studies focused on asylum seekers, refugees, migrants and deprived communities. Recall of previous vaccinations received was poor, and serology was conducted in some cases to confirm protection for those who received prior vaccinations. Vaccination coverage was lower among study populations compared to the general population or national average. Factors that influenced uptake, which presented differently at different population levels, included health service accessibility, language and vaccine literacy, including risk perception, disease severity and vaccination benefits. Strategies that could be implemented in vaccination policy and programs were also identified. Overall, interventions specific to target communities are vital to improving uptake. More innovative strategies need to be deployed to improve vaccination coverage among disadvantaged groups.
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Affiliation(s)
- Winifred Ekezie
- Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany; (W.E.); (S.A.)
- Department of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1PB, UK
- College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
| | - Samy Awwad
- Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany; (W.E.); (S.A.)
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
- Stanford University, Palo Alto, CA 94305, USA
| | - Arja Krauchenberg
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
- European Parents Association, 1000 Brussels, Belgium
| | - Nora Karara
- Young European Academy of Paediatrics, 1000 Brussels, Belgium;
- Evangelical Hospital Queen Elisabeth Herzberge, 10365 Berlin, Germany
| | - Łukasz Dembiński
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Zachi Grossman
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Stefano del Torso
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Hans Juergen Dornbusch
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Ana Neves
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Sian Copley
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Artur Mazur
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Adamos Hadjipanayis
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Yevgenii Grechukha
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare, FI-00271 Helsinki, Finland;
| | - Kaja Damnjanović
- Faculty of Philosophy, University of Belgrade, 11000 Beograd, Serbia;
| | - Milica Lazić
- Faculty of Philosophy, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Vana Papaevangelou
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | - Fedir Lapii
- European Academy of Paediatrics, 1000 Brussels, Belgium; (Ł.D.); (Z.G.); (S.d.T.); (H.J.D.); (A.N.); (S.C.); (A.M.); (A.H.); (Y.G.); (V.P.); (F.L.)
| | | | - Barbara Rath
- Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany; (W.E.); (S.A.)
- Department of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1PB, UK
- ImmuHubs Consortium, Coordinating Entity: Vienna Vaccine Safety Initiative e.V., 10437 Berlin, Germany;
- Correspondence:
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Affiliation(s)
- Hanna Nohynek
- From the Finnish Institute for Health and Welfare, Helsinki (H.N.); and the Institute of Preventive and Social Medicine, University of Bern, Bern, Switzerland (A.W.-S.). Dr. Nohynek serves as chair of the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) Working Group for Covid-19 vaccines and as the secretary of the National Immunization Technical Advisory Group of the Finnish Institute for Health and Welfare, and Dr. Wilder-Smith serves as coordinator for the WHO SAGE Working Group for Covid-19 vaccines
| | - Annelies Wilder-Smith
- From the Finnish Institute for Health and Welfare, Helsinki (H.N.); and the Institute of Preventive and Social Medicine, University of Bern, Bern, Switzerland (A.W.-S.). Dr. Nohynek serves as chair of the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) Working Group for Covid-19 vaccines and as the secretary of the National Immunization Technical Advisory Group of the Finnish Institute for Health and Welfare, and Dr. Wilder-Smith serves as coordinator for the WHO SAGE Working Group for Covid-19 vaccines
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Haveri A, Solastie A, Ekström N, Österlund P, Nohynek H, Nieminen T, Palmu AA, Melin M. Neutralizing antibodies to SARS-CoV-2 Omicron variant after third mRNA vaccination in health care workers and elderly subjects. Eur J Immunol 2022; 52:816-824. [PMID: 35312186 PMCID: PMC9087434 DOI: 10.1002/eji.202149785] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/27/2022] [Accepted: 02/28/2022] [Indexed: 01/05/2023]
Abstract
The emergence of SARS-CoV-2 Omicron variant (B.1.1.529) with major spike protein mutations has raised concern over potential neutralization escape and breakthrough infections among vaccinated and previously SARS-CoV-2-infected subjects. We measured cross-protective antibodies against variants in health care workers (HCW, n = 20) and nursing home residents (n = 9) from samples collected at 1-2 months, following the booster (3rd) dose. We also assessed the antibody responses in subjects infected before the Omicron era (n = 38) with subsequent administration of a single mRNA vaccine dose. Following booster vaccination, HCWs had high IgG antibody concentrations to the spike protein and neutralizing antibodies (NAb) were detectable against all variants. IgG concentrations among the elderly remained lower, and some lacked NAbs against the Beta and Omicron variants. NAb titers were significantly reduced against Delta, Beta, and Omicron compared to WT virus regardless of age. Vaccination induced high IgG concentrations and variable titers of cross-reactive NAbs in previously infected subjects, whereas NAb titers against Omicron were barely detectable 1 month postinfection. High IgG concentrations with cross-protective neutralizing activity were detected after three Coronavirus Disease 2019 (COVID-19) vaccine doses in HCWs. However, lower NAb titers seen in the frail elderly suggest inadequate protection against Omicron breakthrough infections, yet protection against severe COVID-19 is expected.
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Affiliation(s)
- Anu Haveri
- Department of Health SecurityFinnish Institute for Health and WelfareHelsinkiFinland
| | - Anna Solastie
- Department of Health SecurityFinnish Institute for Health and WelfareHelsinkiFinland
| | - Nina Ekström
- Department of Health SecurityFinnish Institute for Health and WelfareHelsinkiFinland
| | - Pamela Österlund
- Department of Health SecurityFinnish Institute for Health and WelfareHelsinkiFinland
| | - Hanna Nohynek
- Department of Health SecurityFinnish Institute for Health and WelfareHelsinkiFinland
| | - Tuomo Nieminen
- Department of Information ServicesFinnish Institute for Health and WelfareHelsinkiFinland
| | - Arto A. Palmu
- Department of Public Health and WelfareFinnish Institute for Health and WelfareTampereFinland
| | - Merit Melin
- Department of Health SecurityFinnish Institute for Health and WelfareHelsinkiFinland
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25
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Hammer CC, Lyytikäinen O, Arifulla D, Toura S, Nohynek H. High influenza vaccination coverage among healthcare workers in acute care hospitals in Finland, seasons 2017/18, 2018/19 and 2019/20. Euro Surveill 2022; 27. [PMID: 35485269 PMCID: PMC9052766 DOI: 10.2807/1560-7917.es.2022.27.17.2100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundInfluenza vaccination is widely recommended for healthcare workers (HCWs) in European countries, but the coverage is not always satisfactory. In Finland, a new act was introduced in March 2017, according to which it is the employer's responsibility to appoint only vaccinated HCWs for servicing vulnerable patients.AimWe determined the influenza vaccination coverage among HCWs in Finnish acute care hospitals in three influenza seasons after introduction of the act.MethodsWe analysed data collected by an internet-based survey sent annually to all Finnish acute care hospitals and described the influenza vaccination coverage among HCWs during seasons 2017/18, 2018/19 and 2019/20. We calculated mean coverage per healthcare district and season.ResultsIn season 2017/18, 38 of 39 hospitals, in 2018/19, 35 of 36 hospitals and in 2018/19 31 of 33 hospitals provided data. The mean influenza vaccination coverage was 83.7% (SD: 12.3) in season 2017/18, 90.8% (SD: 8.7) in 2018/19 and 87.6% (SD: 10.9) in season 2019/20. There was no significant increase or decrease in the mean coverage across the three seasons. The differences between districts were only significant in 2018/19 (p < 0.005).ConclusionsThe coverage of influenza-vaccinated HCWs in Finnish hospitals was high in all three seasons and the current legal situation (semi-mandatory system) in Finland seems to provide a good background for this. Data collection should be maintained and improved for further monitoring.
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Affiliation(s)
- Charlotte C Hammer
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Outi Lyytikäinen
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Dinah Arifulla
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Saija Toura
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Hanna Nohynek
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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26
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Karlstad Ø, Hovi P, Husby A, Härkänen T, Selmer RM, Pihlström N, Hansen JV, Nohynek H, Gunnes N, Sundström A, Wohlfahrt J, Nieminen TA, Grünewald M, Gulseth HL, Hviid A, Ljung R. SARS-CoV-2 Vaccination and Myocarditis in a Nordic Cohort Study of 23 Million Residents. JAMA Cardiol 2022; 7:600-612. [PMID: 35442390 PMCID: PMC9021987 DOI: 10.1001/jamacardio.2022.0583] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Question Is SARS-CoV-2 messenger RNA (mRNA) vaccination associated with risk of myocarditis? Findings In a cohort study of 23.1 million residents across 4 Nordic countries, risk of myocarditis after the first and second doses of SARS-CoV-2 mRNA vaccines was highest in young males aged 16 to 24 years after the second dose. For young males receiving 2 doses of the same vaccine, data were compatible with between 4 and 7 excess events in 28 days per 100 000 vaccinees after second-dose BNT162b2, and between 9 and 28 per 100 000 vaccinees after second-dose mRNA-1273. Meaning The risk of myocarditis in this large cohort study was highest in young males after the second SARS-CoV-2 vaccine dose, and this risk should be balanced against the benefits of protecting against severe COVID-19 disease. Importance Reports of myocarditis after SARS-CoV-2 messenger RNA (mRNA) vaccination have emerged. Objective To evaluate the risks of myocarditis and pericarditis following SARS-CoV-2 vaccination by vaccine product, vaccination dose number, sex, and age. Design, Setting, and Participants Four cohort studies were conducted according to a common protocol, and the results were combined using meta-analysis. Participants were 23 122 522 residents aged 12 years or older. They were followed up from December 27, 2020, until incident myocarditis or pericarditis, censoring, or study end (October 5, 2021). Data on SARS-CoV-2 vaccinations, hospital diagnoses of myocarditis or pericarditis, and covariates for the participants were obtained from linked nationwide health registers in Denmark, Finland, Norway, and Sweden. Exposures The 28-day risk periods after administration date of the first and second doses of a SARS-CoV-2 vaccine, including BNT162b2, mRNA-1273, and AZD1222 or combinations thereof. A homologous schedule was defined as receiving the same vaccine type for doses 1 and 2. Main Outcomes and Measures Incident outcome events were defined as the date of first inpatient hospital admission based on primary or secondary discharge diagnosis for myocarditis or pericarditis from December 27, 2020, onward. Secondary outcome was myocarditis or pericarditis combined from either inpatient or outpatient hospital care. Poisson regression yielded adjusted incidence rate ratios (IRRs) and excess rates with 95% CIs, comparing rates of myocarditis or pericarditis in the 28-day period following vaccination with rates among unvaccinated individuals. Results Among 23 122 522 Nordic residents (81% vaccinated by study end; 50.2% female), 1077 incident myocarditis events and 1149 incident pericarditis events were identified. Within the 28-day period, for males and females 12 years or older combined who received a homologous schedule, the second dose was associated with higher risk of myocarditis, with adjusted IRRs of 1.75 (95% CI, 1.43-2.14) for BNT162b2 and 6.57 (95% CI, 4.64-9.28) for mRNA-1273. Among males 16 to 24 years of age, adjusted IRRs were 5.31 (95% CI, 3.68-7.68) for a second dose of BNT162b2 and 13.83 (95% CI, 8.08-23.68) for a second dose of mRNA-1273, and numbers of excess events were 5.55 (95% CI, 3.70-7.39) events per 100 000 vaccinees after the second dose of BNT162b2 and 18.39 (9.05-27.72) events per 100 000 vaccinees after the second dose of mRNA-1273. Estimates for pericarditis were similar. Conclusions and Relevance Results of this large cohort study indicated that both first and second doses of mRNA vaccines were associated with increased risk of myocarditis and pericarditis. For individuals receiving 2 doses of the same vaccine, risk of myocarditis was highest among young males (aged 16-24 years) after the second dose. These findings are compatible with between 4 and 7 excess events in 28 days per 100 000 vaccinees after BNT162b2, and between 9 and 28 excess events per 100 000 vaccinees after mRNA-1273. This risk should be balanced against the benefits of protecting against severe COVID-19 disease.
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Affiliation(s)
- Øystein Karlstad
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Petteri Hovi
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anders Husby
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Tommi Härkänen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Randi Marie Selmer
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Nicklas Pihlström
- Division of Licensing, Swedish Medical Products Agency, Uppsala, Sweden
| | | | - Hanna Nohynek
- Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Nina Gunnes
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.,Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
| | - Anders Sundström
- Division of Use and Information, Swedish Medical Products Agency, Uppsala, Sweden
| | - Jan Wohlfahrt
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Tuomo A Nieminen
- Information Services, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Maria Grünewald
- Division of Licensing, Swedish Medical Products Agency, Uppsala, Sweden
| | - Hanne Løvdal Gulseth
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Drug Design and Pharmacology, Pharmacovigilance Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Rickard Ljung
- Division of Use and Information, Swedish Medical Products Agency, Uppsala, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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27
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Parker EPK, Desai S, Marti M, O'Brien KL, Kaslow DC, Kochhar S, Olayinka F, Cravioto A, Nohynek H, Hombach J, Wilder-Smith A. Emerging evidence on heterologous COVID-19 vaccine schedules—To mix or not to mix? The Lancet Infectious Diseases 2022; 22:438-440. [PMID: 35278358 PMCID: PMC8906806 DOI: 10.1016/s1473-3099(22)00178-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Edward P K Parker
- Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland; The Vaccine Centre, London School of Hygiene &Tropical Medicine, London, UK.
| | - Shalini Desai
- Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | - Melanie Marti
- Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | | | | | - Sonali Kochhar
- Global Healthcare Consulting, New Delhi, India; Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Alejandro Cravioto
- Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Hanna Nohynek
- Department of Health Security at the Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Joachim Hombach
- Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland
| | - Annelies Wilder-Smith
- Immunization, Vaccines and Biologicals, WHO, Geneva, Switzerland; Institute of Social and Preventive Medicine, University of Berne, Berne, Switzerland; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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28
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Parker EPK, Desai S, Marti M, Nohynek H, Kaslow DC, Kochhar S, O'Brien KL, Hombach J, Wilder-Smith A. Response to additional COVID-19 vaccine doses in people who are immunocompromised: a rapid review. The Lancet Global Health 2022; 10:e326-e328. [PMID: 35180408 PMCID: PMC8846615 DOI: 10.1016/s2214-109x(21)00593-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/22/2021] [Accepted: 12/06/2021] [Indexed: 12/11/2022] Open
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29
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O Murchu E, Comber L, Jordan K, Hawkshaw S, Marshall L, O'Neill M, Ryan M, Teljeur C, Carnahan A, Pérez JJ, Robertson AH, Johansen K, Jonge JD, Krause T, Nicolay N, Nohynek H, Pavlopoulou I, Pebody R, Penttinen P, Soler-Soneira M, Wichmann O, Harrington P. Systematic review of the efficacy, effectiveness and safety of MF59 ® adjuvanted seasonal influenza vaccines for the prevention of laboratory-confirmed influenza in individuals ≥18 years of age. Rev Med Virol 2022; 33:e2329. [PMID: 35142401 DOI: 10.1002/rmv.2329] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 01/18/2023]
Abstract
The most effective means of preventing seasonal influenza is through vaccination. In this systematic review, we investigated the efficacy, effectiveness and safety of MF59® adjuvanted trivalent and quadrivalent influenza vaccines to prevent laboratory-confirmed influenza. A systematic literature search was conducted in electronic databases and grey literature sources up to 7 February 2020. Randomised controlled trials and non-randomised studies of interventions (NRSIs) were eligible for inclusion. The search returned 28,846 records, of which 48 studies on MF59® adjuvanted vaccines met our inclusion criteria. No efficacy trials were identified. In terms of vaccine effectiveness (VE), MF59® adjuvanted trivalent influenza vaccines were effective in preventing laboratory-confirmed influenza in older adults (aged ≥65 years) compared with no vaccination (VE = 45%, 95% confidence interval (CI) 23%-61%, 5 NRSIs across 3 influenza seasons). By subtype, significant effect was found for influenza A(H1N1) (VE = 61%, 95% CI 44%-73%) and B (VE = 29%, 95% CI 5%-46%), but not for A(H3N2). In terms of relative VE, there was no significant difference comparing MF59® adjuvanted trivalent vaccines with either non-adjuvanted trivalent or quadrivalent vaccines. Compared with traditional trivalent influenza vaccines, MF59® adjuvanted trivalent influenza vaccines were associated with a greater number of local adverse events (RR = 1.90, 95% CI 1.50-2.39) and systemic reactions (RR = 1.18, 95% CI 1.02-1.38). In conclusion, MF59® adjuvanted trivalent influenza vaccines were found to be more effective than 'no vaccination'. Based on limited data, there was no significant difference comparing the effectiveness of MF59® adjuvanted vaccines with their non-adjuvanted counterparts.
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Affiliation(s)
- Eamon O Murchu
- Health Information and Quality Authority (HIQA), Dublin, Ireland.,Department of Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Laura Comber
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Karen Jordan
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Sarah Hawkshaw
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Liam Marshall
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Michelle O'Neill
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Máirín Ryan
- Health Information and Quality Authority (HIQA), Dublin, Ireland.,Department of Pharmacology & Therapeutics, Trinity College Dublin, Trinity Health Sciences, Dublin, Ireland
| | - Conor Teljeur
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | | | - Jaime Jesús Pérez
- General Directorate of Public Health and Addictions, IMIB-Arrixaca. Murcia University, Region of Murcia, Spain
| | - Anna Hayman Robertson
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kari Johansen
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jorgen de Jonge
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ioanna Pavlopoulou
- Pediatric Research Laboratory, School of Health Sciences, Faculty of Nursing National and Kapodistrian University of Athens, Athens, Greece.,National Advisory Committee on Immunisation, Hellenic Ministry of Health, Athens, Greece
| | - Richard Pebody
- Institute of Epidemiology & Health, University College London, London, UK
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Marta Soler-Soneira
- Vigilancia de Enfermedades Prevenibles por Vacunación, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Madrid, Spain
| | - Ole Wichmann
- Immunization Unit, Robert Koch-Institute, Berlin, Germany
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30
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Jordan K, Murchu EO, Comber L, Hawkshaw S, Marshall L, O'Neill M, Teljeur C, Harrington P, Carnahan A, Pérez-Martín JJ, Robertson AH, Johansen K, Jonge JD, Krause T, Nicolay N, Nohynek H, Pavlopoulou I, Pebody R, Penttinen P, Soler-Soneira M, Wichmann O, Ryan M. Systematic review of the efficacy, effectiveness and safety of cell-based seasonal influenza vaccines for the prevention of laboratory-confirmed influenza in individuals ≥18 years of age. Rev Med Virol 2022; 33:e2332. [PMID: 35137512 DOI: 10.1002/rmv.2332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/06/2022]
Abstract
The most effective means of preventing seasonal influenza is through strain-specific vaccination. In this study, we investigated the efficacy, effectiveness and safety of cell-based trivalent and quadrivalent influenza vaccines. A systematic literature search was conducted in electronic databases and grey literature sources up to 7 February 2020. Randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) were eligible for inclusion. Two reviewers independently screened, extracted data and assessed the risk of bias of included studies. Certainty of evidence for key outcomes was assessed using the GRADE methodology. The search returned 28,846 records, of which 868 full-text articles were assessed for relevance. Of these, 19 studies met the inclusion criteria. No relative efficacy data were identified for the direct comparison of cell-based vaccines compared with traditional vaccines (egg-based). Efficacy data were available comparing cell-based trivalent influenza vaccines with placebo in adults (aged 18-49 years). Overall vaccine efficacy was 70% against any influenza subtype (95% CI 61%-77%, two RCTS), 82% against influenza A(H1N1) (95% CI 71%-89%, 2 RCTs), 72% against influenza A(H3N2) (95% CI 39%-87%, 2 RCTs) and 52% against influenza B (95% CI 30%-68%, 2 RCTs). Limited and heterogeneous data were presented for effectiveness when compared with no vaccination. One NRSI compared cell-based trivalent and quadrivalent vaccination with traditional trivalent and quadrivalent vaccination, finding a small but significant difference in favour of cell-based vaccines for influenza-related hospitalisation, hospital encounters and physician office visits. The safety profile of cell-based trivalent vaccines was comparable to traditional trivalent influenza vaccines. Compared with placebo, cell-based trivalent influenza vaccines have demonstrated greater efficacy in adults aged 18-49 years. Overall cell-based vaccines are well-tolerated in adults, however, evidence regarding the effectiveness of these vaccines compared with traditional seasonal influenza vaccines is limited.
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Affiliation(s)
- Karen Jordan
- Health Technology Assessment, Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Eamon O Murchu
- Health Technology Assessment, Health Information and Quality Authority (HIQA), Dublin, Ireland.,Department of Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Laura Comber
- Health Technology Assessment, Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Sarah Hawkshaw
- Health Technology Assessment, Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Liam Marshall
- Health Technology Assessment, Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Michelle O'Neill
- Health Technology Assessment, Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Conor Teljeur
- Health Technology Assessment, Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Patricia Harrington
- Health Technology Assessment, Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Annasara Carnahan
- Public Health Agency of Sweden, Solna, Sweden.,European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) collaboration on newer and enhanced inactivated seasonal influenza vaccines, Stockholm, Sweden
| | - Jaime Jesús Pérez-Martín
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) collaboration on newer and enhanced inactivated seasonal influenza vaccines, Stockholm, Sweden.,General Directorate of Public Health and Addictions, IMIB-Arrixaca, Murcia University, Murcia, Spain
| | - Anna Hayman Robertson
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) collaboration on newer and enhanced inactivated seasonal influenza vaccines, Stockholm, Sweden.,Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kari Johansen
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) collaboration on newer and enhanced inactivated seasonal influenza vaccines, Stockholm, Sweden.,European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Jorgen de Jonge
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) collaboration on newer and enhanced inactivated seasonal influenza vaccines, Stockholm, Sweden.,Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Tyra Krause
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) collaboration on newer and enhanced inactivated seasonal influenza vaccines, Stockholm, Sweden.,Statens Serum Institut, Copenhagen, Denmark
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) collaboration on newer and enhanced inactivated seasonal influenza vaccines, Stockholm, Sweden.,European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Hanna Nohynek
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) collaboration on newer and enhanced inactivated seasonal influenza vaccines, Stockholm, Sweden.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ioanna Pavlopoulou
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) collaboration on newer and enhanced inactivated seasonal influenza vaccines, Stockholm, Sweden.,School of Health Sciences, Faculty of Nursing, Pediatric Research Laboratory, National and Kapodistrian University of Athens, Athens, Greece.,National Advisory Committee on Immunisation, Hellenic Ministry of Health, Athens, Greece
| | - Richard Pebody
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) collaboration on newer and enhanced inactivated seasonal influenza vaccines, Stockholm, Sweden.,Institute of Epidemiology & Health, University College London, London, UK
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) collaboration on newer and enhanced inactivated seasonal influenza vaccines, Stockholm, Sweden.,European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Marta Soler-Soneira
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) collaboration on newer and enhanced inactivated seasonal influenza vaccines, Stockholm, Sweden.,Vigilancia de Enfermedades Prevenibles por Vacunación, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Madrid, Spain
| | - Ole Wichmann
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) collaboration on newer and enhanced inactivated seasonal influenza vaccines, Stockholm, Sweden.,Immunization Unit, Robert Koch-Institute, Berlin, Germany
| | - Máirín Ryan
- Health Technology Assessment, Health Information and Quality Authority (HIQA), Dublin, Ireland.,Department of Pharmacology & Therapeutics, Trinity College Dublin, Trinity. Health Sciences, Dublin, Ireland
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31
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Comber L, O Murchu E, Jordan K, Hawkshaw S, Marshall L, O'Neill M, Teljeur C, Ryan M, Carnahan A, Pérez Martín JJ, Robertson AH, Johansen K, de Jonge J, Krause T, Nicolay N, Nohynek H, Pavlopoulou I, Pebody R, Penttinen P, Soler-Soneira M, Wichmann O, Harrington P. Systematic review of the efficacy, effectiveness and safety of high-dose seasonal influenza vaccines for the prevention of laboratory-confirmed influenza in individuals ≥18 years of age. Rev Med Virol 2022; 33:e2330. [PMID: 35119149 DOI: 10.1002/rmv.2330] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 12/24/2022]
Abstract
This review sought to assess the efficacy, effectiveness and safety of high-dose inactivated influenza vaccines (HD-IIV) for the prevention of laboratory-confirmed influenza in individuals aged 18 years or older. A systematic literature search was conducted in electronic databases and grey literature sources up to 7 February 2020. Randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) were included. The search returned 28,846 records, of which 36 studies were included. HD-IIV was shown to have higher relative vaccine efficacy in preventing influenza compared with standard-dose influenza vaccines (SD-IIV3) in older adults (Vaccine effectiveness (VE) = 24%, 95% CI 10-37, one RCT). One NRSI demonstrated significant effect for HD-IIV3 against influenza B (VE = 89%, 95% CI 47-100), but not for influenza A(H3N2) (VE = 22%, 95% CI -82 to 66) when compared with no vaccination in older adults. HD-IIV3 showed significant relative effect compared with SD-IIV3 for influenza-related hospitalisation (VE = 11.8%, 95% CI 6.4-17.0, two NRSIs), influenza- or pneumonia-related hospitalisation (VE = 13.7%, 95% CI 9.5-17.7, three NRSIs), influenza-related hospital encounters (VE = 13.1%, 95% CI 8.4-17.7, five NRSIs), and influenza-related office visits (VE = 3.5%, 95% CI 1.5-5.5, two NRSIs). For safety, HD-IIV were associated with significantly higher rates of local and systemic adverse events compared with SD-IIV (combined local reactions, pain at injection site, swelling, induration, headache, chills and malaise). From limited data, compared with SD-IIV, HD-IIV were found to be more effective in the prevention of laboratory-confirmed influenza, for a range of proxy outcome measures, and associated with more adverse events.
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Affiliation(s)
- Laura Comber
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Eamon O Murchu
- Health Information and Quality Authority (HIQA), Dublin, Ireland.,Department of Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Karen Jordan
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Sarah Hawkshaw
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Liam Marshall
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Michelle O'Neill
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Conor Teljeur
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Máirín Ryan
- Health Information and Quality Authority (HIQA), Dublin, Ireland.,Department of Pharmacology & Therapeutics, Trinity College Dublin, Trinity Health Sciences, Dublin, Ireland
| | - AnnaSara Carnahan
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Public Health Agency of Sweden, Solna, Sweden
| | - Jaime Jesús Pérez Martín
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,General Directorate of Public Health and Addictions, IMIB-Arrixaca, Murcia University, Region of Murcia, Spain
| | - Anna Hayman Robertson
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kari Johansen
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Jorgen de Jonge
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,National Institute for Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, The Netherlands
| | - Tyra Krause
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Statens Serum Institut, Copenhagen, Denmark
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Hanna Nohynek
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ioanna Pavlopoulou
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Pediatric Research Laboratory, School of Health Sciences, Faculty of Nursing, National & Kapodistrian University of Athens, Goudi, Greece.,National Advisory Committee on Immunisation, Hellenic Ministry of Health, Athens, Greece
| | - Richard Pebody
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Institute of Epidemiology & Health, University College London, London, UK
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Marta Soler-Soneira
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Vigilancia de Enfermedades Prevenibles por Vacunación, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Madrid, Spain
| | - Ole Wichmann
- European Centre for Disease Prevention and Control, EU/EEA National Immunisation Technical Advisory Group (NITAG) Collaboration on Newer and Enhanced Inactivated Seasonal Influenza Vaccines, Solna, Sweden.,Immunization Unit, Robert Koch-Institute, Berlin, Germany
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32
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O Murchu E, Comber L, Jordan K, Hawkshaw S, Marshall L, O'Neill M, Ryan M, Teljeur C, Carnahan A, Pérez JJ, Robertson AH, Johansen K, Jonge JD, Krause T, Nicolay N, Nohynek H, Pavlopoulou I, Pebody R, Penttinen P, Soler-Soneira M, Wichmann O, Harrington P. Systematic review of the efficacy, effectiveness and safety of recombinant haemagglutinin seasonal influenza vaccines for the prevention of laboratory-confirmed influenza in individuals ≥18 years of age. Rev Med Virol 2022; 33:e2331. [PMID: 35106885 DOI: 10.1002/rmv.2331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/16/2022] [Accepted: 01/18/2022] [Indexed: 12/25/2022]
Abstract
The most effective means of preventing seasonal influenza is through vaccination. In this systematic review, we investigated the efficacy, effectiveness and safety of recombinant haemagglutinin (HA) seasonal influenza vaccines to prevent laboratory-confirmed influenza. A systematic literature search was conducted in electronic databases and grey literature sources up to 7 February 2020. Randomised controlled trials and non-randomised studies of interventions were eligible for inclusion. The search returned 28,846 records, of which 10 studies on recombinant HA influenza vaccine met our inclusion criteria. One study found that the quadrivalent recombinant HA influenza vaccine had higher relative vaccine efficacy (rVE) in preventing laboratory-confirmed influenza during the 2014-15 season compared with traditional quadrivalent vaccination in adults aged ≥50 years (rVE = 30%, 95% CI 10%-47%, moderate-certainty evidence). In a subgroup analysis, higher rVE was reported for influenza A (rVE = 36%, 95% CI 14% to 53%), but not for B (non-significant). Another study reported higher efficacy for the trivalent recombinant HA vaccine compared with placebo (VE = 45%, 95% CI 19-63, 1 RCT, low-certainty evidence) in adults aged 18-55 years. With the exception of a higher rate of chills (RR = 1.33, 95% CI 1.03-1.72), the safety profile of recombinant HA vaccines was comparable to that of traditional influenza vaccines. The evidence base for the efficacy and effectiveness of recombinant HA influenza vaccines is limited at present, although one study found that the quadrivalent recombinant HA influenza vaccine had higher rVE compared with traditional quadrivalent vaccination in adults aged ≥50 years.
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Affiliation(s)
- Eamon O Murchu
- Health Information and Quality Authority (HIQA), Dublin, Ireland.,Department of Health Policy & Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Laura Comber
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Karen Jordan
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Sarah Hawkshaw
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Liam Marshall
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Michelle O'Neill
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | - Máirín Ryan
- Health Information and Quality Authority (HIQA), Dublin, Ireland.,Department of Pharmacology & Therapeutics, Trinity Health Sciences, Trinity College Dublin, Dublin, Ireland
| | - Conor Teljeur
- Health Information and Quality Authority (HIQA), Dublin, Ireland
| | | | - Jaime Jesús Pérez
- General Directorate of Public Health and Addictions, IMIB-Arrixaca, Murcia University, Region of Murcia, Spain
| | - Anna Hayman Robertson
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Kari Johansen
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Jorgen de Jonge
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Nathalie Nicolay
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ioanna Pavlopoulou
- Pediatric Research Laboratory, School of Health Sciences, Faculty of Nursing, National Kapodistrian University of Athens, Athens, Greece.,National Advisory Committee on Immunisation, Hellenic Ministry of Health, Athens, Greece
| | - Richard Pebody
- Institute of Epidemiology & Health, University College London, London, UK
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Marta Soler-Soneira
- Vigilancia de Enfermedades Prevenibles por Vacunación, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Madrid, Spain
| | - Ole Wichmann
- Immunization Unit, Robert Koch-Institute, Berlin, Germany
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33
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Sääksvuori L, Betsch C, Nohynek H, Salo H, Sivelä J, Böhm R. Information nudges for influenza vaccination: Evidence from a large-scale cluster-randomized controlled trial in Finland. PLoS Med 2022; 19:e1003919. [PMID: 35139082 PMCID: PMC8870595 DOI: 10.1371/journal.pmed.1003919] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 02/24/2022] [Accepted: 01/18/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Vaccination is the most effective means of preventing the spread of infectious diseases. Despite the proven benefits of vaccination, vaccine hesitancy keeps many people from getting vaccinated. METHODS AND FINDINGS We conducted a large-scale cluster randomized controlled trial in Finland to test the effectiveness of centralized written reminders (distributed via mail) on influenza vaccination coverage. The study included the entire older adult population (aged 65 years and above) in 2 culturally and geographically distinct regions with historically low (31.8%, n = 7,398, mean age 75.5 years) and high (57.7%, n = 40,727, mean age 74.0 years) influenza vaccination coverage. The study population was randomized into 3 treatments: (i) no reminder (only in the region with low vaccination coverage); (ii) an individual-benefits reminder, informing recipients about the individual benefits of vaccination; and (iii) an individual- and social-benefits reminder, informing recipients about the additional social benefits of vaccination in the form of herd immunity. There was no control treatment group in the region with high vaccination coverage as general reminders had been sent in previous years. The primary endpoint was a record of influenza vaccination in the Finnish National Vaccination Register during a 5-month follow-up period (from October 18, 2018 to March 18, 2019). Vaccination coverage after the intervention in the region with historically low coverage was 41.8% in the individual-benefits treatment, 38.9% in the individual- and social-benefits treatment and 34.0% in the control treatment group. Vaccination coverage after the intervention in the region with historically high coverage was 59.0% in the individual-benefits treatment and 59.2% in the individual- and social-benefits treatment. The effect of receiving any type of reminder letter in comparison to control treatment group (no reminder) was 6.4 percentage points (95% CI: 3.6 to 9.1, p < 0.001). The effect of reminders was particularly large among individuals with no prior influenza vaccination (8.8 pp, 95% CI: 6.5 to 11.1, p < 0.001). There was a substantial positive effect (5.3 pp, 95% CI: 2.8 to 7.8, p < 0.001) among the most consistently unvaccinated individuals who had not received any type of vaccine during the 9 years prior to the study. There was no difference in influenza vaccination coverage between the individual-benefit reminder and the individual- and social-benefit reminder (region with low vaccination coverage: 2.9 pp, 95% CI: -0.4 to 6.1, p = 0.087, region with high vaccination coverage: 0.2 pp, 95% CI: -1.0 to 1.3, p = 0.724). Study limitations included potential contamination between the treatments due to information spillovers and the lack of control treatment group in the region with high vaccination coverage. CONCLUSIONS In this study, we found that sending reminders was an effective and scalable intervention strategy to increase vaccination coverage in an older adult population with low vaccination coverage. Communicating the social benefits of vaccinations, in addition to individual benefits, did not enhance vaccination coverage. The effectiveness of letter reminders about the benefits of vaccination to improve influenza vaccination coverage may depend on the prior vaccination history of the population. TRIAL REGISTRATION AEA RCT registry AEARCTR-0003520 and ClinicalTrials.gov NCT03748160.
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Affiliation(s)
- Lauri Sääksvuori
- Tampere University, Department of Health Sciences, Faculty of Social Sciences, Tampere, Finland
- University of Turku, INVEST Research Flagship Center, Turku, Finland
- Finnish Institute for Health and Welfare, Centre for Health and Social Economics, Helsinki, Finland
- * E-mail:
| | - Cornelia Betsch
- University of Erfurt, Media and Communication Science and Center for Empirical Research in Economics and Behavioral Sciences, Erfurt, Germany
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare, Infectious Disease Control and Vaccinations, Department of Health Security, Helsinki, Finland
| | - Heini Salo
- Finnish Institute for Health and Welfare, Infectious Disease Control and Vaccinations, Department of Health Security, Helsinki, Finland
| | - Jonas Sivelä
- Finnish Institute for Health and Welfare, Infectious Disease Control and Vaccinations, Department of Health Security, Helsinki, Finland
| | - Robert Böhm
- University of Vienna, Faculty of Psychology, Vienna, Austria
- University of Copenhagen, Department of Psychology and Copenhagen Center for Social Data Science (SODAS), Copenhagen, Denmark
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34
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Poukka E, Baum U, Palmu AA, Lehtonen TO, Salo H, Nohynek H, Leino T. Cohort study of Covid-19 vaccine effectiveness among healthcare workers in Finland, December 2020 - October 2021. Vaccine 2022; 40:701-705. [PMID: 34953607 PMCID: PMC8683266 DOI: 10.1016/j.vaccine.2021.12.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/13/2021] [Indexed: 01/25/2023]
Abstract
Recently, Covid-19 vaccine effectiveness has decreased especially against mild disease due to emergence of the Delta variant and waning protection. In this register-based study among healthcare workers in Finland, the vaccine effectiveness of two-dose mRNA vaccine series against SARS-CoV-2 infection decreased from 82% (95% CI 79-85%) 14-90 days after vaccination to 53% (43-62%) after 6 months. Similar trend was observed for other series. Waning was not observed against Covid-19 hospitalization. These results facilitate decision-making of booster doses for healthcare workers.
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Affiliation(s)
- Eero Poukka
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Ulrike Baum
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
| | - Arto A Palmu
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Tampere, Finland
| | - Toni O Lehtonen
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Heini Salo
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Hanna Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tuija Leino
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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35
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McIntyre PB, Aggarwal R, Jani I, Jawad J, Kochhar S, MacDonald N, Madhi SA, Mohsni E, Mulholland K, Neuzil KM, Nohynek H, Olayinka F, Pitisuttithum P, Pollard AJ, Cravioto A. COVID-19 vaccine strategies must focus on severe disease and global equity. Lancet 2022; 399:406-410. [PMID: 34922639 PMCID: PMC8676417 DOI: 10.1016/s0140-6736(21)02835-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Peter B McIntyre
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand.
| | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ilesh Jani
- Instituto Nacional de Saúde, Marracuene, Mozambique
| | | | - Sonali Kochhar
- Department of Global Health, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA
| | - Noni MacDonald
- Dalhousie Medical School, Dalhousie University, Halifax, NS, Canada
| | - Shabir A Madhi
- South African Medical Research Council Vaccine and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Kim Mulholland
- Department of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kathleen M Neuzil
- Center for Vaccine Development and Global Health, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Hanna Nohynek
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Folake Olayinka
- STAR Fellows Department, Public Health Institute, Washington DC, USA
| | - Punnee Pitisuttithum
- Department of Clinical Tropical Medicine and the Vaccine Trial Centre, Mahidol University, Nakhon Pathom, Bangkok
| | | | - Alejandro Cravioto
- Department of Public Health, National Autonomous University of Mexico, Mexico City, Mexico
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36
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Auvinen R, Syrjänen R, Ollgren J, Nohynek H, Skogberg K. Clinical characteristics and population-based attack rates of respiratory syncytial virus versus influenza hospitalizations among adults-An observational study. Influenza Other Respir Viruses 2021; 16:276-288. [PMID: 34605172 PMCID: PMC8818833 DOI: 10.1111/irv.12914] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022] Open
Abstract
Background The clinical significance of respiratory syncytial virus (RSV) among adults remains underinvestigated. We compared the characteristics and population‐based attack rates of RSV and influenza hospitalizations. Methods During 2018–2020, we recruited hospitalized adults with respiratory infection to our prospective substudy at a tertiary care hospital in Finland and compared the characteristics of RSV and influenza patients. In our retrospective substudy, we calculated the attack rates of all RSV and influenza hospitalizations among adults in the same geographic area during 2016–2020. Results Of the 537 prospective substudy patients, 31 (6%) had RSV, and 106 (20%) had influenza. Duration of hospitalization, need for intensive care or outcome did not differ significantly between RSV and influenza patients. RSV was more often missed or its diagnosis omitted from medical record (13% vs 1% p = 0.016 and 48% vs 15%, p > 0.001). In the retrospective substudy, the mean attack rates of RSV, influenza A, and influenza B hospitalizations rose with age from 4.1 (range by season 1.9–5.9), 15.4 (12.3–23.3), and 4.7 (0.5–16.2) per 100,000 persons among 18‐ to 64‐year‐olds to 58.3 (19.3–117.6), 204.1 (31.0–345.0), and 60.4 (0.0–231.0) per 100,000 persons among 65+‐year‐olds and varied considerably between seasons. Discussion While the attack rates of influenza hospitalizations were higher compared with RSV, RSV and influenza hospitalizations were similar in severity. Missing or underreporting of RSV infections may lead to underestimating its disease burden. Both RSV and influenza caused a substantial amount of hospitalizations among the elderly, stressing the need for more effective interventions.
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Affiliation(s)
- Raija Auvinen
- Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland.,Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ritva Syrjänen
- Population Health Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jukka Ollgren
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kirsi Skogberg
- Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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37
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Haveri A, Ekström N, Solastie A, Virta C, Österlund P, Isosaari E, Nohynek H, Palmu AA, Melin M. Persistence of neutralizing antibodies a year after SARS-CoV-2 infection in humans. Eur J Immunol 2021; 51:3202-3213. [PMID: 34580856 PMCID: PMC8646652 DOI: 10.1002/eji.202149535] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/02/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
Most subjects develop antibodies to SARS‐CoV‐2 following infection. In order to estimate the duration of immunity induced by SARS‐CoV‐2 it is important to understand for how long antibodies persist after infection in humans. Here, we assessed the persistence of serum antibodies following WT SARS‐CoV‐2 infection at 8 and 13 months after diagnosis in 367 individuals. The SARS‐CoV‐2 spike IgG (S‐IgG) and nucleoprotein IgG (N‐IgG) concentrations and the proportion of subjects with neutralizing antibodies (NAb) were assessed. Moreover, the NAb titers among a smaller subset of participants (n = 78) against a WT virus (B) and variants of concern (VOCs): Alpha (B.1.1.7), Beta (B.1.351), and Delta (B.1.617.2) were determined. We found that NAb against the WT virus persisted in 89% and S‐IgG in 97% of subjects for at least 13 months after infection. Only 36% had N‐IgG by 13 months. The mean S‐IgG concentrations declined from 8 to 13 months by less than one third; N‐IgG concentrations declined by two‐thirds. Subjects with severe infection had markedly higher IgG and NAb levels and are expected to remain seropositive for longer. Significantly lower NAb titers against the variants compared to the WT virus, especially after a mild disease, suggests reduced protection against VOCs.
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Affiliation(s)
- Anu Haveri
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Nina Ekström
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anna Solastie
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Camilla Virta
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pamela Österlund
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Elina Isosaari
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Nohynek
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Arto A Palmu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Merit Melin
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
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38
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Affiliation(s)
- Annelies Wilder-Smith
- Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland. .,Institute of Social and Preventive Medicine, University of Berne, Berne, Switzerland. .,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.
| | - Shalini Desai
- Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Alejandro Cravioto
- Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Hanna Nohynek
- Department of Health Security at the Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Joachim Hombach
- Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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39
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Hetemäki I, Kääriäinen S, Alho P, Mikkola J, Savolainen-Kopra C, Ikonen N, Nohynek H, Lyytikäinen O. An outbreak caused by the SARS-CoV-2 Delta variant (B.1.617.2) in a secondary care hospital in Finland, May 2021. ACTA ACUST UNITED AC 2021; 26. [PMID: 34328076 PMCID: PMC8323455 DOI: 10.2807/1560-7917.es.2021.26.30.2100636] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
An outbreak caused by the SARS-CoV-2 Delta variant (B.1.617.2) spread from one inpatient in a secondary care hospital to three primary care facilities, resulting in 58 infections including 18 deaths in patients and 45 infections in healthcare workers (HCW). Only one of the deceased cases was fully vaccinated. Transmission occurred despite the use of personal protective equipment by the HCW, as advised in national guidelines, and a high two-dose COVID-19 vaccination coverage among permanent staff members in the COVID-19 cohort ward.
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Affiliation(s)
- Iivo Hetemäki
- Translational Immunology Program, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland.,Infectious Diseases Unit, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Sohvi Kääriäinen
- Finnish Institute for Health and Welfare, Helsinki, Finland.,ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
| | - Pirjo Alho
- Infectious Diseases Unit, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Janne Mikkola
- Infectious Diseases Unit, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | | | - Niina Ikonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare, Helsinki, Finland
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40
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Stuurman AL, Biccler J, Carmona A, Descamps A, Díez-Domingo J, Muñoz Quiles C, Nohynek H, Rizzo C, Riera-Montes M. Brand-specific influenza vaccine effectiveness estimates during 2019/20 season in Europe - Results from the DRIVE EU study platform. Vaccine 2021; 39:3964-3973. [PMID: 34092427 DOI: 10.1016/j.vaccine.2021.05.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
DRIVE (Development of Robust and Innovative Vaccine Effectiveness) is an IMI funded public-private platform that aims to annually estimate brand-specific influenza vaccine effectiveness (IVE), for public health and regulatory purposes. IVE analyses and reporting are conducted by public partners in the consortium. In 2019/20, four primary care-based test-negative design (TND) studies (Austria, England, Italy (n = 2)), eight hospital-based TND studies (Finland, France, Italy, Romania, Spain (n = 4)), and one population-based cohort study (Finland) were conducted. The COVID-19 pandemic affected influenza surveillance in all participating study sites, therefore the study period was truncated on February 29, 2020. Age-stratified (6 m-17y, 18-64y, ≥65y), confounder-adjusted, site-specific adjusted IVE estimates were calculated and pooled through meta-analysis. Parsimonious confounder-adjustment was performed, adjusting the estimates for age, sex and calendar time. TND studies included 3531 cases (351 vaccinated) and 5546 controls (1415 vaccinated) of all ages. IVE estimates were available for 8/11 brands marketed in Europe in 2019. Most children and adults < 64y were captured in primary care setting and the most frequently observed vaccine brand was Vaxigrip Tetra. The estimate against any influenza for Vaxigrip Tetra in primary care setting was 61% (95%CI 38-77) in children and 32% (95%CI -13-59) in adults up to 64y. Most adults ≥ 65y were captured in hospital setting and the most frequently observed brand was Fluad, with an estimate of 52% (95%CI 27-68). The population-based cohort covered 511,854 person-years and two vaccine brands. In children aged 2-6y, the IVE against any influenza was 68% (95%CI 58-75) for Fluenz Tetra and 71% (56-80) for Vaxigrip Tetra. In adults ≥ 65y, IVE against any influenza was 29% (20-36) for Vaxigrip Tetra. DRIVE is a growing platform. Public health institutes with surveillance data and hospitals in countries with high influenza vaccine coverage are encouraged to join DRIVE.
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Affiliation(s)
| | - Jorne Biccler
- P95 Pharmacovigilance and Epidemiology, Leuven, Belgium.
| | | | - Alexandre Descamps
- Institut National de la Sante et de la Recherche Medicale (INSERM), Paris, France.
| | | | | | - Hanna Nohynek
- Finnish Institute for Health and Welfare, Helsinki, Finland.
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41
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Dub T, Søborg B, Andersen PH, Gudnason T, Nøkleby H, Lindstrand A, Carlsson RM, Nohynek H. Immunisation of healthcare workers in the Nordic countries: Variation in recommendations and practices and a lack of assessment. ACTA ACUST UNITED AC 2021; 26. [PMID: 33509337 PMCID: PMC7848784 DOI: 10.2807/1560-7917.es.2021.26.4.1900555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Healthcare workers (HCWs) are at increased risk of both exposure and transmission of infectious disease. Two European Union (EU) directives state that health services are responsible for assessing their employees’ potential exposure to infectious diseases and offering immunisation free of charge. We assessed current policy for immunisation of HCWs and the availability of vaccine coverage data in the Nordic countries by surveying national vaccination experts in Denmark, Finland, Iceland, Norway and Sweden, as well as Swedish county medical officers (CMOs). All national experts and 17 of 21 Swedish CMOs responded. All EU countries had transposed the European directives into national law, while Norway and Iceland had similar national legislation. Recommendations or guidelines were issued in Denmark, Finland, Iceland, Norway and 15 of 17 responding Swedish counties. The range of diseases covered differed by countries and Swedish counties. HCW vaccine coverage data were not systematically collected; incomplete estimates were only available for Finland and two Swedish counties. In conclusion, recommendations or guidelines exist in the Nordic countries, but their impact cannot be assessed, as vaccine uptake among HCWs is not currently measured. Systematic collection of data is a necessary step towards improving HCW immunisation policy and practice in the Nordic countries.
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Affiliation(s)
- Timothee Dub
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | | | - Peter Henrik Andersen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Thorolfur Gudnason
- Centre for Health Security and Communicable Disease Control, Directorate of Health, Reykjavik, Iceland
| | | | - Ann Lindstrand
- Unit for Vaccination Programmes, Public Health Agency of Sweden, Solna, Sweden
| | - Rose-Marie Carlsson
- Unit for Vaccination Programmes, Public Health Agency of Sweden, Solna, Sweden
| | - Hanna Nohynek
- Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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42
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Baum U, Kulathinal S, Auranen K, Nohynek H. Effectiveness of 2 Influenza Vaccines in Nationwide Cohorts of Finnish 2-Year-Old Children in the Seasons 2015-2016 Through 2017-2018. Clin Infect Dis 2021; 71:e255-e261. [PMID: 31955204 DOI: 10.1093/cid/ciaa050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/15/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND From 2015-2016 through 2017-2018, injectable, trivalent inactivated influenza vaccines (IIV3) and a nasal spray, tetravalent live-attenuated influenza vaccine (LAIV4) were used in parallel in Finland. To understand how well vaccination with each vaccine type protected children against influenza under real-life conditions, vaccine effectiveness in 2-year-olds was estimated for all 3 seasons. METHODS Each season, a nationwide register-based cohort study was conducted. The study population comprised 60 088, 60 860, and 60 345 children in 2015-2016, 2016-2017, and 2017-2018, respectively. Laboratory-confirmed influenza was the study outcome. Seasonal influenza vaccination with either LAIV4 or IIV3 was the time-dependent exposure of interest. Vaccine effectiveness was defined as 1 minus the hazard ratio comparing vaccinated with unvaccinated children. RESULTS From 2015-2016 through 2017-2018, the effectiveness of LAIV4 against influenza of any virus type was estimated at 54.2% (95% confidence interval, 32.2-69.0%), 20.3% (-12.7%, 43.6%), and 30.5% (10.9-45.9%); the corresponding effectiveness of IIV3 was 77.2% (48.9-89.8%), 24.5% (-29.8%, 56.1%), and -20.1% (-61.5%, 10.7%). Neither influenza vaccine clearly excelled in protecting children. The LAIV4 effectiveness against type B was greater than against type A and greater than the IIV3 effectiveness against type B. CONCLUSIONS To understand how influenza vaccines could be improved, vaccine effectiveness must be analyzed by vaccine and virus type. Effectiveness estimates also expressing overall protection levels are needed to guide individual and programmatic decision-making processes. Supported by this analysis, the vaccination program in Finland now recommends LAIV4 and injectable, tetravalent inactivated influenza vaccines replacing IIV3.
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Affiliation(s)
- Ulrike Baum
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sangita Kulathinal
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Kari Auranen
- Department of Mathematics and Statistics, University of Turku, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Hanna Nohynek
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
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Teirlinck AC, Broberg EK, Berg AS, Campbell H, Reeves RM, Carnahan A, Lina B, Pakarna G, Bøås H, Nohynek H, Emborg HD, Nair H, Reiche J, Oliva JA, Gorman JO, Paget J, Szymanski K, Danis K, Socan M, Gijon M, Rapp M, Havlíčková M, Trebbien R, Guiomar R, Hirve SS, Buda S, van der Werf S, Meijer A, Fischer TK. Recommendations for respiratory syncytial virus surveillance at national level. Eur Respir J 2021; 58:13993003.03766-2020. [PMID: 33888523 PMCID: PMC8485062 DOI: 10.1183/13993003.03766-2020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/08/2021] [Indexed: 11/25/2022]
Abstract
Respiratory syncytial virus (RSV) is a common cause of acute lower respiratory tract infections and hospitalisations among young children and is globally responsible for many deaths in young children, especially in infants aged <6 months. Furthermore, RSV is a common cause of severe respiratory disease and hospitalisation among older adults. The development of new candidate vaccines and monoclonal antibodies highlights the need for reliable surveillance of RSV. In the European Union (EU), no up-to-date general recommendations on RSV surveillance are currently available. Based on outcomes of a workshop with 29 European experts in the field of RSV virology, epidemiology and public health, we provide recommendations for developing a feasible and sustainable national surveillance strategy for RSV that will enable harmonisation and data comparison at the European level. We discuss three surveillance components: active sentinel community surveillance, active sentinel hospital surveillance and passive laboratory surveillance, using the EU acute respiratory infection and World Health Organization (WHO) extended severe acute respiratory infection case definitions. Furthermore, we recommend the use of quantitative reverse transcriptase PCR-based assays as the standard detection method for RSV and virus genetic characterisation, if possible, to monitor genetic evolution. These guidelines provide a basis for good quality, feasible and affordable surveillance of RSV. Harmonisation of surveillance standards at the European and global level will contribute to the wider availability of national level RSV surveillance data for regional and global analysis, and for estimation of RSV burden and the impact of future immunisation programmes. Recommendations for developing a feasible and sustainable national surveillance strategy for respiratory syncytial virus that will enable harmonisation and data comparison at the European level.https://bit.ly/3rWUOOI
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Affiliation(s)
- Anne C Teirlinck
- National Institute for Public Health and the Environment (RIVM) - Centre for Infectious Disease Control, Bilthoven, the Netherlands
| | - Eeva K Broberg
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | | | | | | | | | | | - Håkon Bøås
- Norwegian Institute of Public Health, Oslo, Norway
| | - Hanna Nohynek
- Finnish National Institute for Health and Welfare, Finland
| | | | - Harish Nair
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Jesus Angel Oliva
- Instituto de Salud Carlos III Madrid, CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | | | - John Paget
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
| | | | - Kostas Danis
- Santé publique France (SpFrance), the French national public health agency, Saint-Maurice, France
| | - Maja Socan
- Public Health Institute, Ljubljana, Slovenia
| | | | - Marie Rapp
- Public Health Agency Stockholm, Solna, Sweden
| | | | | | | | | | | | | | - Adam Meijer
- National Institute for Public Health and the Environment (RIVM) - Centre for Infectious Disease Control, Bilthoven, the Netherlands
| | - Thea K Fischer
- Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark and Department of Global Health and Infectious Diseases, University of Southern Denmark, Odense, Denmark
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Lohiniva AL, Dub T, Hagberg L, Nohynek H. Learning about COVID-19-related stigma, quarantine and isolation experiences in Finland. PLoS One 2021; 16:e0247962. [PMID: 33852581 PMCID: PMC8046198 DOI: 10.1371/journal.pone.0247962] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has intensely changed the everyday lives of people worldwide. This study explores the forms and outcomes of coronavirus and COVID-19-related social stigma and the experiences of people who were home quarantined or isolated in Finland during the spring 2020. The findings of this study can be used to improve support for those quarantined or isolated and to develop strategies to reduce the stigma associated with coronavirus and COVID-19. METHODS The study is based on qualitative one-to-one interviews with households with at least two members and at least one PCR confirmed COVID-19 case. Recruitment took place via website or SMS messages sent to PCR confirmed cases in the capital area of Helsinki. Sampling was based on maximum variation to acquire different types of respondents. The framework of health stigma was used to develop question guides and analyze stigma. Quarantine and isolation experiences were explored through open-ended questions. The analysis was based on thematic analysis. RESULTS The study included 64 participants from 24 households. Perceived stigma among respondents was driven by fear and blame for infection, and it manifested in various ways leading to a reluctance to disclose their coronavirus status to others. Self-stigma developed from conflicting information and advice about coronavirus and COVID-19 led to difficulties interacting with others outside of the house and reluctance to meet people after quarantine and isolation. Quarantine and isolation experiences included uncertainty, health concerns, and boredom. Communication with others in similar situations was perceived vital, whereas discussions with family members about worries and fears related to coronavirus and COVID-19 was not preferred. CONCLUSIONS This study shed light on the lives of those quarantined or isolated at home and provided a set of operational recommendations to minimize coronavirus and COVID-19-associated stigma and to reduce challenges faced by those in quarantine or isolation.
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Affiliation(s)
| | - Timothee Dub
- The Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Lotta Hagberg
- The Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Nohynek
- The Finnish Institute for Health and Welfare, Helsinki, Finland
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45
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Affiliation(s)
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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46
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Grant R, Dub T, Andrianou X, Nohynek H, Wilder-Smith A, Pezzotti P, Fontanet A. SARS-CoV-2 population-based seroprevalence studies in Europe: a scoping review. BMJ Open 2021; 11:e045425. [PMID: 33795310 PMCID: PMC8021754 DOI: 10.1136/bmjopen-2020-045425] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/09/2021] [Accepted: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES We aimed to review SARS-CoV-2 seroprevalence studies conducted in Europe to understand how they may be used to inform ongoing control strategies for COVID-19. DESIGN Scoping review of peer-reviewed publications and manuscripts on preprint servers from January 2020 to 15 September 2020. PRIMARY MEASURE Seroprevalence estimate (and lower and upper CIs). For studies conducted across a country or territory, we used the seroprevalence estimate and the upper and lower CIs and compared them to the total number of reported infections to calculate the ratio of reported to expected infections. RESULTS We identified 23 population-based seroprevalence studies conducted in Europe. Among 12 general population studies, seroprevalence ranged from 0.42% among residual clinical samples in Greece to 13.6% in an area of high transmission in Gangelt, Germany. Of the eight studies in blood donors, seroprevalence ranged from 0.91% in North-Western Germany to 23.3% in a high-transmission area in Lombardy region, Italy. In three studies which recruited individuals through employment, seroprevalence ranged from 0.5% among factory workers in Frankfurt, Germany, to 10.2% among university employees in Milan, Italy. In comparison to nationally reported cases, the extent of infection, as derived from these seroprevalence estimates, is manyfold higher and largely heterogeneous. CONCLUSION Exposure to the virus in Europe has not reached a level of infection that would prevent further circulation of the virus. Effective vaccine candidates are urgently required to deliver the level of immunity in the population.
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Affiliation(s)
- Rebecca Grant
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France
- Sorbonne Université, Paris, France
| | - Timothée Dub
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Xanthi Andrianou
- Department of Infectious Diseases, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Hanna Nohynek
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Patrizio Pezzotti
- Department of Infectious Diseases, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Arnaud Fontanet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France
- PACRI Unit, Conservatoire National des Arts et Métiers, Paris, France
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Kochhar S, Dubé E, Graham J, Jee Y, Memish ZA, Menning L, Nohynek H, Salmon D, Top KA, MacDonald NE. COVID-19 vaccine safety questions and answers for healthcare providers (CONSIDER). Vaccine 2021; 39:2504-2505. [PMID: 33836897 PMCID: PMC7983421 DOI: 10.1016/j.vaccine.2021.03.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Sonali Kochhar
- Department of Global Health, University of Washington, Seattle, United States; Global Healthcare Consulting, India.
| | - Eve Dubé
- Quebec National Institute of Public Health, Canada; Laval University, Canada
| | | | - Youngmee Jee
- GSPA, Seoul National University, Republic of Korea; Special Representative for Health Diplomacy, Korea Foundation, Republic of Korea
| | - Ziad A Memish
- Research and Innovation Center, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
| | - Lisa Menning
- WHO HQ Department of Immunization, Vaccines, and Biologicals, Geneva, Switzerland
| | - Hanna Nohynek
- Deputy Head of Unit, Finnish Institute for Health and Welfare THL, Finland
| | - Daniel Salmon
- Institute for Vaccine Safety, Johns Hopkins University School of Public Health, United States
| | - Karina A Top
- Pediatrics and Community Health & Epidemiology, Dalhousie University, Canada
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Auvinen R, Nohynek H, Syrjänen R, Ollgren J, Kerttula T, Mäntylä J, Ikonen N, Loginov R, Haveri A, Kurkela S, Skogberg K. Comparison of the clinical characteristics and outcomes of hospitalized adult COVID-19 and influenza patients - a prospective observational study. Infect Dis (Lond) 2020; 53:111-121. [PMID: 33170050 DOI: 10.1080/23744235.2020.1840623] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We compared the clinical characteristics, findings, and outcomes of hospitalized patients with coronavirus disease 2019 (COVID-19) or influenza to detect relevant differences. METHODS From December 2019 to April 2020, we recruited all eligible hospitalized adults with respiratory infection to a prospective observational study at a tertiary care hospital in Finland. Influenza and SARS-CoV-2 infections were confirmed by RT-PCR. Follow-up lasted for 3 months from admission. RESULTS We included 61 patients, of whom 28 were COVID-19 and 33 influenza patients with median ages of 53 and 56 years. Majority of both COVID-19 and influenza patients were men (61% vs. 67%) and had at least one comorbidity (68% vs. 85%). Pulmonary diseases and current smoking were less common among COVID-19 than influenza patients (5 [18%] vs. 15 [45%], p=.03 and 1 [4%] vs. 10 [30%], p=.008). In chest X-ray at admission, ground-glass opacities (GGOs) and consolidations were more frequent among COVID-19 than influenza patients (19 [68%] and 7 [21%], p<.001). Severe disease and intensive care unit (ICU) admission occurred more often among COVID-19 than influenza patients (26 [93%] vs. 19 [58%], p=.003 and 8 [29%] vs. 2 [6%], p=.034). COVID-19 patients were hospitalized longer than influenza patients (six days [IQR 4-21] vs. 3 [2-4], p<.001). CONCLUSIONS Bilateral GGOs and consolidations in chest X-ray may help to differentiate COVID-19 from influenza. Hospitalized COVID-19 patients had more severe disease, required longer hospitalization and were admitted to ICU more often than influenza patients, which has important implications for public health policies.
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Affiliation(s)
- Raija Auvinen
- Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Health Security, Infectious Disease Control and Vaccinations Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Nohynek
- Department of Health Security, Infectious Disease Control and Vaccinations Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ritva Syrjänen
- Department of Public Health Solutions, Public Health Projection and Evaluation Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jukka Ollgren
- Department of Health Security, Infectious Disease Control and Vaccinations Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuija Kerttula
- HUS Medical Imaging Center, Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jarkko Mäntylä
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Niina Ikonen
- Department of Health Security, Expert Microbiology Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Raisa Loginov
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anu Haveri
- Department of Health Security, Expert Microbiology Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Satu Kurkela
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kirsi Skogberg
- Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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49
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Njuma Libwea J, Gröndahl-Yli-Hannuksela K, Kobela M, Toropainen M, Nyholm O, Ndombo PK, Koulla-Shiro S, Nohynek H, Nuorti JP, Vuopio J, Palmu AA. Prevalence of pneumococcal nasopharyngeal colonization and serotypes circulating in Cameroonian children after the 13-valent pneumococcal conjugate vaccine introduction. Int J Infect Dis 2020; 98:113-120. [DOI: 10.1016/j.ijid.2020.06.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 01/08/2023] Open
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Linkevicius M, Cristea V, Siira L, Mäkelä H, Toropainen M, Pitkäpaasi M, Dub T, Nohynek H, Puumalainen T, Rintala E, Laaksonen ME, Feuth T, Grönroos JO, Peltoniemi J, Frilander H, Lindström I, Sane J. Outbreak of invasive pneumococcal disease among shipyard workers, Turku, Finland, May to November 2019. ACTA ACUST UNITED AC 2020; 24. [PMID: 31822326 PMCID: PMC6905297 DOI: 10.2807/1560-7917.es.2019.24.49.1900681] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report an outbreak of invasive pneumococcal disease and pneumococcal pneumonia among shipyard workers, in Turku, Southwest Finland. In total, 31 confirmed and six probable cases were identified between 3 May and 28 November 2019. Streptococcus pneumoniae serotypes 12F, 4 and 8 were isolated from blood cultures of 25 cases. Occupational hygiene measures and vaccination of ca 4,000 workers are underway to control the outbreak at the shipyard.
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Affiliation(s)
- Marius Linkevicius
- European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, Stockholm, Sweden.,Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Veronica Cristea
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden.,Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Lotta Siira
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Henna Mäkelä
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Maija Toropainen
- Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Marjaana Pitkäpaasi
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Timothee Dub
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Hanna Nohynek
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Taneli Puumalainen
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Esa Rintala
- Department of Hospital Hygiene and Infection Control, Turku University Hospital (TYKS), Turku, Finland
| | - Merja E Laaksonen
- Department of Hospital Hygiene and Infection Control, Turku University Hospital (TYKS), Turku, Finland
| | - Thijs Feuth
- Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.,Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital (TYKS), Turku Finland
| | - Juha O Grönroos
- Department of Clinical Microbiology, Turku University Hospital (TYKS), Turku, Finland
| | - Jutta Peltoniemi
- Infection Control Unit, Welfare Division, City of Turku, Finland
| | | | | | - Jussi Sane
- Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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