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Seghezzo G, Allen H, Griffiths C, Pooley J, Beardsmore L, Caul S, Glickman M, Clare T, Dabrera G, Kall M. Comparison of two COVID-19 mortality measures used during the pandemic response in England. Int J Epidemiol 2024; 53:dyad116. [PMID: 37615969 PMCID: PMC10859127 DOI: 10.1093/ije/dyad116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/07/2023] [Indexed: 08/25/2023] Open
Affiliation(s)
- Giulia Seghezzo
- COVID-19 Vaccines and Epidemiology Division, UK Health Security Agency, London, UK
| | - Hester Allen
- COVID-19 Vaccines and Epidemiology Division, UK Health Security Agency, London, UK
| | - Clare Griffiths
- Data Product Development Division, UK Health Security Agency, London, UK
| | - Justine Pooley
- Health Analysis and Pandemic Insight Division, Office for National Statistics, London, UK
| | - Liam Beardsmore
- Health Analysis and Pandemic Insight Division, Office for National Statistics, London, UK
| | - Sarah Caul
- Health Analysis and Pandemic Insight Division, Office for National Statistics, London, UK
| | - Myer Glickman
- Health Analysis and Pandemic Insight Division, Office for National Statistics, London, UK
| | - Tom Clare
- COVID-19 Vaccines and Epidemiology Division, UK Health Security Agency, London, UK
| | - Gavin Dabrera
- COVID-19 Vaccines and Epidemiology Division, UK Health Security Agency, London, UK
| | - Meaghan Kall
- COVID-19 Vaccines and Epidemiology Division, UK Health Security Agency, London, UK
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2
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Kirsebom FCM, Harman K, Lunt RJ, Andrews N, Groves N, Abdul Aziz N, Hope R, Stowe J, Chand M, Ramsay M, Dabrera G, Kall M, Bernal JL. Vaccine effectiveness against hospitalisation estimated using a test-negative case-control study design, and comparative odds of hospital admission and severe outcomes with COVID-19 sub-lineages BQ.1, CH.1.1. and XBB.1.5 in England. Lancet Reg Health Eur 2023; 35:100755. [PMID: 38115965 PMCID: PMC10730318 DOI: 10.1016/j.lanepe.2023.100755] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 12/21/2023]
Abstract
Background Since the first emergence of Omicron BA.1 in England in November 2021, numerous sub-lineages have evolved. In September 2022, BA.5 dominated. The prevalence of BQ.1 increased from October, while the prevalence of CH.1.1 and XBB.1.5 increased from December 2022 and January 2023, respectively. Little is known about the effectiveness of the vaccines against hospitalisation with these sub-lineages, nor the relative severity, so we here used national-level electronic health records from England to estimate vaccine effectiveness and variant severity. Methods The study period for tests contributing to all analyses was from 5th December 2022 to 2nd April 2023, when the variants of interest were co-circulating. A test-negative case-control study was used to estimate the incremental effectiveness of the bivalent BA.1 booster vaccines against hospitalisation, relative to those with waned immunity where the last dose was at least 6 months prior. The odds of hospital admission for those testing PCR positive on the day of an attendance to accident and emergency departments and the odds of intensive care unit admission or death amongst COVID-19 admissions were compared between variants. Additionally, a Cox proportional hazards survival regression was used to investigate length of stay amongst hospitalised cases by variant. Findings Our vaccine effectiveness study included 191,229 eligible tests with 1647 BQ.1 cases, 877 CH.1.1 cases, 1357 XBB.1.5 cases and 187,348 test negative controls. There was no difference in incremental vaccine effectiveness against hospitalisation with BQ.1, CH.1.1 or XBB.1.5, nor was there a difference in the severity of these variants. Effectiveness against hospitalisation was 48.0% (95% C.I.; 38.5-56.0%), 29.7% (95% C.I.; 7.5-46.6%) and 52.7% (95% C.I.; 24.6-70.4%) against BQ.1, CH.1.1 and XBB.1.5, respectively, at 5-9 weeks post booster vaccination. Compared to BQ.1, the odds of hospital admission were 0.87 (95% C.I.; 0.77-0.99) and 0.88 (95% C.I.; 0.75-1.02) for CH.1.1 and XBB.1.5 cases attending accident and emergency departments, respectively. There was no significant difference in the odds of admission to intensive care units or death for those with CH.1.1 (OR 0.96, 95% C.I.; 0.71-1.30) or XBB.1.5 (OR 0.67, 95% C.I.; 0.44-1.02) compared to BQ.1. There was also no significant difference in the length of hospital stay by variant. Interpretation Together, these results provide reassuring evidence that the bivalent BA.1 booster vaccines provide similar protection against hospitalisation with BQ.1, CH.1.1 and XBB.1.5, and that the emergent CH.1.1 and XBB.1.5 sub-lineages do not cause more severe disease than BQ.1. Funding None.
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Affiliation(s)
| | - Katie Harman
- UK Health Security Agency, London, United Kingdom
| | | | - Nick Andrews
- UK Health Security Agency, London, United Kingdom
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Russell Hope
- UK Health Security Agency, London, United Kingdom
| | - Julia Stowe
- UK Health Security Agency, London, United Kingdom
| | - Meera Chand
- UK Health Security Agency, London, United Kingdom
- Guys and St Thomas’s Hospital NHS Trust, London, United Kingdom
| | - Mary Ramsay
- UK Health Security Agency, London, United Kingdom
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Meaghan Kall
- UK Health Security Agency, London, United Kingdom
| | - Jamie Lopez Bernal
- UK Health Security Agency, London, United Kingdom
- NIHR Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine, London, United Kingdom
- NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London, London, United Kingdom
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3
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Wiginton JM, Murray S, Kall M, Maksut JL, Augustinavicius J, Delpech V, Baral SD. HIV-related Stigma and Discrimination in Health Care and Health-related Quality of Life among People Living with HIV in England and Wales: A Latent Class Analysis. Stigma Health 2023; 8:487-496. [PMID: 38292669 PMCID: PMC10824403 DOI: 10.1037/sah0000299] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Though life expectancy of people living with HIV (PLHIV) is now comparable to that of HIV-negative persons, their health-related quality of life (HRQoL) lags behind. Lower HRQoL among PLHIV may vary meaningfully, shaped in part by social factors, including stigma. Using data from Positive Voices, a national cross-sectional probability survey of adults ≥ 18 years living with HIV and accessing HIV care services in England and Wales (N = 4,422), we conducted latent class analysis on responses to a HRQoL measure (problems with mobility, usual activities, self-care, pain/discomfort, anxiety/depression) to identify HRQoL patterns, followed by multinomial logistic regression to examine relationships between HRQoL classes and a 4-item measure of HIV-related stigma and discrimination in health care. Four classes emerged: All Problems (18% prevalence); Pain and Distress (18%); Pain and Mobility (9%); No Problems (55%). Scale scores of HIV-related stigma and discrimination in health care were positively, significantly associated with membership in the All Problems (adjusted odds ratio [aOR] = 2.05; 95% confidence interval [CI] = 1.85, 2.28), Pain and Distress (aOR = 1.56; CI = 1.41, 1.73), and Pain and Mobility classes (aOR = 1.33; CI = 1.16, 1.52) compared to the No Problems class. A similar trend was observed for individual stigma and discrimination items. HRQoL among PLHIV in England and Wales varies and may be underpinned or exacerbated by HIV-related stigma and discrimination in health care. Ensuring stigma-mitigation interventions reach all health care systems/providers and emotional support services reach all PLHIV may improve HRQoL for PLHIV.
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Affiliation(s)
- John Mark Wiginton
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah Murray
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Meaghan Kall
- HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Jessica L Maksut
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jura Augustinavicius
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Valerie Delpech
- HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Stefan D Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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4
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Tsui JLH, McCrone JT, Lambert B, Bajaj S, Inward RP, Bosetti P, Tegally H, Hill V, Pena RE, Zarebski AE, Peacock TP, Liu L, Wu N, Davis M, Bogoch II, Khan K, Kall M, Abdul Aziz NIB, Colquhoun R, O’Toole Á, Jackson B, Dasgupta A, Wilkinson E, de Oliveira T, Connor TR, Loman NJ, Colizza V, Fraser C, Volz E, Ji X, Gutierrez B, Chand M, Dellicour S, Cauchemez S, Raghwani J, Suchard MA, Lemey P, Rambaut A, Pybus OG, Kraemer MU. Genomic assessment of invasion dynamics of SARS-CoV-2 Omicron BA.1. Science 2023; 381:336-343. [PMID: 37471538 PMCID: PMC10866301 DOI: 10.1126/science.adg6605] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/12/2023] [Accepted: 06/15/2023] [Indexed: 07/22/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) now arise in the context of heterogeneous human connectivity and population immunity. Through a large-scale phylodynamic analysis of 115,622 Omicron BA.1 genomes, we identified >6,000 introductions of the antigenically distinct VOC into England and analyzed their local transmission and dispersal history. We find that six of the eight largest English Omicron lineages were already transmitting when Omicron was first reported in southern Africa (22 November 2021). Multiple datasets show that importation of Omicron continued despite subsequent restrictions on travel from southern Africa as a result of export from well-connected secondary locations. Initiation and dispersal of Omicron transmission lineages in England was a two-stage process that can be explained by models of the country's human geography and hierarchical travel network. Our results enable a comparison of the processes that drive the invasion of Omicron and other VOCs across multiple spatial scales.
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Affiliation(s)
| | - John T. McCrone
- College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
- Helix, San Mateo, USA
| | - Ben Lambert
- Institute of Ecology and Evolution, University of Edinburgh, Edinburgh, UK
| | - Sumali Bajaj
- Department of Biology, University of Oxford, Oxford, UK
| | | | - Paolo Bosetti
- Institut Pasteur, Université Paris Cité, CNRS, Paris, France
| | - Houriiyah Tegally
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Centre for Epidemic Response and Innovation (CERI), School for Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
| | - Verity Hill
- Helix, San Mateo, USA
- Yale University, New Haven, USA
| | | | | | - Thomas P. Peacock
- Department of Infectious Disease, Imperial College London, London, UK
- UK Health Security Agency, London, UK
| | | | - Neo Wu
- Google Research, Mountain View, USA
| | | | - Isaac I. Bogoch
- Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Canada
| | - Kamran Khan
- BlueDot, Toronto, Canada
- Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Canada
| | | | | | | | | | | | | | - Eduan Wilkinson
- BlueDot, Toronto, Canada
- Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Canada
| | - Tulio de Oliveira
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Centre for Epidemic Response and Innovation (CERI), School for Data Science and Computational Thinking, Stellenbosch University, Stellenbosch, South Africa
| | | | - Thomas R. Connor
- Pathogen Genomics Unit, Public Health Wales NHS Trust, Cardiff, UK
- School of Biosciences, The Sir Martin Evans Building, Cardiff University, UK
- Quadram Institute, Norwich, UK
| | - Nicholas J. Loman
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Vittoria Colizza
- Sorbonne Université, INSERM, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Christophe Fraser
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, UK
- Pandemic Sciences Institute, University of Oxford, UK
| | - Erik Volz
- MRC Centre of Global Infectious Disease Analysis, Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK
| | - Xiang Ji
- Department of Mathematics, Tulane University, New Orleans, USA
| | | | | | - Simon Dellicour
- Spatial Epidemiology Lab (SpELL), Université Libre de Bruxelles, Bruxelles, Belgium
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | - Simon Cauchemez
- Institut Pasteur, Université Paris Cité, CNRS, Paris, France
| | - Jayna Raghwani
- Department of Biology, University of Oxford, Oxford, UK
- Department of Pathobiology and Population Science, Royal Veterinary College, London, UK
| | - Marc A. Suchard
- Departments of Biostatistics, Biomathematics and Human Genetics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Philippe Lemey
- Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Leuven, Belgium
| | | | - Oliver G. Pybus
- Department of Biology, University of Oxford, Oxford, UK
- Pandemic Sciences Institute, University of Oxford, UK
- Department of Pathobiology and Population Science, Royal Veterinary College, London, UK
| | - Moritz U.G. Kraemer
- Department of Biology, University of Oxford, Oxford, UK
- Pandemic Sciences Institute, University of Oxford, UK
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5
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Bertran M, Amin-Chowdhury Z, Davies HG, Allen H, Clare T, Davison C, Sinnathamby M, Seghezzo G, Kall M, Williams H, Gent N, Ramsay ME, Ladhani SN, Oligbu G. COVID-19 deaths in children and young people in England, March 2020 to December 2021: An active prospective national surveillance study. PLoS Med 2022; 19:e1004118. [PMID: 36346784 PMCID: PMC9642873 DOI: 10.1371/journal.pmed.1004118] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronavirus Disease 2019 (COVID-19) deaths are rare in children and young people (CYP). The high rates of asymptomatic and mild infections complicate assessment of cause of death in CYP. We assessed the cause of death in all CYP with a positive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) test since the start of the pandemic in England. METHODS AND FINDINGS CYP aged <20 years who died within 100 days of laboratory-confirmed SARS-CoV-2 infection between 01 March 2020 and 31 December 2021 in England were followed up in detail, using national databases, surveillance questionnaires, post-mortem reports, and clinician interviews. There were 185 deaths during the 22-month follow-up and 81 (43.8%) were due to COVID-19. Compared to non-COVID-19 deaths in CYP with a positive SARS-CoV-2 test, death due to COVID-19 was independently associated with older age (aOR 1.06 95% confidence interval (CI) 1.01 to 1.11, p = 0.02) and underlying comorbidities (aOR 2.52 95% CI 1.27 to 5.01, p = 0.008), after adjusting for age, sex, ethnicity group, and underlying conditions, with a shorter interval between SARS-CoV-2 testing and death. Half the COVID-19 deaths (41/81, 50.6%) occurred within 7 days of confirmation of SARS-CoV-2 infection and 91% (74/81) within 30 days. Of the COVID-19 deaths, 61 (75.3%) had an underlying condition, especially severe neurodisability (n = 27) and immunocompromising conditions (n = 12). Over the 22-month surveillance period, SARS-CoV-2 was responsible for 1.2% (81/6,790) of all deaths in CYP aged <20 years, with an infection fatality rate of 0.70/100,000 SARS-CoV-2 infections in this age group estimated through real-time, nowcasting modelling, and a mortality rate of 0.61/100,000. Limitations include possible under-ascertainment of deaths in CYP who were not tested for SARS-CoV-2 and lack of direct access to clinical data for hospitalised CYP. CONCLUSIONS COVID-19 deaths remain extremely rare in CYP, with most fatalities occurring within 30 days of infection and in children with specific underlying conditions.
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Affiliation(s)
- Marta Bertran
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Zahin Amin-Chowdhury
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Hannah G. Davies
- Paediatric Infectious Diseases Research Group, St George’s University of London, London, United Kingdom
| | - Hester Allen
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Tom Clare
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Chloe Davison
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Mary Sinnathamby
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Giulia Seghezzo
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Meaghan Kall
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Hannah Williams
- Joint Modelling Team (JMT), UK Health Security Agency, London, United Kingdom
- Emergency Preparedness, Response and Resilience, UK Health Security Agency, Porton Down, United Kingdom
| | - Nick Gent
- Joint Modelling Team (JMT), UK Health Security Agency, London, United Kingdom
- Emergency Preparedness, Response and Resilience, UK Health Security Agency, Porton Down, United Kingdom
| | - Mary E. Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Shamez N. Ladhani
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
- Paediatric Infectious Diseases Research Group, St George’s University of London, London, United Kingdom
- * E-mail:
| | - Godwin Oligbu
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
- Paediatric Infectious Diseases Research Group, St George’s University of London, London, United Kingdom
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6
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Halford F, Nash S, Tessier E, Kall M, Dabrera G. Variation in reported SARS-CoV-2 cases after testing policy changes. The Lancet Infectious Diseases 2022; 22:1418-1419. [PMID: 36027903 PMCID: PMC9398209 DOI: 10.1016/s1473-3099(22)00572-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 11/09/2022]
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7
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Amin-Chowdhury Z, Bertran M, Kall M, Ireland G, Aiano F, Powell A, Jones SE, Brent AJ, Brent BE, Baawuah F, Okike I, Beckmann J, Garstang J, Ahmad S, Sundaram N, Bonell C, Langan SM, Hargreaves J, Ladhani SN. Parents' and teachers' attitudes to and experiences of the implementation of COVID-19 preventive measures in primary and secondary schools following reopening of schools in autumn 2020: a descriptive cross-sectional survey. BMJ Open 2022; 12:e052171. [PMID: 36171032 PMCID: PMC9527746 DOI: 10.1136/bmjopen-2021-052171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess implementation and ease of implementation of control measures in schools as reported by staff and parents. DESIGN A descriptive cross-sectional survey. SETTING Staff and parents/guardians of the 132 primary schools and 19 secondary schools participating in COVID-19 surveillance in school kids (sKIDs and sKIDsPLUS Studies). MAIN OUTCOME MEASURE Prevalence of control measures implemented in schools in autumn 2020, parental and staff perception of ease of implementation. RESULTS In total, 56 of 151 (37%) schools participated in this study, with 1953 parents and 986 staff members completing the questionnaire. Most common measures implemented by schools included regular hand cleaning for students (52 of 56, 93%) and staff (70 of 73, 96%), as reported by parents and staff, respectively, and was among the easiest to implement at all times for students (57%) and even more so, for staff (78%). Maintaining 2-metre distancing was less commonly reported for students (24%-51%) as it was for staff (81%-84%), but was one of the most difficult to follow at all times for students (25%) and staff (16%) alike. Some measures were more commonly reported by primary school compared to secondary school parents, including keeping students within the same small groups (28 of 41, 68% vs 8 of 15, 53%), ensuring the same teacher for classes (29 of 41, 71% vs 6 of 15, 40%). On the other hand, wearing a face covering while at school was reported by three-quarters of secondary school parents compared with only parents of 4 of 41 (10%) primary schools. Other measures such as student temperature checks (5%-13%) and advising staff work from home if otherwise healthy (7%-15%) were rarely reported. CONCLUSIONS Variable implementation of infection control measures was reported, with some easier to implement (hand hygiene) than others (physical distancing).
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Affiliation(s)
- Zahin Amin-Chowdhury
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Marta Bertran
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Meaghan Kall
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Georgina Ireland
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Felicity Aiano
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Annabel Powell
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Samuel E Jones
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Andrew J Brent
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Bernadette E Brent
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Frances Baawuah
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Ifeanychukwu Okike
- Derbyshire Children's Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Joanne Beckmann
- Specialist Children & Young People's Services, East London NHS Foundation Trust, London, UK
| | - Joanna Garstang
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Allens Croft Children's Centre, Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - Shazaad Ahmad
- Department of Virology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Neisha Sundaram
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Sinéad M Langan
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - James Hargreaves
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Shamez N Ladhani
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
- Paediatric Infectious Diseases Research Group, St George's University of London, London, UK
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8
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Seaman SR, Samartsidis P, Kall M, De Angelis D. Nowcasting COVID-19 deaths in England by age and region. J R Stat Soc Ser C Appl Stat 2022; 71:RSSC12576. [PMID: 35942006 PMCID: PMC9349735 DOI: 10.1111/rssc.12576] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/11/2022] [Indexed: 11/29/2022]
Abstract
Understanding the trajectory of the daily number of COVID-19 deaths is essential to decisions on how to respond to the pandemic, but estimating this trajectory is complicated by the delay between deaths occurring and being reported. In England the delay is typically several days, but it can be weeks. This causes considerable uncertainty about how many deaths occurred in recent days. Here we estimate the deaths per day in five age strata within seven English regions, using a Bayesian model that accounts for reporting-day effects and longer-term changes in the delay distribution. We show how the model can be computationally efficiently fitted when the delay distribution is the same in multiple strata, for example, over a wide range of ages.
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Affiliation(s)
- Shaun R. Seaman
- MRC Biostatistics UnitUniversity of CambridgeCambridgeCambridgeshireUK
| | | | - Meaghan Kall
- COVID‐19 National Epidemiology CellUK Health Security AgencyLondonUK
| | - Daniela De Angelis
- MRC Biostatistics UnitUniversity of CambridgeCambridgeCambridgeshireUK
- Statistics, Modelling and Economics Department, Data, Analytics and SurveillanceUK Health Security AgencyLondonUK
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9
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Dabrera G, Allen H, Zaidi A, Flannagan J, Twohig K, Thelwall S, Marchant E, Aziz NA, Lamagni T, Myers R, Charlett A, Capelastegui F, Chudasama D, Clare T, Coukan F, Sinnathamby M, Ferguson N, Hopkins S, Chand M, Hope R, Kall M. Assessment of mortality and hospital admissions associated with confirmed infection with SARS-CoV-2 Alpha variant: a matched cohort and time-to-event analysis, England, October to December 2020. Euro Surveill 2022; 27:2100377. [PMID: 35593163 PMCID: PMC9121661 DOI: 10.2807/1560-7917.es.2022.27.20.2100377] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/29/2022] Open
Abstract
BackgroundThe emergence of the SARS-CoV-2 Alpha variant in England coincided with a rapid increase in the number of PCR-confirmed COVID-19 cases in areas where the variant was concentrated.AimOur aim was to assess whether infection with Alpha was associated with more severe clinical outcomes than the wild type.MethodsLaboratory-confirmed infections with genomically sequenced SARS-CoV-2 Alpha and wild type between October and December 2020 were linked to routine healthcare and surveillance datasets. We conducted two statistical analyses to compare the risk of hospital admission and death within 28 days of testing between Alpha and wild-type infections: a matched cohort study and an adjusted Cox proportional hazards model. We assessed differences in disease severity by comparing hospital admission and mortality, including length of hospitalisation and time to death.ResultsOf 63,609 COVID-19 cases sequenced in England between October and December 2020, 6,038 had the Alpha variant. In the matched cohort analysis, we matched 2,821 cases with Alpha to 2,821 to cases with wild type. In the time-to-event analysis, we observed a 34% increased risk in hospitalisation associated with Alpha compared with wild type, but no significant difference in the risk of mortality.ConclusionWe found evidence of increased risk of hospitalisation after adjusting for key confounders, suggesting increased infection severity associated with the Alpha variant. Rapid assessments of the relative morbidity in terms of clinical outcomes and mortality associated with emerging SARS-CoV-2 variants compared with dominant variants are required to assess overall impact of SARS-CoV-2 mutations.
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Affiliation(s)
- Gavin Dabrera
- National Infection Service, Public Health England, London, United Kingdom
| | - Hester Allen
- National Infection Service, Public Health England, London, United Kingdom
| | - Asad Zaidi
- National Infection Service, Public Health England, London, United Kingdom
| | - Joe Flannagan
- National Infection Service, Public Health England, London, United Kingdom
| | - Katherine Twohig
- National Infection Service, Public Health England, London, United Kingdom
| | - Simon Thelwall
- National Infection Service, Public Health England, London, United Kingdom
| | - Elizabeth Marchant
- National Infection Service, Public Health England, London, United Kingdom
| | - Nurin Abdul Aziz
- National Infection Service, Public Health England, London, United Kingdom
| | - Theresa Lamagni
- National Infection Service, Public Health England, London, United Kingdom
| | - Richard Myers
- National Infection Service, Public Health England, London, United Kingdom
| | - André Charlett
- National Infection Service, Public Health England, London, United Kingdom
| | | | - Dimple Chudasama
- National Infection Service, Public Health England, London, United Kingdom
| | - Tom Clare
- National Infection Service, Public Health England, London, United Kingdom
| | - Flavien Coukan
- National Infection Service, Public Health England, London, United Kingdom
| | - Mary Sinnathamby
- National Infection Service, Public Health England, London, United Kingdom
| | - Neil Ferguson
- MRC Centre for Global Infectious Disease Analysis, Jameel Institute for Disease and Emergency Analytics, Imperial College London, St Mary's Campus, London, United Kingdom
| | - Susan Hopkins
- National Infection Service, Public Health England, London, United Kingdom
| | - Meera Chand
- National Infection Service, Public Health England, London, United Kingdom
| | - Russell Hope
- National Infection Service, Public Health England, London, United Kingdom
| | - Meaghan Kall
- National Infection Service, Public Health England, London, United Kingdom
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- https://www.cogconsortium.uk
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Andrews N, Stowe J, Kirsebom F, Toffa S, Rickeard T, Gallagher E, Gower C, Kall M, Groves N, O'Connell AM, Simons D, Blomquist PB, Zaidi A, Nash S, Iwani Binti Abdul Aziz N, Thelwall S, Dabrera G, Myers R, Amirthalingam G, Gharbia S, Barrett JC, Elson R, Ladhani SN, Ferguson N, Zambon M, Campbell CNJ, Brown K, Hopkins S, Chand M, Ramsay M, Lopez Bernal J. Covid-19 Vaccine Effectiveness against the Omicron (B.1.1.529) Variant. N Engl J Med 2022; 386:1532-1546. [PMID: 35249272 DOI: 10.1101/2021.12.14.21267615] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND A rapid increase in coronavirus disease 2019 (Covid-19) cases due to the omicron (B.1.1.529) variant of severe acute respiratory syndrome coronavirus 2 in highly vaccinated populations has aroused concerns about the effectiveness of current vaccines. METHODS We used a test-negative case-control design to estimate vaccine effectiveness against symptomatic disease caused by the omicron and delta (B.1.617.2) variants in England. Vaccine effectiveness was calculated after primary immunization with two doses of BNT162b2 (Pfizer-BioNTech), ChAdOx1 nCoV-19 (AstraZeneca), or mRNA-1273 (Moderna) vaccine and after a booster dose of BNT162b2, ChAdOx1 nCoV-19, or mRNA-1273. RESULTS Between November 27, 2021, and January 12, 2022, a total of 886,774 eligible persons infected with the omicron variant, 204,154 eligible persons infected with the delta variant, and 1,572,621 eligible test-negative controls were identified. At all time points investigated and for all combinations of primary course and booster vaccines, vaccine effectiveness against symptomatic disease was higher for the delta variant than for the omicron variant. No effect against the omicron variant was noted from 20 weeks after two ChAdOx1 nCoV-19 doses, whereas vaccine effectiveness after two BNT162b2 doses was 65.5% (95% confidence interval [CI], 63.9 to 67.0) at 2 to 4 weeks, dropping to 8.8% (95% CI, 7.0 to 10.5) at 25 or more weeks. Among ChAdOx1 nCoV-19 primary course recipients, vaccine effectiveness increased to 62.4% (95% CI, 61.8 to 63.0) at 2 to 4 weeks after a BNT162b2 booster before decreasing to 39.6% (95% CI, 38.0 to 41.1) at 10 or more weeks. Among BNT162b2 primary course recipients, vaccine effectiveness increased to 67.2% (95% CI, 66.5 to 67.8) at 2 to 4 weeks after a BNT162b2 booster before declining to 45.7% (95% CI, 44.7 to 46.7) at 10 or more weeks. Vaccine effectiveness after a ChAdOx1 nCoV-19 primary course increased to 70.1% (95% CI, 69.5 to 70.7) at 2 to 4 weeks after an mRNA-1273 booster and decreased to 60.9% (95% CI, 59.7 to 62.1) at 5 to 9 weeks. After a BNT162b2 primary course, the mRNA-1273 booster increased vaccine effectiveness to 73.9% (95% CI, 73.1 to 74.6) at 2 to 4 weeks; vaccine effectiveness fell to 64.4% (95% CI, 62.6 to 66.1) at 5 to 9 weeks. CONCLUSIONS Primary immunization with two doses of ChAdOx1 nCoV-19 or BNT162b2 vaccine provided limited protection against symptomatic disease caused by the omicron variant. A BNT162b2 or mRNA-1273 booster after either the ChAdOx1 nCoV-19 or BNT162b2 primary course substantially increased protection, but that protection waned over time. (Funded by the U.K. Health Security Agency.).
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Affiliation(s)
- Nick Andrews
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Julia Stowe
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Freja Kirsebom
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Samuel Toffa
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Tim Rickeard
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Eileen Gallagher
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Charlotte Gower
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Meaghan Kall
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Natalie Groves
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Anne-Marie O'Connell
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - David Simons
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Paula B Blomquist
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Asad Zaidi
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Sophie Nash
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Nurin Iwani Binti Abdul Aziz
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Simon Thelwall
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Gavin Dabrera
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Richard Myers
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Gayatri Amirthalingam
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Saheer Gharbia
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Jeffrey C Barrett
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Richard Elson
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Shamez N Ladhani
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Neil Ferguson
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Maria Zambon
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Colin N J Campbell
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Kevin Brown
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Susan Hopkins
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Meera Chand
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Mary Ramsay
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Jamie Lopez Bernal
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
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Andrews N, Stowe J, Kirsebom F, Toffa S, Rickeard T, Gallagher E, Gower C, Kall M, Groves N, O'Connell AM, Simons D, Blomquist PB, Zaidi A, Nash S, Iwani Binti Abdul Aziz N, Thelwall S, Dabrera G, Myers R, Amirthalingam G, Gharbia S, Barrett JC, Elson R, Ladhani SN, Ferguson N, Zambon M, Campbell CNJ, Brown K, Hopkins S, Chand M, Ramsay M, Lopez Bernal J. Covid-19 Vaccine Effectiveness against the Omicron (B.1.1.529) Variant. N Engl J Med 2022; 386:1532-1546. [PMID: 35249272 PMCID: PMC8908811 DOI: 10.1056/nejmoa2119451] [Citation(s) in RCA: 1317] [Impact Index Per Article: 658.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND A rapid increase in coronavirus disease 2019 (Covid-19) cases due to the omicron (B.1.1.529) variant of severe acute respiratory syndrome coronavirus 2 in highly vaccinated populations has aroused concerns about the effectiveness of current vaccines. METHODS We used a test-negative case-control design to estimate vaccine effectiveness against symptomatic disease caused by the omicron and delta (B.1.617.2) variants in England. Vaccine effectiveness was calculated after primary immunization with two doses of BNT162b2 (Pfizer-BioNTech), ChAdOx1 nCoV-19 (AstraZeneca), or mRNA-1273 (Moderna) vaccine and after a booster dose of BNT162b2, ChAdOx1 nCoV-19, or mRNA-1273. RESULTS Between November 27, 2021, and January 12, 2022, a total of 886,774 eligible persons infected with the omicron variant, 204,154 eligible persons infected with the delta variant, and 1,572,621 eligible test-negative controls were identified. At all time points investigated and for all combinations of primary course and booster vaccines, vaccine effectiveness against symptomatic disease was higher for the delta variant than for the omicron variant. No effect against the omicron variant was noted from 20 weeks after two ChAdOx1 nCoV-19 doses, whereas vaccine effectiveness after two BNT162b2 doses was 65.5% (95% confidence interval [CI], 63.9 to 67.0) at 2 to 4 weeks, dropping to 8.8% (95% CI, 7.0 to 10.5) at 25 or more weeks. Among ChAdOx1 nCoV-19 primary course recipients, vaccine effectiveness increased to 62.4% (95% CI, 61.8 to 63.0) at 2 to 4 weeks after a BNT162b2 booster before decreasing to 39.6% (95% CI, 38.0 to 41.1) at 10 or more weeks. Among BNT162b2 primary course recipients, vaccine effectiveness increased to 67.2% (95% CI, 66.5 to 67.8) at 2 to 4 weeks after a BNT162b2 booster before declining to 45.7% (95% CI, 44.7 to 46.7) at 10 or more weeks. Vaccine effectiveness after a ChAdOx1 nCoV-19 primary course increased to 70.1% (95% CI, 69.5 to 70.7) at 2 to 4 weeks after an mRNA-1273 booster and decreased to 60.9% (95% CI, 59.7 to 62.1) at 5 to 9 weeks. After a BNT162b2 primary course, the mRNA-1273 booster increased vaccine effectiveness to 73.9% (95% CI, 73.1 to 74.6) at 2 to 4 weeks; vaccine effectiveness fell to 64.4% (95% CI, 62.6 to 66.1) at 5 to 9 weeks. CONCLUSIONS Primary immunization with two doses of ChAdOx1 nCoV-19 or BNT162b2 vaccine provided limited protection against symptomatic disease caused by the omicron variant. A BNT162b2 or mRNA-1273 booster after either the ChAdOx1 nCoV-19 or BNT162b2 primary course substantially increased protection, but that protection waned over time. (Funded by the U.K. Health Security Agency.).
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Affiliation(s)
- Nick Andrews
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Julia Stowe
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Freja Kirsebom
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Samuel Toffa
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Tim Rickeard
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Eileen Gallagher
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Charlotte Gower
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Meaghan Kall
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Natalie Groves
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Anne-Marie O'Connell
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - David Simons
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Paula B Blomquist
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Asad Zaidi
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Sophie Nash
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Nurin Iwani Binti Abdul Aziz
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Simon Thelwall
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Gavin Dabrera
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Richard Myers
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Gayatri Amirthalingam
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Saheer Gharbia
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Jeffrey C Barrett
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Richard Elson
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Shamez N Ladhani
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Neil Ferguson
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Maria Zambon
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Colin N J Campbell
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Kevin Brown
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Susan Hopkins
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Meera Chand
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Mary Ramsay
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Jamie Lopez Bernal
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
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12
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Nyberg T, Ferguson NM, Nash SG, Webster HH, Flaxman S, Andrews N, Hinsley W, Bernal JL, Kall M, Bhatt S, Blomquist P, Zaidi A, Volz E, Aziz NA, Harman K, Funk S, Abbott S, Hope R, Charlett A, Chand M, Ghani AC, Seaman SR, Dabrera G, De Angelis D, Presanis AM, Thelwall S. Comparative analysis of the risks of hospitalisation and death associated with SARS-CoV-2 omicron (B.1.1.529) and delta (B.1.617.2) variants in England: a cohort study. Lancet 2022; 399:1303-1312. [PMID: 35305296 PMCID: PMC8926413 DOI: 10.1016/s0140-6736(22)00462-7] [Citation(s) in RCA: 674] [Impact Index Per Article: 337.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND The omicron variant (B.1.1.529) of SARS-CoV-2 has demonstrated partial vaccine escape and high transmissibility, with early studies indicating lower severity of infection than that of the delta variant (B.1.617.2). We aimed to better characterise omicron severity relative to delta by assessing the relative risk of hospital attendance, hospital admission, or death in a large national cohort. METHODS Individual-level data on laboratory-confirmed COVID-19 cases resident in England between Nov 29, 2021, and Jan 9, 2022, were linked to routine datasets on vaccination status, hospital attendance and admission, and mortality. The relative risk of hospital attendance or admission within 14 days, or death within 28 days after confirmed infection, was estimated using proportional hazards regression. Analyses were stratified by test date, 10-year age band, ethnicity, residential region, and vaccination status, and were further adjusted for sex, index of multiple deprivation decile, evidence of a previous infection, and year of age within each age band. A secondary analysis estimated variant-specific and vaccine-specific vaccine effectiveness and the intrinsic relative severity of omicron infection compared with delta (ie, the relative risk in unvaccinated cases). FINDINGS The adjusted hazard ratio (HR) of hospital attendance (not necessarily resulting in admission) with omicron compared with delta was 0·56 (95% CI 0·54-0·58); for hospital admission and death, HR estimates were 0·41 (0·39-0·43) and 0·31 (0·26-0·37), respectively. Omicron versus delta HR estimates varied with age for all endpoints examined. The adjusted HR for hospital admission was 1·10 (0·85-1·42) in those younger than 10 years, decreasing to 0·25 (0·21-0·30) in 60-69-year-olds, and then increasing to 0·47 (0·40-0·56) in those aged at least 80 years. For both variants, past infection gave some protection against death both in vaccinated (HR 0·47 [0·32-0·68]) and unvaccinated (0·18 [0·06-0·57]) cases. In vaccinated cases, past infection offered no additional protection against hospital admission beyond that provided by vaccination (HR 0·96 [0·88-1·04]); however, for unvaccinated cases, past infection gave moderate protection (HR 0·55 [0·48-0·63]). Omicron versus delta HR estimates were lower for hospital admission (0·30 [0·28-0·32]) in unvaccinated cases than the corresponding HR estimated for all cases in the primary analysis. Booster vaccination with an mRNA vaccine was highly protective against hospitalisation and death in omicron cases (HR for hospital admission 8-11 weeks post-booster vs unvaccinated: 0·22 [0·20-0·24]), with the protection afforded after a booster not being affected by the vaccine used for doses 1 and 2. INTERPRETATION The risk of severe outcomes following SARS-CoV-2 infection is substantially lower for omicron than for delta, with higher reductions for more severe endpoints and significant variation with age. Underlying the observed risks is a larger reduction in intrinsic severity (in unvaccinated individuals) counterbalanced by a reduction in vaccine effectiveness. Documented previous SARS-CoV-2 infection offered some protection against hospitalisation and high protection against death in unvaccinated individuals, but only offered additional protection in vaccinated individuals for the death endpoint. Booster vaccination with mRNA vaccines maintains over 70% protection against hospitalisation and death in breakthrough confirmed omicron infections. FUNDING Medical Research Council, UK Research and Innovation, Department of Health and Social Care, National Institute for Health Research, Community Jameel, and Engineering and Physical Sciences Research Council.
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Affiliation(s)
- Tommy Nyberg
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK.
| | - Neil M Ferguson
- NIHR Health Protection Research Unit for Modelling and Health Economics, MRC Centre for Global Infectious Disease Analysis, Jameel Institute, Imperial College London, London, UK.
| | - Sophie G Nash
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Harriet H Webster
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Seth Flaxman
- Department of Computer Science, University of Oxford, Oxford, UK
| | - Nick Andrews
- COVID-19 Surveillance Cell, UK Health Security Agency, London, UK
| | - Wes Hinsley
- NIHR Health Protection Research Unit for Modelling and Health Economics, MRC Centre for Global Infectious Disease Analysis, Jameel Institute, Imperial College London, London, UK
| | - Jamie Lopez Bernal
- NIHR Health Protection Research Unit for Respiratory Infections, Imperial College London, London, UK; COVID-19 Surveillance Cell, UK Health Security Agency, London, UK
| | - Meaghan Kall
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Samir Bhatt
- NIHR Health Protection Research Unit for Modelling and Health Economics, MRC Centre for Global Infectious Disease Analysis, Jameel Institute, Imperial College London, London, UK
| | - Paula Blomquist
- Outbreak Surveillance Team, UK Health Security Agency, London, UK
| | - Asad Zaidi
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Erik Volz
- NIHR Health Protection Research Unit for Modelling and Health Economics, MRC Centre for Global Infectious Disease Analysis, Jameel Institute, Imperial College London, London, UK
| | - Nurin Abdul Aziz
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Katie Harman
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Sebastian Funk
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Sam Abbott
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Russell Hope
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Andre Charlett
- NIHR Health Protection Research Unit for Modelling and Health Economics, MRC Centre for Global Infectious Disease Analysis, Jameel Institute, Imperial College London, London, UK; Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK; Joint Modelling Team, UK Health Security Agency, London, UK; NIHR Health Protection Research Unit for Behavioural Science and Evaluation at the University of Bristol, University of the West of England, and University of Cambridge, Bristol, UK
| | - Meera Chand
- COVID-19 Genomics Cell, UK Health Security Agency, London, UK
| | - Azra C Ghani
- NIHR Health Protection Research Unit for Modelling and Health Economics, MRC Centre for Global Infectious Disease Analysis, Jameel Institute, Imperial College London, London, UK
| | - Shaun R Seaman
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Gavin Dabrera
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
| | - Daniela De Angelis
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK; Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK; Joint Modelling Team, UK Health Security Agency, London, UK; NIHR Health Protection Research Unit for Behavioural Science and Evaluation at the University of Bristol, University of the West of England, and University of Cambridge, Bristol, UK
| | - Anne M Presanis
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Simon Thelwall
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, UK
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Sandmann FG, Tessier E, Lacy J, Kall M, Van Leeuwen E, Charlett A, Eggo RM, Dabrera G, Edmunds WJ, Ramsay M, Campbell H, Amirthalingam G, Jit M. Long-Term Health-Related Quality of Life in Non-Hospitalized Coronavirus Disease 2019 (COVID-19) Cases With Confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in England: Longitudinal Analysis and Cross-Sectional Comparison With Controls. Clin Infect Dis 2022; 75:e962-e973. [PMID: 35245941 PMCID: PMC8903473 DOI: 10.1093/cid/ciac151] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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] [Received: 10/08/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We aimed to quantify the unknown losses in health-related quality of life of coronavirus disease 2019 (COVID-19) cases using quality-adjusted lifedays (QALDs) and the recommended EQ-5D instrument in England. METHODS Prospective cohort study of nonhospitalized, polymerase chain reaction (PCR)-confirmed severe acute respiratory syndrome coronavirus 2-positive (SARS-CoV-2-positive) cases aged 12-85 years and followed up for 6 months from 1 December 2020, with cross-sectional comparison to SARS-CoV-2-negative controls. Main outcomes were QALD losses; physical symptoms; and COVID-19-related private expenditures. We analyzed results using multivariable regressions with post hoc weighting by age and sex, and conditional logistic regressions for the association of each symptom and EQ-5D limitation on cases and controls. RESULTS Of 548 cases (mean age 41.1 years; 61.5% female), 16.8% reported physical symptoms at month 6 (most frequently extreme tiredness, headache, loss of taste and/or smell, and shortness of breath). Cases reported more limitations with doing usual activities than controls. Almost half of cases spent a mean of £18.1 on nonprescription drugs (median: £10.0), and 52.7% missed work or school for a mean of 12 days (median: 10). On average, all cases lost 13.7 (95% confidence interval [CI]: 9.7, 17.7) QALDs, whereas those reporting symptoms at month 6 lost 32.9 (95% CI: 24.5, 37.6) QALDs. Losses also increased with older age. Cumulatively, the health loss from morbidity contributes at least 18% of the total COVID-19-related disease burden in the England. CONCLUSIONS One in 6 cases report ongoing symptoms at 6 months, and 10% report prolonged loss of function compared to pre-COVID-19 baselines. A marked health burden was observed among older COVID-19 cases and those with persistent physical symptoms.
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Affiliation(s)
- Frank G Sandmann
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,Corresponding author: Frank G. Sandmann Infectious Disease Modeller / Health Economist
| | - Elise Tessier
- Immunisation Division, UK Health Security Agency, London, UK,COVID-19 National Epidemiology Cell, UK Health Security Agency, Wellington House, London, UK
| | - Joanne Lacy
- Immunisation Division, UK Health Security Agency, London, UK
| | - Meaghan Kall
- COVID-19 National Epidemiology Cell, UK Health Security Agency, Wellington House, London, UK
| | - Edwin Van Leeuwen
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Andre Charlett
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK
| | - Rosalind M Eggo
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Gavin Dabrera
- COVID-19 National Epidemiology Cell, UK Health Security Agency, Wellington House, London, UK
| | - W John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Mary Ramsay
- Immunisation Division, UK Health Security Agency, London, UK
| | - Helen Campbell
- Immunisation Division, UK Health Security Agency, London, UK
| | | | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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14
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Ladhani SN, Ireland G, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Aiano F, Amin-Chowdhury Z, Kall M, Borrow R, Linley E, Zambon M, Poh J, Warrener L, Lackenby A, Ellis J, Amirthalingam G, Brown KE, Ramsay ME. Emergence of the delta variant and risk of SARS-CoV-2 infection in secondary school students and staff: Prospective surveillance in 18 schools, England. EClinicalMedicine 2022; 45:101319. [PMID: 35233517 PMCID: PMC8882000 DOI: 10.1016/j.eclinm.2022.101319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The role of educational settings in SARS-CoV-2 infection and transmission remains controversial. We investigated SARS-CoV-2 infection, seroprevalence, and seroconversion rates in secondary schools during the 2020/21 academic year, which included the emergence of the more transmissible alpha and delta variants, in England. METHODS The UK Health Security Agency (UKHSA) initiated prospective surveillance in 18 urban English secondary schools. Participants had nasal swabs for SARS-CoV-2 RT-PCR and blood sampling for SARS-CoV-2 nucleoprotein and spike protein antibodies at the start (Round 1: September-October 2020) and end (Round 2: December 2020) of the autumn term, when schools reopened after national lockdown was imposed in January 2021 (Round 3: March-April 2021), and end of the academic year (Round 4: May-July 2021). FINDINGS We enrolled 2314 participants (1277 students, 1037 staff; one participant had missing data for PCR testing). In-school testing identified 31 PCR-positive participants (20 students, 11 staff). Another 247 confirmed cases (112 students, 135 staff) were identified after linkage with national surveillance data, giving an overall positivity rate of 12.0% (278/2313; staff: 14.1%, 146/1037 vs students: 10.3%, 132/1276; p = 0.006). Trends were similar to national infection data. Nucleoprotein-antibody seroprevalence increased for students and staff between Rounds 1 and 3 but were similar between Rounds 3 and 4, when the delta variant was the dominant circulating strain. Overall, Nucleoprotein-antibody seroconversion was 18.4% (137/744) in staff and 18.8% (146/778) in students, while Spike-antibody seroconversion was higher in staff (72.8%, 525/721) than students (21.3%, 163/764) because of vaccination. INTERPRETATION SARS-CoV-2 infection rates in secondary schools remained low when community infection rates were low, even as the delta variant was emerging in England. FUNDING This study was funded by the UK Department of Health and Social Care.
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Affiliation(s)
- Shamez N. Ladhani
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
- Paediatric Infectious Diseases Research Group, St. George's University of London, London SW17 0RE, UK
| | - Georgina Ireland
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
- Corresponding author.
| | - Frances Baawuah
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Joanne Beckmann
- East London NHS Foundation Trust, 9 Alie Street, London E1 8DE, UK
| | - Ifeanyichukwu O. Okike
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, 201 London Road, Derby DE1 2TZ, UK
| | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Holt Street, Aston B7 4BN, UK
| | - Andrew J. Brent
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, UK
- University of Oxford, Wellington Square, Oxford OX1 2JD, UK
| | | | - Felicity Aiano
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Zahin Amin-Chowdhury
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Meaghan Kall
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Ray Borrow
- UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Ezra Linley
- UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Maria Zambon
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - John Poh
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Lenesha Warrener
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Angie Lackenby
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Joanna Ellis
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Kevin E. Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mary E. Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
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Burgui C, Guy D, Fresán U, Kall M, Castilla J, Lazarus JV. Patient satisfaction with HIV care service in Spain: results from a cross-sectional patient survey. AIDS Care 2022; 35:892-898. [PMID: 35102807 DOI: 10.1080/09540121.2022.2029818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Understanding patient satisfaction with healthcare services can help identify patients' unmet needs and increase treatment adherence. This study aimed to evaluate the satisfaction of people living with HIV with overall HIV care service in Navarra, Spain, using a cross-sectional survey. The survey included a patient-reported experience measure (PREMs) consisting of five statements, and participants were also asked to rate the overall care they receive from the HIV service. Chi-square tests were used to detect differences between groups for statements and Kruskal-Wallis rank test was used to detect differences in ranking of the HIV service. The 395 participants gave the HIV service a mean score of 9.3 points out of 10 (standard deviation 1.1). Only 15 (4%) gave a score of under 8 out of 10, and adherence to antiretroviral therapy was associated with higher ranking of the service. Agreement for all five statements ranged from 80% to 96%. Those without stable housing, with mental health problems, and unemployed felt less supported to manage their HIV. These results highlight the need to regularly assess patient satisfaction with the HIV care and that care should account for social and economic factors that could influence health.
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Affiliation(s)
- Cristina Burgui
- Instituto de Salud Pública de Navarra – IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Danielle Guy
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, University of Barcelona, Barcelona, Spain
| | - Ujué Fresán
- Barcelona Institute for Global Health (ISGlobal), Campus Mar, University of Barcelona, Barcelona, Spain
| | - Meaghan Kall
- HIV/STI Department, Public Health England, London, UK
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra – IdiSNA, Pamplona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, University of Barcelona, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
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16
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Allen H, Vusirikala A, Flannagan J, Twohig KA, Zaidi A, Chudasama D, Lamagni T, Groves N, Turner C, Rawlinson C, Lopez-Bernal J, Harris R, Charlett A, Dabrera G, Kall M. Household transmission of COVID-19 cases associated with SARS-CoV-2 delta variant (B.1.617.2): national case-control study. Lancet Reg Health Eur 2022; 12:100252. [PMID: 34729548 PMCID: PMC8552812 DOI: 10.1016/j.lanepe.2021.100252] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The SARS-CoV-2 Delta variant (B.1.617.2), first detected in India, has rapidly become the dominant variant in England. Early reports suggest this variant has an increased growth rate suggesting increased transmissibility. This study indirectly assessed differences in transmissibility between the emergent Delta variant compared to the previously dominant Alpha variant (B.1.1.7). METHODS A matched case-control study was conducted to estimate the odds of household transmission (≥ 2 cases within 14 days) for Delta variant index cases compared with Alpha cases. Cases were derived from national surveillance data (March to June 2021). One-to-two matching was undertaken on geographical location of residence, time period of testing and property type, and a multivariable conditional logistic regression model was used for analysis. FINDINGS In total 5,976 genomically sequenced index cases in household clusters were matched to 11,952 sporadic index cases (single case within a household). 43.3% (n=2,586) of cases in household clusters were confirmed Delta variant compared to 40.4% (n= 4,824) of sporadic cases. The odds ratio of household transmission was 1.70 among Delta variant cases (95% CI 1.48-1.95, p <0.001) compared to Alpha cases after adjusting for age, sex, ethnicity, index of multiple deprivation (IMD), number of household contacts and vaccination status of index case. INTERPRETATION We found evidence of increased household transmission of SARS-CoV-2 Delta variant, potentially explaining its success at displacing Alpha variant as the dominant strain in England. With the Delta variant now having been detected in many countries worldwide, the understanding of the transmissibility of this variant is important for informing infection prevention and control policies internationally.
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Affiliation(s)
| | | | - Joe Flannagan
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Katherine A. Twohig
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Asad Zaidi
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Dimple Chudasama
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Theresa Lamagni
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Natalie Groves
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Charlie Turner
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | | | - Jamie Lopez-Bernal
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Ross Harris
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Andre Charlett
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Gavin Dabrera
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Meaghan Kall
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
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17
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Chudasama DY, Tessier E, Flannagan J, Leeman D, Webster H, Demirjian A, Falconer C, Thelwall S, Kall M, Saliba V, Ramsay M, Dabrera G, Lamagni T. Surge in SARS-CoV-2 transmission in school-aged children and household contacts, England, August to October 2021. Euro Surveill 2021; 26. [PMID: 34857070 PMCID: PMC8641067 DOI: 10.2807/1560-7917.es.2021.26.48.2101019] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Easing of COVID-19 restrictions in England in the summer of 2021 was followed by a sharp rise in cases among school-aged children. Weekly rates of SARS-CoV-2 infection in primary and secondary school children reached 733.3 and 1,664.7/100,000 population, respectively, by week 39 2021. A surge in household clusters with school-aged index cases was noted at the start of the school term, with secondary cases predominantly in children aged 5–15 years and adults aged 30–49 years.
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Affiliation(s)
- Dimple Y Chudasama
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Elise Tessier
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Joe Flannagan
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - David Leeman
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Harriet Webster
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Alicia Demirjian
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom.,Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, United Kingdom.,Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Catherine Falconer
- Clinical & Public Health, Young People Cell, UK Health Security Agency, London, United Kingdom
| | - Simon Thelwall
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Meaghan Kall
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Vanessa Saliba
- Surveillance Cell, UK Health Security Agency, London, United Kingdom
| | - Mary Ramsay
- Surveillance Cell, UK Health Security Agency, London, United Kingdom
| | - Gavin Dabrera
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Theresa Lamagni
- COVID-19 Epidemiology Cell, UK Health Security Agency, London, United Kingdom
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18
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Wiginton JM, Maksut JL, Murray SM, Augustinavicius JL, Kall M, Delpech V, Baral SD. Brief report: HIV-related healthcare stigma/discrimination and unmet needs among persons living with HIV in England and Wales. Prev Med Rep 2021; 24:101580. [DOI: 10.1016/j.pmedr.2021.101580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 11/25/2022] Open
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19
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Ireland G, Jeffery-Smith A, Zambon M, Hoschler K, Harris R, Poh J, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Aiano F, Amin-Chowdhury Z, Letley L, Jones SEI, Kall M, Patel M, Gopal R, Borrow R, Linley E, Amirthalingam G, Brown KE, Ramsay ME, Ladhani SN. Antibody persistence and neutralising activity in primary school students and staff: Prospective active surveillance, June to December 2020, England. EClinicalMedicine 2021; 41:101150. [PMID: 34608455 PMCID: PMC8481203 DOI: 10.1016/j.eclinm.2021.101150] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prospective, longitudinal SARS-CoV-2 sero-surveillance in schools across England was initiated after the first national lockdown, allowing comparison of child and adult antibody responses over time. METHODS Prospective active serological surveillance in 46 primary schools in England tested for SARS-CoV-2 antibodies during June, July and December 2020. Samples were tested for nucleocapsid (N) and receptor binding domain (RBD) antibodies, to estimate antibody persistence at least 6 months after infection, and for the correlation of N, RBD and live virus neutralising activity. FINDINGS In June 2020, 1,344 staff and 835 students were tested. Overall, 11.5% (95%CI: 9.4-13.9) and 11.3% (95%CI: 9.2-13.6; p = 0.88) of students had nucleoprotein and RBD antibodies, compared to 15.6% (95%CI: 13.7-17.6) and 15.3% (95%CI: 13.4-17.3; p = 0.83) of staff. Live virus neutralising activity was detected in 79.8% (n = 71/89) of nucleocapsid and 85.5% (71/83) of RBD antibody positive children. RBD antibodies correlated more strongly with neutralising antibodies (rs=0.7527; p<0.0001) than nucleocapsid antibodies (rs=0.3698; p<0.0001). A median of 24.4 weeks later, 58.2% (107/184) participants had nucleocapsid antibody seroreversion, compared to 20.9% (33/158) for RBD (p<0.001). Similar seroreversion rates were observed between staff and students for nucleocapsid (p = 0.26) and RBD-antibodies (p = 0.43). Nucleocapsid and RBD antibody quantitative results were significantly lower in staff compared to students (p = 0.028 and <0.0001 respectively) at baseline, but not at 24 weeks (p = 0.16 and p = 0.37, respectively). INTERPRETATION The immune response in children following SARS-CoV-2 infection was robust and sustained (>6 months) but further work is required to understand the extent to which this protects against reinfection.
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Affiliation(s)
- Georgina Ireland
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Anna Jeffery-Smith
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Maria Zambon
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Katja Hoschler
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Ross Harris
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - John Poh
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Frances Baawuah
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Joanne Beckmann
- East London NHS Foundation Trust, 9 Allie Street, London E1 8DE, United Kingdom
| | - Ifeanyichukwu O Okike
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
- University Hospitals of Derby and Burton NHS Foundation Trust, 201 London Road, Derby DE1 2TZ, United Kingdom
| | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Holt Street, Aston, B7 4BN, United Kingdom
| | - Andrew J Brent
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, United Kingdom
- Wellington Square, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Bernadette Brent
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, United Kingdom
| | - Felicity Aiano
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Zahin Amin-Chowdhury
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Louise Letley
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Samuel E I Jones
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Meaghan Kall
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Monika Patel
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Robin Gopal
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Ray Borrow
- Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Ezra Linley
- Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Kevin E Brown
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
- Paediatric Infectious Diseases Research Group, St. George's University of London, London SW17 0RE, United Kingdom
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20
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Meslé MM, Brown J, Mook P, Hagan J, Pastore R, Bundle N, Spiteri G, Ravasi G, Nicolay N, Andrews N, Dykhanovska T, Mossong J, Sadkowska-Todys M, Nikiforova R, Riccardo F, Meijerink H, Mazagatos C, Kyncl J, McMenamin J, Melillo T, Kaoustou S, Lévy-Bruhl D, Haarhuis F, Rich R, Kall M, Nitzan D, Smallwood C, Pebody RG. Estimated number of deaths directly averted in people 60 years and older as a result of COVID-19 vaccination in the WHO European Region, December 2020 to November 2021. Euro Surveill 2021; 26:2101021. [PMID: 34823641 PMCID: PMC8619871 DOI: 10.2807/1560-7917.es.2021.26.47.2101021] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/25/2021] [Indexed: 01/31/2023] Open
Abstract
Since December 2019, over 1.5 million SARS-CoV-2-related fatalities have been recorded in the World Health Organization European Region - 90.2% in people ≥ 60 years. We calculated lives saved in this age group by COVID-19 vaccination in 33 countries from December 2020 to November 2021, using weekly reported deaths and vaccination coverage. We estimated that vaccination averted 469,186 deaths (51% of 911,302 expected deaths; sensitivity range: 129,851-733,744; 23-62%). Impact by country ranged 6-93%, largest when implementation was early.
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Affiliation(s)
- Margaux Mi Meslé
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Jeremy Brown
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Piers Mook
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - José Hagan
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Roberta Pastore
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Nick Bundle
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Gianfranco Spiteri
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Giovanni Ravasi
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Nathalie Nicolay
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Nick Andrews
- UK Health Security Agency, London, United Kingdom
| | | | | | | | - Raina Nikiforova
- Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | | | | | | | - Jan Kyncl
- National Institute of Public Health, Prague, Czechia
| | | | | | | | | | | | - Rivka Rich
- Israel Ministry of Health, Jerusalem, Israel
| | - Meaghan Kall
- UK Health Security Agency, London, United Kingdom
| | - Dorit Nitzan
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Catherine Smallwood
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
| | - Richard G Pebody
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, Denmark
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21
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Popping S, Kall M, Nichols BE, Stempher E, Versteegh L, van de Vijver DAMC, van Sighem A, Versteegh M, Boucher C, Delpech V, Verbon A. Quality of life among people living with HIV in England and the Netherlands: a population-based study. Lancet Reg Health Eur 2021; 8:100177. [PMID: 34557859 PMCID: PMC8454587 DOI: 10.1016/j.lanepe.2021.100177] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background HIV is now considered a chronic condition, and people living with HIV, when treated, have a similar life expectancy as compared to the general population. Consequently, improving and ensuring a good health-related quality of life (HrQoL) among people living with HIV (people living with HIV) is increasingly important and has risen on the global agenda in recent years. A 'fourth 90' as 90% of people with viral load suppression have a good HrQoL should therefore be adopted alongside the other 90-90-90 targets. This study aims to report the progress on HrQoL as the 'fourth 90' and compare against the general population in the Netherlands and England. Methods In the Netherlands, individuals attending the HIV outpatient clinic of a tertiary hospital were asked to complete the EQ-5D-5L from June 2016 until December 2018. In England, individuals attending one of 73 HIV outpatient clinics were randomly sampled to complete the Positive Voices survey, which included the EQ-5D-5L, from January to September 2017. HrQoL scores were combined with demographic data and compared to general population data. Findings The EQ-5D-5L was filled-out by 895 people living with HIV in the NL and 4,137 in England. HrQoLutility was 0·85 among Dutch and 0·83 among English people living with HIV. This equated to 98% and 94% of the general population HrQoLutility in the Netherlands and England, respectively. Of the EQ-5D domains, anxiety/depression was mostly affected, with one-third in Dutch (35%) and almost half (47%) of English people living with HIV reporting symptoms. This was higher compared to their respective general populations (21% NL and 31% England). Interpretation Overall, HrQoLutility for people living with HIV was high in both countries and highly comparable to the general populations Nevertheless, there should be an increased focus on anxiety and depression in the people living with HIV population The EQ-5D-5L proved an easy HrQoL measurement tool and identified areas for improvement by social and behavioural interventions. Funding The study received funding (unrestricted grants) from: Gilead sciences, ViiV Healthcare, MSD, and Jansen pharmaceuticals.
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Affiliation(s)
- Stephanie Popping
- Erasmus Medical Centre, Rotterdam, Department of Viroscience, The Netherlands.,Erasmus Medical Centre, Rotterdam, Department of Medical Microbiology and Infectious Diseases
| | - Meaghan Kall
- HIV and STI Department, National Infection Service, Public Health England, London, United Kingdom
| | - Brooke E Nichols
- Erasmus Medical Centre, Rotterdam, Department of Viroscience, The Netherlands.,Department of Global Health, School of Public Health, Boston University Boston, United States.,Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Evelien Stempher
- Erasmus Medical Centre, Rotterdam, Department of Viroscience, The Netherlands
| | - Lisbeth Versteegh
- Erasmus Medical Centre, Rotterdam, Department of Viroscience, The Netherlands
| | | | | | - M Versteegh
- institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam
| | - Charles Boucher
- Erasmus Medical Centre, Rotterdam, Department of Viroscience, The Netherlands
| | - Valerie Delpech
- HIV and STI Department, National Infection Service, Public Health England, London, United Kingdom
| | - Annelies Verbon
- Erasmus Medical Centre, Rotterdam, Department of Medical Microbiology and Infectious Diseases.,Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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22
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Brown AE, Croxford SE, Nash S, Khawam J, Kirwan P, Kall M, Bradshaw D, Sabin C, Miller RF, Post FA, Harding R, Collins S, Waters L, Asboe D, Chadwick DR, Delpech V, Sullivan AK. COVID-19 mortality among people with diagnosed HIV compared to those without during the first wave of the COVID-19 pandemic in England. HIV Med 2021; 23:90-102. [PMID: 34528739 PMCID: PMC8652768 DOI: 10.1111/hiv.13167] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Received: 05/11/2021] [Revised: 07/22/2021] [Accepted: 08/13/2021] [Indexed: 01/28/2023]
Abstract
Objectives We describe COVID‐19 mortality among people with and without HIV during the first wave of the pandemic in England. Methods National surveillance data on adults (aged ≥ 15 years) with diagnosed HIV resident in England were linked to national COVID‐19 mortality surveillance data (2 March 2020–16 June 2020); HIV clinicians verified linked cases and provided information on the circumstances of death. We present COVID‐19 mortality rates by HIV status, using negative binomial regression to assess the association between HIV and mortality, adjusting for gender, age and ethnicity. Results Overall, 99 people with HIV, including 61 of black ethnicity, died of/with COVID‐19 (107/100 000) compared with 49 483 people without HIV (109/100 000). Compared to people without HIV, higher COVID‐19 mortality rates were observed in people with HIV of black (188 vs. 122/100 000) and Asian (131 vs. 77.0/100 000) ethnicity, and in both younger (15–59 years: 58.3 vs. 10.2/100 000) and older (≥ 60 years: 434 vs. 355/100 000) people. After adjustment for demographic factors, people with HIV had a higher COVID‐19 mortality risk than those without (2.18; 95% CI: 1.76–2.70). Most people with HIV who died of/with COVID‐19 had suppressed HIV viraemia (91%) and at least one comorbidity reported to be associated with poor COVID‐19 outcomes (87%). Conclusions In the first wave of the pandemic in England, COVID‐19 mortality among people with HIV was low, but was higher than in those without HIV, after controlling for demographic factors. This supports the strategy of prioritizing COVID‐19 vaccination for people with HIV and strongly encouraging its uptake, especially in those of black and Asian ethnicity.
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Affiliation(s)
- Alison E Brown
- National Infection Service, Public Health England, London, UK
| | - Sara E Croxford
- National Infection Service, Public Health England, London, UK
| | - Sophie Nash
- National Infection Service, Public Health England, London, UK
| | - Jameel Khawam
- National Infection Service, Public Health England, London, UK
| | - Peter Kirwan
- National Infection Service, Public Health England, London, UK.,Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Meaghan Kall
- National Infection Service, Public Health England, London, UK
| | - Daniel Bradshaw
- National Infection Service, Public Health England, London, UK
| | - Caroline Sabin
- Institute for Global Health, University College London, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Robert F Miller
- Institute for Global Health, University College London, London, UK.,Central and North West London NHS Foundation Trust, Mortimer Market Centre, London, UK
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College, London, UK
| | - Simon Collins
- HIV i-Base, London, UK.,British HIV Association, London, UK
| | - Laura Waters
- Central and North West London NHS Foundation Trust, Mortimer Market Centre, London, UK.,British HIV Association, London, UK
| | - David Asboe
- British HIV Association, London, UK.,Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - David R Chadwick
- British HIV Association, London, UK.,South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Valerie Delpech
- National Infection Service, Public Health England, London, UK
| | - Ann K Sullivan
- National Infection Service, Public Health England, London, UK.,British HIV Association, London, UK.,Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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23
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Nash SG, Maffeo M, Likatavicius G, Cosmaro L, Rudaitis K, Lapsinov A, Enayat Q, Delpech V, Kall M. Acceptability and usability of HIV self-tests in two European countries: findings from surveys of clients at non-governmental organisations in Lithuania and Italy. BMC Infect Dis 2021; 21:844. [PMID: 34517818 PMCID: PMC8438811 DOI: 10.1186/s12879-021-06442-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Uptake of HIV self-tests (HIVST) remains low in Europe. We conducted two separate surveys to understand facilitators and barriers to the use of HIVST in two European countries, as part of the EU INTEGRATE Joint Action. In both countries, HIV has been legal since 2016. In Lithuania, where HIVST sales have been low, the survey primarily assessed acceptability whilst in Italy, with better HIVST uptake, usability was the focus. Methods Participants were recruited through community HIV testing sites, and in Lithuania also through social media. In Lithuania, participants self-completed a survey on their testing history, and attitudes toward and experiences with self-testing. In Italy participants performed an HIVST (Mylan Autotest) while being observed by a community health worker (CHW). Both participants and CHW completed a self-administered survey evaluating the experience of the participant. Results In Lithuania, awareness of HIV self-testing (75%) was high among the 138 people who completed the survey. Privacy and confidentiality (70%) was the most common reason to use an HIVST whilst cost was reported as the main barrier by 60%, only 15% were willing to pay the current price. Almost half (42%) were concerned about doing the test incorrectly and 36% preferred that a trained person could discuss their result. Purchasing HIVST at a pharmacy (70%) or online (61%) was favoured and 68% would opt to simultaneously test for other infections. In Italy, 28 people who had never used an HIVST before were observed using one. 43% found the test easy to use but CHWs reported that 36% of participants failed at least one step. The quick result (68%) was the most common reason to use one again, yet the main concerns were the lack of counselling (50%) and reading result alone (32%). Conclusions HIVST are acceptable and usable, however cost is a major barrier. Local and national strategies are needed to increase awareness of and access to HIVST and target HIVST campaigns toward key risk groups such as MSM. Meanwhile, steps can be taken to improve testing instructions and support for self-testers. Offering multiplex testing for other infections would also likely increase uptake.
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Affiliation(s)
- Sophie G Nash
- Blood Safety, Hepatitis, STI and HIV division, National Infection Service, Public Health England, London, UK.
| | - Manuel Maffeo
- Arcigay - Associazione LGBTI Italiana, Bologna, Italy
| | | | - Lella Cosmaro
- Fondazione LILA Milano - Italian League for Fighting AIDS, Milan, Italy
| | | | | | - Qudsia Enayat
- Blood Safety, Hepatitis, STI and HIV division, National Infection Service, Public Health England, London, UK
| | - Valerie Delpech
- Blood Safety, Hepatitis, STI and HIV division, National Infection Service, Public Health England, London, UK
| | - Meaghan Kall
- Blood Safety, Hepatitis, STI and HIV division, National Infection Service, Public Health England, London, UK
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Kall M, Fresán U, Guy D, Brown G, Burgui C, Castilla J, Grecu VI, Dumitrescu F, Delpech V, Lazarus JV. Quality of life in people living with HIV in Romania and Spain. BMC Infect Dis 2021; 21:898. [PMID: 34517820 PMCID: PMC8436864 DOI: 10.1186/s12879-021-06567-w] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 01/30/2023] Open
Abstract
Background Health-related quality of life (HRQoL) is a crucial component in assessing and addressing the unmet needs of people, especially those with chronic illnesses such as HIV. The aim of the study was to examine and compare the health-related quality of life of people living with HIV in Romania and Spain, compared to the general populations of each country. Methods A cross-sectional survey was conducted among adults (≥ 18 years) attending for HIV care in Romania and Spain from October 2019 to March 2020. The survey included two validated HRQoL instruments: a generic instrument, EQ-5D-5L, and an HIV-specific instrument, PozQoL, and questions on socio-demographics, HIV-related characteristics, physical and mental health conditions, and substance use. Multivariable linear regression was used to determine factors associated with HRQoL. Results 570 people living with HIV responded (170 in Romania and 400 in Spain). The median age was 31 (18–67) in Romania and 52 (19–83) in Spain. Anxiety/depression symptoms were frequently reported by people with HIV (Romania: 50% vs 30% in the Romanian population; Spain: 38% vs 15% in Spanish population). Spain reported higher mean EQ-5Dutility scores than Romania (0.88 and 0.85, respectively) but identical PozQoL scores (3.5, on a scale of 0–5). In both countries, health concerns were highlighted as a key issue for people with HIV. In multivariable analysis, two factors were consistently associated with worse HRQoL in people with HIV: bad or very bad self-rated health status and presence of a mental health condition. In Romania, being gay/bisexual and being disabled/unemployed were associated with worse HRQoL. Whereas in Spain, older age and financial insecurity were significant predictors. Conclusions Our results indicated a good HRQoL for people living with HIV in Romania and Spain; however, worse HRQoL profiles were characterized by health concerns, poor self-rated health status, and the presence of mental health conditions. This study highlights the importance of monitoring HRQoL in people living with HIV due to the chronic nature of the disease. In this highly-treatment experienced group, disparities were found, particularly highlighting mental health as an area which needs more attention to improve the well-being of people living with HIV.
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Affiliation(s)
- Meaghan Kall
- HIV/STI Department, Public Health England, London, NW9 5EQ, UK.
| | - Ujué Fresán
- Instituto de Salud Pública de Navarra-IdiSNA-CIBERESP, Pamplona, Spain
| | - Danielle Guy
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, S08036, Barcelona, Spain
| | - Graham Brown
- Centre for Social Impact, University of New South Wales, High Street, Sydney, Australia
| | - Cristina Burgui
- Instituto de Salud Pública de Navarra-IdiSNA-CIBERESP, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra-IdiSNA-CIBERESP, Pamplona, Spain
| | - Victor Ionel Grecu
- Spitalul Clinic de Boli Infectioase si Pneumoftiziologie "Victor Babes" Craiova, 200515, Craiova, Romania
| | - Florentina Dumitrescu
- Spitalul Clinic de Boli Infectioase si Pneumoftiziologie "Victor Babes" Craiova, 200515, Craiova, Romania
| | - Valerie Delpech
- HIV/STI Department, Public Health England, London, NW9 5EQ, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, S08036, Barcelona, Spain
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Raben D, Casabona J, Cosmaro L, Gasbarrini N, Lambert JS, Glapsy S, Kakalou C, Maffeo M, Mommi M, Corradini G, Klavs I, Kurbatova A, Wawer I, Wysocki P, Raahauge A, Jakobsen SF, Lazarus JV, Sullivan A, Kall M, Hedrich D, Johnson CC, Seguy NS, Simões D, Delpech V. Lessons learned from the first European project on the integration of infectious diseases in testing services, data collection and country responses. BMC Infect Dis 2021; 21:690. [PMID: 34517824 PMCID: PMC8436854 DOI: 10.1186/s12879-021-06362-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Dorthe Raben
- CHIP, Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Jordi Casabona
- Centre for Epidemiological Studies on STI/HIV/AIDS in Catalonia (CEEISCAT), Institut Josep Carreras, Campus de Can Ruti, Ctra de Can Ruti, Camí de les Escoles, s/n, 08916, Badalona, Catalonia, Spain
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - Lella Cosmaro
- Fondazione LILA Milano - Italian League for Fighting AIDS, Via Carlo Maderno 4, 20136, Milan, MI, Italy
| | - Nadia Gasbarrini
- Fondazione Villa Maraini, Via Bernardino Ramazzini, 31 -, 00151, Rome, RM, Italy
| | - John S Lambert
- Mater Misericordiae University Hospital and UCD School of Medicine, Belfield, Dublin 4, Ireland
| | - Shannon Glapsy
- Mater Misericordiae University Hospital and UCD School of Medicine, Belfield, Dublin 4, Ireland
| | - Christine Kakalou
- Centre for Research & Technology Hellas, Institute of Applied Biosciences, 6th km Charilaou-Thermi Rd, P.O. Box 60361, 57001, Thessaloniki, GR, Greece
| | - Manuel Maffeo
- Arcigay Associazione LGBTI Italiana, Via Don Minzoni 18, 40121, Bologna, Italy
| | - Michele Mommi
- Arcigay Associazione LGBTI Italiana, Via Don Minzoni 18, 40121, Bologna, Italy
| | - Gianmarco Corradini
- Arcigay Associazione LGBTI Italiana, Via Don Minzoni 18, 40121, Bologna, Italy
| | - Irena Klavs
- National Institute of Public Health, Trubarjeva 2, 1000, Ljubljana, Slovenia
| | - Aljona Kurbatova
- National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia
| | - Iwona Wawer
- National AIDS Centre, Agency of the Ministry of Health, Samsonowska 1, 02-829, Warszawa, Poland
| | - Piotr Wysocki
- National AIDS Centre, Agency of the Ministry of Health, Samsonowska 1, 02-829, Warszawa, Poland
| | - Anne Raahauge
- CHIP, Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Stine Finne Jakobsen
- CHIP, Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Calle del Rossellon 132, ES-08036, Barcelona, Spain
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, London, SW10, UK
| | - Meaghan Kall
- Public Health England, Wellington House 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Dagmar Hedrich
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Praça Europa 1, Cais do Sodré, 1249-289, Lisbon, Portugal
| | - Cheryl Case Johnson
- World Health Organisation (WHO) Regional Office for Europe, FN Byen, Marmorvej 51, 2100, Copenhagen, Denmark
| | - Nicole Simone Seguy
- World Health Organisation (WHO) HQ, Avenue Appia 20, 1202, Geneva, Switzerland
| | - Daniel Simões
- Grupo de Ativistas em Tratamentos (GAT), Avenida Paris, 4 - 1 Direito, 1000-228, Lisbon, Portugal
| | - Valerie Delpech
- Public Health England, Wellington House 133-155 Waterloo Road, London, SE1 8UG, UK
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26
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Ladhani SN, Ireland G, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Aiano F, Amin-Chowdhury Z, Kall M, Borrow R, Linley E, Zambon M, Poh J, Warrener L, Lackenby A, Ellis J, Amirthalingam G, Brown KE, Ramsay ME. Emergence of SARS-CoV-2 Alpha (B.1.1.7) variant, infection rates, antibody seroconversion and seroprevalence rates in secondary school students and staff: Active prospective surveillance, December 2020 to March 2021, England. J Infect 2021; 83:573-580. [PMID: 34400220 PMCID: PMC8361003 DOI: 10.1016/j.jinf.2021.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022]
Abstract
Objectives We assessed SARS-CoV-2 infection, seroprevalence and seroconversion in students and staff when secondary schools reopened in March 2021. Methods We initiated SARS-CoV-2 surveillance in 18 secondary schools across six regions in September 2020. Participants provided nasal swabs for RT-PCR and blood samples for SARS-CoV-2 antibodies at the beginning (September 2020) and end (December 2020) of the autumn term and at the start of the spring term (March 2021). Findings In March 2021, 1895 participants (1100 students:795 staff) were tested; 5.6% (61/1094) students and 4.4% (35/792) staff had laboratory-confirmed SARS-CoV-2 infection from December 2020-March 2021. Nucleoprotein-antibody seroprevalence was 36.3% (370/1018) in students and 31.9% (245/769) in staff, while spike-antibody prevalence was 39.5% (402/1018) and 59.8% (459/769), respectively, similar to regional community seroprevalence. Between December 2020 and March 2021, 14.8% (97/656; 95%CI: 12.2–17.7) students and 10.0% (59/590; 95%CI: 7.7–12.7) staff seroconverted. Weekly seroconversion rates were similar from September to December 2020 (8.0/1000) and from December 2020 to March 2021 (7.9/1000; students: 9.3/1,000; staff: 6.3/1,000). Interpretation By March 2021, a third of secondary school students and staff had evidence of prior infection based on N-antibody seropositivity, and an additional third of staff had evidence of vaccine-induced immunity based on S-antibody seropositivity.
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Affiliation(s)
- Shamez N Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; Paediatric Infectious Diseases Research Group, St. George's University of London, London SW17 0RE, United Kingdom
| | - Georgina Ireland
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Frances Baawuah
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Joanne Beckmann
- East London NHS Foundation Trust, 9 Alie Street, London E1 8DE, United Kingdom
| | - Ifeanyichukwu O Okike
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK, 201 London Road, Derby DE1 2TZ, United Kingdom
| | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Holt Street, Aston B7 4BN, United Kingdom
| | - Andrew J Brent
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, United Kingdom; University of Oxford, Wellington Square, Oxford OX1 2JD, United Kingdom
| | - Bernadette Brent
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, United Kingdom
| | - Felicity Aiano
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Zahin Amin-Chowdhury
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Meaghan Kall
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Ray Borrow
- Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Ezra Linley
- Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Maria Zambon
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - John Poh
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Lenesha Warrener
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Angie Lackenby
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Joanna Ellis
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Kevin E Brown
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
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Hall JA, Harris RJ, Emmett HE, Lowe B, Singanayagam A, Twohig KA, Zaidi A, Kall M, Zambon M, Dabrera G. On the Sensitivity and Specificity of Postmortem Upper Respiratory Tract Testing for SARS-CoV-2. J Infect Dis 2021; 224:389-394. [PMID: 33999152 PMCID: PMC8194530 DOI: 10.1093/infdis/jiab270] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 03/24/2021] [Accepted: 05/13/2021] [Indexed: 01/18/2023] Open
Abstract
Background Post-mortem testing can improve our understanding of the impact of SARS-CoV-2 if it is sufficiently sensitive and specific. Methods We investigated the post-mortem sensitivity and specificity of reverse transcriptase PCR testing on upper respiratory swabs using a dataset of everyone who had been tested for SARS-CoV-2 before and after death in England between 1 st March-29 th October 2020. We analysed sensitivity in those who had a positive test before death by time to post-mortem test. We developed a multivariate model and conducted time-to-negativity survival analysis. For specificity we analysed those with a negative test in the week before death. Results Post-mortem testing within a week after death had a sensitivity of 96.8% if the person had tested positive within a week before death. There was no effect of age, sex, or specimen type on sensitivity, but individuals with COVID-19-related codes on their death certificate were 5.65 times more likely to test positive after death (95%CI 2.31,13.9). Specificity was 94.2%, increasing to 97.5% in individuals without COVID-19 on the death certificate. Conclusion Post-mortem testing has high sensitivity (96.8%) and specificity (94.2%) if performed within a week after death and could be a useful diagnostic tool.
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Affiliation(s)
- Jennifer A Hall
- National COVID-19 Epidemiology Cell, Public Health England, London, United Kingdom.,University College London Elizabeth Garrett Anderson (UCL EGA), Institute for Women's Health, London, United Kingdom
| | - Ross J Harris
- Statistics Modelling and Economics Department, Public Health England, London, United Kingdom
| | - Hannah E Emmett
- National COVID-19 Epidemiology Cell, Public Health England, London, United Kingdom
| | - Belinda Lowe
- National COVID-19 Epidemiology Cell, Public Health England, London, United Kingdom
| | - Anika Singanayagam
- National COVID-19 Virology Cell, Public Health England, London, United Kingdom
| | - Katherine A Twohig
- National COVID-19 Epidemiology Cell, Public Health England, London, United Kingdom
| | - Asad Zaidi
- National COVID-19 Epidemiology Cell, Public Health England, London, United Kingdom
| | - Meaghan Kall
- National COVID-19 Epidemiology Cell, Public Health England, London, United Kingdom
| | - Maria Zambon
- National COVID-19 Virology Cell, Public Health England, London, United Kingdom
| | - Gavin Dabrera
- National COVID-19 Epidemiology Cell, Public Health England, London, United Kingdom
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28
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Lazarus JV, Safreed-Harmon K, Kamarulzaman A, Anderson J, Leite RB, Behrens G, Bekker LG, Bhagani S, Brown D, Brown G, Buchbinder S, Caceres C, Cahn PE, Carrieri P, Caswell G, Cooke GS, Monforte AD, Dedes N, Del Amo J, Elliott R, El-Sadr WM, Fuster-Ruiz de Apodaca MJ, Guaraldi G, Hallett T, Harding R, Hellard M, Jaffar S, Kall M, Klein M, Lewin SR, Mayer K, Pérez-Molina JA, Moraa D, Naniche D, Nash D, Noori T, Pozniak A, Rajasuriar R, Reiss P, Rizk N, Rockstroh J, Romero D, Sabin C, Serwadda D, Waters L. Consensus statement on the role of health systems in advancing the long-term well-being of people living with HIV. Nat Commun 2021; 12:4450. [PMID: 34272399 PMCID: PMC8285468 DOI: 10.1038/s41467-021-24673-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023] Open
Abstract
Health systems have improved their abilities to identify, diagnose, treat and, increasingly, achieve viral suppression among people living with HIV (PLHIV). Despite these advances, a higher burden of multimorbidity and poorer health-related quality of life are reported by many PLHIV in comparison to people without HIV. Stigma and discrimination further exacerbate these poor outcomes. A global multidisciplinary group of HIV experts developed a consensus statement identifying key issues that health systems must address in order to move beyond the HIV field's longtime emphasis on viral suppression to instead deliver integrated, person-centered healthcare for PLHIV throughout their lives.
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Affiliation(s)
- Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
| | - Kelly Safreed-Harmon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Adeeba Kamarulzaman
- University of Malaya, Kuala Lumpur, Malaysia
- International AIDS Society (IAS), Geneva, Switzerland
| | - Jane Anderson
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Georg Behrens
- Medizinische Hochschule Hannover (MHH), Hannover, Germany
| | | | - Sanjay Bhagani
- Royal Free London NHS Trust and University College London, London, United Kingdom
| | - Darren Brown
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - Graham Brown
- Centre for Social Impact, University of New South Wales, Sydney, Australia
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, United States
| | - Carlos Caceres
- Center for Research in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Patrizia Carrieri
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseilles, France
| | - Georgina Caswell
- Global Network of People Living with HIV (GNP+), Cape Town, South Africa
| | | | | | | | - Julia Del Amo
- National Plan on AIDS, Ministry of Health, Madrid, Spain
| | | | | | | | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Università degli studi di Modena e Reggio Emilia, Modena, Italy
| | - Tim Hallett
- Imperial College London, London, United Kingdom
| | | | | | - Shabbar Jaffar
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Marina Klein
- McGill University Health Centre Research Institute, Montreal, Canada
| | - Sharon R Lewin
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Ken Mayer
- Fenway Health and Harvard Medical School, Boston, United States
| | - Jose A Pérez-Molina
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Denise Naniche
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Denis Nash
- City University of New York Graduate School of Public Health and Health Policy, New York City, United States
| | - Teymur Noori
- European Centre for Disease Control and Prevention, Solna, Sweden
| | - Anton Pozniak
- Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Peter Reiss
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Diana Romero
- City University of New York Graduate School of Public Health and Health Policy, New York City, United States
| | | | - David Serwadda
- Makerere University School of Public Health, Kampala, Uganda
| | - Laura Waters
- Central and North West London NHS Trust, London, United Kingdom
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Ladhani SN, Ireland G, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Walker J, Aiano F, Amin-Chowdhury Z, Letley L, Flood J, Jones SEI, Kall M, Borrow R, Linley E, Zambon M, Poh J, Lackenby A, Ellis J, Amirthalingam G, Brown KE, Ramsay ME. SARS-CoV-2 infection, antibody positivity and seroconversion rates in staff and students following full reopening of secondary schools in England: A prospective cohort study, September-December 2020. EClinicalMedicine 2021; 37:100948. [PMID: 34386740 PMCID: PMC8343251 DOI: 10.1016/j.eclinm.2021.100948] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Older children have higher SARS-CoV-2 infection rates than younger children. We investigated SARS-CoV-2 infection, seroprevalence and seroconversion rates in staff and students following the full reopening of all secondary schools in England. METHODS Public Health England (PHE) invited secondary schools in six regions (East and West London, Hertfordshire, Derbyshire, Manchester and Birmingham) to participate in SARS-CoV-2 surveillance during the 2020/21 academic year. Participants had nasal swabs for RT-PCR and blood samples for SARS-CoV-2 antibodies at the beginning (September 2020) and end (December 2020) of the autumn term. Multivariable logistic regression was used to assess independent risk factors for seropositivity and seroconversion. FINDINGS Eighteen schools in six regions enrolled 2,209 participants, including 1,189 (53.8%) students and 1,020 (46.2%) staff. SARS-CoV-2 infection rates were not significantly different between students and staff in round one (5/948; [0.53%] vs. 2/876 [0.23%]; p = 0.46) or round two (10/948 [1.05%] vs. 7/886 [0.79%]; p = 0.63), and similar to national prevalence. None of four and 7/15 (47%) sequenced strains in rounds 1 and 2 were the highly transmissible SARS-CoV-2 B.1.1.7 variant. In round 1, antibody seropositivity was higher in students than staff (114/893 [12.8%] vs. 79/861 [9.2%]; p = 0.016), but similar in round 2 (117/893 [13.1%] vs.117/872 [13.3%]; p = 0.85), comparable to local community seroprevalence. Between the two rounds, 8.7% (57/652) staff and 6.6% (36/549) students seroconverted (p = 0.16). INTERPRETATION In secondary schools, SARS-CoV-2 infection, seropositivity and seroconversion rates were similar in staff and students, and comparable to local community rates. Ongoing surveillance will be important for monitoring the impact of new variants in educational settings.
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Affiliation(s)
- Shamez N Ladhani
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
- Paediatric Infectious Diseases Research Group, St. George's University of London, London SW17 0RE, UK
| | - Georgina Ireland
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Frances Baawuah
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Joanne Beckmann
- East London NHS Foundation Trust, 9 Allie Street, London E1 8DE, UK
| | - Ifeanyichukwu O Okike
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK, 201 London Road, Derby DE1 2TZ, UK
| | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Holt Street, Aston B7 4BN, UK
| | - Andrew J Brent
- Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, UK
- Nuffield Department of Medicine, University of Oxford, Wellington Square, Oxford OX1 2JD, UK
| | - Bernadette Brent
- Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, UK
| | - Jemma Walker
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Felicity Aiano
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Zahin Amin-Chowdhury
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Louise Letley
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Jessica Flood
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Samuel E I Jones
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Meaghan Kall
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Ray Borrow
- Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Ezra Linley
- Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Maria Zambon
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - John Poh
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Angie Lackenby
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Joanna Ellis
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Gayatri Amirthalingam
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Kevin E Brown
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mary E Ramsay
- National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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Hall VJ, Foulkes S, Charlett A, Atti A, Monk EJM, Simmons R, Wellington E, Cole MJ, Saei A, Oguti B, Munro K, Wallace S, Kirwan PD, Shrotri M, Vusirikala A, Rokadiya S, Kall M, Zambon M, Ramsay M, Brooks T, Brown CS, Chand MA, Hopkins S. SARS-CoV-2 infection rates of antibody-positive compared with antibody-negative health-care workers in England: a large, multicentre, prospective cohort study (SIREN). Lancet 2021; 397:1459-1469. [PMID: 33844963 DOI: 10.1101/2021.01.13.21249642] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 05/27/2023]
Abstract
BACKGROUND Increased understanding of whether individuals who have recovered from COVID-19 are protected from future SARS-CoV-2 infection is an urgent requirement. We aimed to investigate whether antibodies against SARS-CoV-2 were associated with a decreased risk of symptomatic and asymptomatic reinfection. METHODS A large, multicentre, prospective cohort study was done, with participants recruited from publicly funded hospitals in all regions of England. All health-care workers, support staff, and administrative staff working at hospitals who could remain engaged in follow-up for 12 months were eligible to join The SARS-CoV-2 Immunity and Reinfection Evaluation study. Participants were excluded if they had no PCR tests after enrolment, enrolled after Dec 31, 2020, or had insufficient PCR and antibody data for cohort assignment. Participants attended regular SARS-CoV-2 PCR and antibody testing (every 2-4 weeks) and completed questionnaires every 2 weeks on symptoms and exposures. At enrolment, participants were assigned to either the positive cohort (antibody positive, or previous positive PCR or antibody test) or negative cohort (antibody negative, no previous positive PCR or antibody test). The primary outcome was a reinfection in the positive cohort or a primary infection in the negative cohort, determined by PCR tests. Potential reinfections were clinically reviewed and classified according to case definitions (confirmed, probable, or possible) and symptom-status, depending on the hierarchy of evidence. Primary infections in the negative cohort were defined as a first positive PCR test and seroconversions were excluded when not associated with a positive PCR test. A proportional hazards frailty model using a Poisson distribution was used to estimate incidence rate ratios (IRR) to compare infection rates in the two cohorts. FINDINGS From June 18, 2020, to Dec 31, 2020, 30 625 participants were enrolled into the study. 51 participants withdrew from the study, 4913 were excluded, and 25 661 participants (with linked data on antibody and PCR testing) were included in the analysis. Data were extracted from all sources on Feb 5, 2021, and include data up to and including Jan 11, 2021. 155 infections were detected in the baseline positive cohort of 8278 participants, collectively contributing 2 047 113 person-days of follow-up. This compares with 1704 new PCR positive infections in the negative cohort of 17 383 participants, contributing 2 971 436 person-days of follow-up. The incidence density was 7·6 reinfections per 100 000 person-days in the positive cohort, compared with 57·3 primary infections per 100 000 person-days in the negative cohort, between June, 2020, and January, 2021. The adjusted IRR was 0·159 for all reinfections (95% CI 0·13-0·19) compared with PCR-confirmed primary infections. The median interval between primary infection and reinfection was more than 200 days. INTERPRETATION A previous history of SARS-CoV-2 infection was associated with an 84% lower risk of infection, with median protective effect observed 7 months following primary infection. This time period is the minimum probable effect because seroconversions were not included. This study shows that previous infection with SARS-CoV-2 induces effective immunity to future infections in most individuals. FUNDING Department of Health and Social Care of the UK Government, Public Health England, The National Institute for Health Research, with contributions from the Scottish, Welsh and Northern Irish governments.
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Affiliation(s)
- Victoria Jane Hall
- Public Health England Colindale, Colindale, London, UK; The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, University of Oxford, Oxford, UK
| | - Sarah Foulkes
- Public Health England Colindale, Colindale, London, UK
| | - Andre Charlett
- Public Health England Colindale, Colindale, London, UK; The National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol in partnership with Public Health England, Bristol, UK
| | - Ana Atti
- Public Health England Colindale, Colindale, London, UK
| | | | - Ruth Simmons
- Public Health England Colindale, Colindale, London, UK
| | | | | | - Ayoub Saei
- Public Health England Colindale, Colindale, London, UK
| | - Blanche Oguti
- Public Health England Colindale, Colindale, London, UK; Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Katie Munro
- Public Health England Colindale, Colindale, London, UK
| | - Sarah Wallace
- Public Health England Colindale, Colindale, London, UK
| | - Peter D Kirwan
- Public Health England Colindale, Colindale, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK
| | | | | | | | - Meaghan Kall
- Public Health England Colindale, Colindale, London, UK
| | - Maria Zambon
- Public Health England Colindale, Colindale, London, UK
| | - Mary Ramsay
- Public Health England Colindale, Colindale, London, UK; Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Tim Brooks
- Public Health England Colindale, Colindale, London, UK
| | - Colin S Brown
- Public Health England Colindale, Colindale, London, UK
| | - Meera A Chand
- Public Health England Colindale, Colindale, London, UK; Guys and St Thomas's Hospital NHS Trust, London, UK
| | - Susan Hopkins
- Public Health England Colindale, Colindale, London, UK; The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, University of Oxford, Oxford, UK.
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Hall VJ, Foulkes S, Charlett A, Atti A, Monk EJM, Simmons R, Wellington E, Cole MJ, Saei A, Oguti B, Munro K, Wallace S, Kirwan PD, Shrotri M, Vusirikala A, Rokadiya S, Kall M, Zambon M, Ramsay M, Brooks T, Brown CS, Chand MA, Hopkins S. SARS-CoV-2 infection rates of antibody-positive compared with antibody-negative health-care workers in England: a large, multicentre, prospective cohort study (SIREN). Lancet 2021; 397:1459-1469. [PMID: 33844963 PMCID: PMC8040523 DOI: 10.1016/s0140-6736(21)00675-9] [Citation(s) in RCA: 400] [Impact Index Per Article: 133.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Increased understanding of whether individuals who have recovered from COVID-19 are protected from future SARS-CoV-2 infection is an urgent requirement. We aimed to investigate whether antibodies against SARS-CoV-2 were associated with a decreased risk of symptomatic and asymptomatic reinfection. METHODS A large, multicentre, prospective cohort study was done, with participants recruited from publicly funded hospitals in all regions of England. All health-care workers, support staff, and administrative staff working at hospitals who could remain engaged in follow-up for 12 months were eligible to join The SARS-CoV-2 Immunity and Reinfection Evaluation study. Participants were excluded if they had no PCR tests after enrolment, enrolled after Dec 31, 2020, or had insufficient PCR and antibody data for cohort assignment. Participants attended regular SARS-CoV-2 PCR and antibody testing (every 2-4 weeks) and completed questionnaires every 2 weeks on symptoms and exposures. At enrolment, participants were assigned to either the positive cohort (antibody positive, or previous positive PCR or antibody test) or negative cohort (antibody negative, no previous positive PCR or antibody test). The primary outcome was a reinfection in the positive cohort or a primary infection in the negative cohort, determined by PCR tests. Potential reinfections were clinically reviewed and classified according to case definitions (confirmed, probable, or possible) and symptom-status, depending on the hierarchy of evidence. Primary infections in the negative cohort were defined as a first positive PCR test and seroconversions were excluded when not associated with a positive PCR test. A proportional hazards frailty model using a Poisson distribution was used to estimate incidence rate ratios (IRR) to compare infection rates in the two cohorts. FINDINGS From June 18, 2020, to Dec 31, 2020, 30 625 participants were enrolled into the study. 51 participants withdrew from the study, 4913 were excluded, and 25 661 participants (with linked data on antibody and PCR testing) were included in the analysis. Data were extracted from all sources on Feb 5, 2021, and include data up to and including Jan 11, 2021. 155 infections were detected in the baseline positive cohort of 8278 participants, collectively contributing 2 047 113 person-days of follow-up. This compares with 1704 new PCR positive infections in the negative cohort of 17 383 participants, contributing 2 971 436 person-days of follow-up. The incidence density was 7·6 reinfections per 100 000 person-days in the positive cohort, compared with 57·3 primary infections per 100 000 person-days in the negative cohort, between June, 2020, and January, 2021. The adjusted IRR was 0·159 for all reinfections (95% CI 0·13-0·19) compared with PCR-confirmed primary infections. The median interval between primary infection and reinfection was more than 200 days. INTERPRETATION A previous history of SARS-CoV-2 infection was associated with an 84% lower risk of infection, with median protective effect observed 7 months following primary infection. This time period is the minimum probable effect because seroconversions were not included. This study shows that previous infection with SARS-CoV-2 induces effective immunity to future infections in most individuals. FUNDING Department of Health and Social Care of the UK Government, Public Health England, The National Institute for Health Research, with contributions from the Scottish, Welsh and Northern Irish governments.
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Affiliation(s)
- Victoria Jane Hall
- Public Health England Colindale, Colindale, London, UK; The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, University of Oxford, Oxford, UK
| | - Sarah Foulkes
- Public Health England Colindale, Colindale, London, UK
| | - Andre Charlett
- Public Health England Colindale, Colindale, London, UK; The National Institute for Health Research Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol in partnership with Public Health England, Bristol, UK
| | - Ana Atti
- Public Health England Colindale, Colindale, London, UK
| | | | - Ruth Simmons
- Public Health England Colindale, Colindale, London, UK
| | | | | | - Ayoub Saei
- Public Health England Colindale, Colindale, London, UK
| | - Blanche Oguti
- Public Health England Colindale, Colindale, London, UK; Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Katie Munro
- Public Health England Colindale, Colindale, London, UK
| | - Sarah Wallace
- Public Health England Colindale, Colindale, London, UK
| | - Peter D Kirwan
- Public Health England Colindale, Colindale, London, UK; Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK
| | | | | | | | - Meaghan Kall
- Public Health England Colindale, Colindale, London, UK
| | - Maria Zambon
- Public Health England Colindale, Colindale, London, UK
| | - Mary Ramsay
- Public Health England Colindale, Colindale, London, UK; Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Tim Brooks
- Public Health England Colindale, Colindale, London, UK
| | - Colin S Brown
- Public Health England Colindale, Colindale, London, UK
| | - Meera A Chand
- Public Health England Colindale, Colindale, London, UK; Guys and St Thomas's Hospital NHS Trust, London, UK
| | - Susan Hopkins
- Public Health England Colindale, Colindale, London, UK; The National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at the University of Oxford, University of Oxford, Oxford, UK.
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Harman K, Allen H, Kall M, Dabrera G. Interpretation of COVID-19 case fatality risk measures in England. J Epidemiol Community Health 2021; 75:jech-2020-216140. [PMID: 33514625 DOI: 10.1136/jech-2020-216140] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/18/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Katie Harman
- COVID-19 Epidemiology Cell, Public Health England, London, UK
| | - Hester Allen
- COVID-19 Epidemiology Cell, Public Health England, London, UK
| | - Meaghan Kall
- COVID-19 Epidemiology Cell, Public Health England, London, UK
| | - Gavin Dabrera
- COVID-19 Epidemiology Cell, Public Health England, London, UK
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Kirwan PD, Hibbert M, Kall M, Nambiar K, Ross M, Croxford S, Nash S, Webb L, Wolton A, Delpech VC. HIV prevalence and HIV clinical outcomes of transgender and gender-diverse people in England. HIV Med 2020; 22:131-139. [PMID: 33103840 DOI: 10.1111/hiv.12987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/03/2020] [Revised: 08/07/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We provide the first estimate of HIV prevalence among trans and gender-diverse people living in England and compare outcomes of people living with HIV according to gender identity. METHODS We analysed a comprehensive national HIV cohort and a nationally representative self-reported survey of people accessing HIV care in England (Positive Voices). Gender identity was recorded using a two-step question co-designed with community members and civil society. Responses were validated by clinic follow-up and/or self-report. Population estimates were obtained from national government offices. RESULTS In 2017, HIV prevalence among trans and gender-diverse people was estimated at 0.46-4.78 per 1000, compared with 1.7 (95% credible interval: 1.6-1.7) in the general population. Of 94 885 people living with diagnosed HIV in England, 178 (0.19%) identified as trans or gender-diverse. Compared with cisgender people, trans and gender-diverse people were more likely to be London residents (57% vs. 43%), younger (median age 42 vs. 46 years), of white ethnicity (61% vs. 52%), under psychiatric care (11% vs. 4%), to report problems with self-care (37% vs. 13%), and to have been refused or delayed healthcare (23% vs. 11%). Antiretroviral uptake and viral suppression were high in both groups. CONCLUSIONS HIV prevalence among trans and gender-diverse people living in England is relatively low compared with international estimates. Furthermore, no inequalities were observed with regard to HIV care. Nevertheless, trans and gender-diverse people with HIV report poorer mental health and higher levels of discrimination compared with cisgender people.
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Affiliation(s)
- P D Kirwan
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, Public Health England, London, UK.,Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - M Hibbert
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, Public Health England, London, UK
| | - M Kall
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, Public Health England, London, UK
| | - K Nambiar
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - S Croxford
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, Public Health England, London, UK
| | - S Nash
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, Public Health England, London, UK
| | - L Webb
- LGBT Foundation, Manchester, UK
| | - A Wolton
- Chelsea and Westminster Hospital NHS Trust, London, UK
| | - V C Delpech
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, Public Health England, London, UK
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Bristowe K, Murtagh FEM, Clift P, James R, Josh J, Platt M, Whetham J, Nixon E, Post FA, McQuillan K, Cheallaigh CN, Kall M, Anderson J, Sullivan AK, Harding R. The development and cognitive testing of the positive outcomes HIV PROM: a brief novel patient-reported outcome measure for adults living with HIV. Health Qual Life Outcomes 2020; 18:214. [PMID: 32631444 PMCID: PMC7336444 DOI: 10.1186/s12955-020-01462-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 03/17/2020] [Accepted: 06/23/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND People living with HIV experience burdensome multidimensional symptoms and concerns requiring person-centred care. Routine use of patient reported outcome measures can improve outcomes. There is no brief patient reported outcome measure (PROM) that currently reflects the breadth of concerns for people living with HIV. This study aimed to develop and cognitively test a brief novel patient reported outcome measure for use within routine adult HIV care- the "Positive Outcomes" HIV PROM. METHODS Development followed the COSMIN taxonomy and guidance for relevance and comprehensiveness, and Rothrock guidance on development of valid patient reported outcome measures. The Positive Outcomes HIV PROM was developed by a steering group (people living with HIV, HIV professionals and health services researchers) using findings from a previously reported qualitative study of priority outcomes for people living with HIV. The prototype measure was cognitively tested with a purposive sample of people living with HIV. RESULTS The Positive Outcomes HIV PROM consists of 23 questions (22 structured, and one open question) informed by the priorities of key stakeholders (n = 28 people living with HIV, n = 21 HIV professionals and n = 8 HIV commissioners) to ensure face and content validity, and refined through cognitive testing (n = 6 people living with HIV). Cognitive testing demonstrated high levels of acceptability and accessibility. CONCLUSIONS The Positive Outcomes HIV PROM is the first brief patient reported outcome measure reflecting the diverse needs of people living with HIV designed specifically for use in the clinical setting to support patient assessment and care, and drive service quality improvement. It is derived from primary data on the priority outcomes for people living with HIV and is comprehensive and acceptable. Further psychometric testing is required to ensure reliability and responsiveness.
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Affiliation(s)
- K Bristowe
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.
| | - F E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - P Clift
- King's College Hospital NHS Foundation Trust, London, UK
| | - R James
- University of Sussex, Brighton, UK
| | | | | | - J Whetham
- Brighton and Sussex University Hospitals Trust, Brighton, UK
| | - E Nixon
- Brighton and Sussex University Hospitals Trust, Brighton, UK
| | - F A Post
- King's College Hospital NHS Foundation Trust, London, UK
| | - K McQuillan
- St James's Hospital Dublin and Trinity College Dublin, Dublin, Ireland
| | - C Ní Cheallaigh
- St James's Hospital Dublin and Trinity College Dublin, Dublin, Ireland
| | - M Kall
- Public Health England, London, UK
| | - J Anderson
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - A K Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - R Harding
- King's College London, Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
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Raben D, Hoekstra M, Combs L, Sullivan AK, Lazarus JV, Lambert JS, Simões D, Streinu‐Cercel A, Rockstroh JK, Streinu‐Cercel A, Amato‐Gauci A, Pop CS, Oprea C, Hedrich D, Gökengin D, Schatz E, Ghita E, Lazarus J, Rockstroh J, Tavochi L, Cosmaro L, Ursan M, Dara M, Dascalu N, Dedes N, Baptista Leite R, Pasanen S, Reic T, Platteau T, Grecu V, Sönnerborg A, Gazzard B, West B, Karpov I, Lundgren JD, de Wit J, Casabona J, Rockstroh J, Cosmaro L, Maistat L, Matičič M, Dedes N, Tsereteli N, Pol S, Platteau T, Delpech V, Zuilhof W, Yazdanpanah Y, Azad Y, Pharris A, Amato‐Gauci A, Noori T, Hedrich D, Mozalevskis A, Vovc E, Dara M, Fenton K, Kakalou C, Klavs I, Wawer I, Casabona J, Hristojeva J, Kivimets K, Cosmaro L, Maffeo M, Kall M, Mommi M, Gasbarrini N, Wysocki P, Delpech V, Koutkias V. A call to action toward integrated testing and earlier care for viral hepatitis, HIV, STIs and TB. HIV Med 2020. [DOI: 10.1111/hiv.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D Raben
- CHIP, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | | | - L Combs
- CHIP, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | | | - JV Lazarus
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic ‐ University of Barcelona Barcelona Spain
| | - JS Lambert
- Catherine McAuley Education & Research Centre University College Dublin Dublin Ireland
| | - D Simões
- EPIUnit Institute of Public Health University of Porto Porto Portugal
- Grupo de Ativistas em Tratamentos Lisbon Portugal
| | - A Streinu‐Cercel
- Infectious Diseases Department Carol Davila University of Medicine and Pharmacy Bucharest Romania
- National Institute of Infectious Diseases “Prof. Dr Matei Bals” Bucharest Romania
| | - JK Rockstroh
- Department of Medicine I University Hospital Bonn Bonn Germany
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Safreed-Harmon K, Kall M, Anderson J, Azzopardi-Muscat N, Behrens GMN, d'Arminio Monforte A, Davidovich U, Noori T, Lazarus JV. Ability to Monitor National Responses to the HIV Epidemic "Beyond Viral Suppression": Findings From Six European Countries. Front Public Health 2020; 8:36. [PMID: 32266194 PMCID: PMC7098908 DOI: 10.3389/fpubh.2020.00036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/21/2019] [Accepted: 02/05/2020] [Indexed: 12/25/2022] Open
Abstract
Objective: With more people living with HIV (PLHIV) ageing into their 50s and beyond in settings where antiretroviral therapy is widely available, non-AIDS comorbidities and health-related quality of life (HRQoL) are becoming major challenges. Information is needed about whether national HIV monitoring programmes have evolved to reflect the changing focus of HIV care. Methods: We created a 56-item English-language survey to assess whether health systems report on common health-related issues for people with HIV including physical and mental health comorbidities, HRQoL, psychosocial needs, and fertility desires. One expert was identified via purposive sampling in each of six countries (Estonia, Italy, the Netherlands, Slovenia, Sweden, and Turkey) and was asked to participate in the survey. Results: Three respondents reported that the current monitoring systems in their countries do not monitor any of four specified aspects of 10 comorbidities including bone loss, cardiovascular disease, and neurocognitive disorders. Two respondents stated that their countries potentially can report on leading causes of hospital admission among PLHIV, and five on leading cases of death. In three countries, respondents reported that there was the ability to report on the HRQoL of PLHIV. In two countries, respondents provided data on the percentage of PLHIV denied health services because of HIV status in the past 12 months. Conclusions: This study identified areas for potential HIV monitoring improvements in six European countries in relation to comorbidities, HRQoL, discrimination within health systems, and other issues associated with the changing nature of the HIV epidemic. It also indicated that some countries either currently monitor or have the ability to monitor some of these issues. There are opportunities for health information systems in European countries to expand the scope of their HIV monitoring in order to support decision-making about how the long-term health-related needs of PLHIV can best be met.
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Affiliation(s)
- Kelly Safreed-Harmon
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Meaghan Kall
- Public Health England, National Infection Service, London, United Kingdom
| | - Jane Anderson
- Homerton University Hospital NHS Foundation Trust, Jonathan Mann Clinic, London, United Kingdom
| | - Natasha Azzopardi-Muscat
- Department of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Georg M N Behrens
- Department for Clinical Immunology and Rheumatology, Hannover Medical School, Hanover, Germany
| | - Antonella d'Arminio Monforte
- Institute of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e VCarlo, University of Milan, Milan, Italy
| | - Udi Davidovich
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands.,Department of Infectious Diseases, Amsterdam Infection and Immunity Institute (AIII), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
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Rai T, Bruton J, Kall M, Ma R, Pufall E, Day S, Delpech V, Ward H. Experience of primary care for people with HIV: a mixed-method analysis. BJGP Open 2019; 3:bjgpopen19X101665. [PMID: 31822490 PMCID: PMC6995868 DOI: 10.3399/bjgpopen19x101665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/13/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Advances in treatment have transformed HIV into a long-term condition (LTC), presenting fresh challenges for health services, HIV specialists, and GPs. AIM To explore the experience of people living with HIV (PLHIV) regarding consulting their GPs. DESIGN & SETTING A mixed-method analysis using data from two sources: a nationally-representative survey of PLHIV and a qualitative study with London-based PLHIV. METHOD Univariate logistic regression was used for quantitative data and framework analysis for qualitative data. RESULTS The survey had 4422 participants; the qualitative study included 52 participants. In both studies, registration with a GP and HIV status disclosure were high. Similar to general population trends, recent GP use was associated with poor self-rated health status, comorbidities, older age, and lower socioeconomic status. Two-thirds reported a good experience with GPs; a lower proportion felt comfortable asking HIV-related questions. Actual or perceived HIV stigma were consistently associated with poor satisfaction. In the interviews, participants with additional LTCs valued sensitive and consistent support from GPs. Some anticipated, and sometimes experienced, problems relating to HIV status, as well as GPs' limited experience and time to manage their complex needs. Sometimes they took their own initiative to facilitate coordination and communication. For PLHIV, a 'good' GP offered continuity and took time to know and accept them without judgment. CONCLUSION The authors suggest clarification of roles and provision of relevant support to build the confidence of PLHIV in GPs and primary care staff to care for them. As the PLHIV population ages, there is a strong need to develop trusting patient-GP relationships and HIV-friendly GP practices.
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Affiliation(s)
- Tanvi Rai
- Research Associate, School of Public Health, Imperial College London, London, UK
| | - Jane Bruton
- Clinical Research Manager, School of Public Health, Imperial College London, London, UK
| | - Meaghan Kall
- Principal Scientist, HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Richard Ma
- General Practitioner and NIHR Doctoral Research Fellow, School of Public Health, Imperial College London, London, UK
| | - Erica Pufall
- Research Associate, School of Public Health, Imperial College London, London, UK
| | - Sophie Day
- Visiting Professor of Anthropology, School of Public Health, Imperial College London, London, UK
| | | | - Helen Ward
- Professor of Public Health, School of Public Health, Imperial College London, London, UK
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Safreed-Harmon K, Anderson J, Azzopardi-Muscat N, Behrens GMN, d'Arminio Monforte A, Davidovich U, Del Amo J, Kall M, Noori T, Porter K, Lazarus JV. Reorienting health systems to care for people with HIV beyond viral suppression. Lancet HIV 2019; 6:e869-e877. [PMID: 31776099 DOI: 10.1016/s2352-3018(19)30334-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 07/18/2019] [Accepted: 08/20/2019] [Indexed: 02/08/2023]
Abstract
The effectiveness of antiretroviral therapy and its increasing availability globally means that millions of people living with HIV now have a much longer life expectancy. However, people living with HIV have disproportionately high incidence of major comorbidities and reduced health-related quality of life. Health systems must respond to this situation by pioneering care and service delivery models that promote wellness rather than mere survival. In this Series paper, we review evidence about the emerging challenges of the care of people with HIV beyond viral suppression and identify four priority areas for action: integrating HIV services and non-HIV services, reducing HIV-related discrimination in health-care settings, identifying indicators to monitor health systems' progress toward new goals, and catalysing new forms of civil society engagement in the more broadly focused HIV response that is now needed worldwide. Furthermore, in the context of an increasing burden of chronic diseases, we must consider the shift that is underway in the HIV field in relation to burgeoning policy and programmatic efforts to promote healthy ageing.
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Affiliation(s)
- Kelly Safreed-Harmon
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jane Anderson
- Centre for the Study of Sexual Health and HIV, Homerton University Hospital National Health Service Foundation Trust, London, UK
| | - Natasha Azzopardi-Muscat
- Department of Health Services Management, WHO Collaborating Centre on Health Systems and Policies in Small States, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Georg M N Behrens
- Department for Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany; German Centre for Infection Research, Hannover, Germany, Partner-site Hannover-Braunschweig, Germany
| | - Antonella d'Arminio Monforte
- Clinic of Infectious and Tropical Diseases, Department of Health Sciences, L'Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Udi Davidovich
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands; Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Julia Del Amo
- National Center for Epidemiology, Institute of Health Carlos III, Madrid, Spain; National Plan against HIV/AIDS/STIs, Ministry of Health, Consumer Affairs and Welfare, Madrid, Spain
| | - Meaghan Kall
- HIV/STI Department, Public Health England, London, UK
| | - Teymur Noori
- Surveillance and Response Unit, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Kholoud Porter
- Surveillance and Response Unit University College London, London, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain.
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Kall M, Marcellin F, Harding R, Lazarus JV, Carrieri P. Patient-reported outcomes to enhance person-centred HIV care. Lancet HIV 2019; 7:e59-e68. [PMID: 31776101 DOI: 10.1016/s2352-3018(19)30345-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 12/19/2022]
Abstract
Quality of life has been proposed as the fourth 90 to complement the UNAIDS 90-90-90 targets to monitor the global HIV response, highlighting a need to address the holistic needs of people living with HIV beyond viral suppression. This proposal has instigated a wider discussion about the use of patient-reported outcomes (PROs) to improve the treatment and care of an ageing HIV population with increasing comorbidities and a disproportionate burden of social problems. PROs can provide a first-hand assessment of the impact of HIV treatment and care on patients' quality of life, including symptoms. The field of PRO measures is rapidly expanding but still no gold standard exists, raising concerns about tool selection. Challenges also remain in the collection, interpretation, and use of PRO data to improve the performance of the health system. An emerging concern is how to adapt PROs to different sociocultural and geographical settings.
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Affiliation(s)
- Meaghan Kall
- HIV/STI Department, National Infection Service, Public Health England, London, UK.
| | - Fabienne Marcellin
- Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, Cicely Saunders Institute, Kings College London, London, UK
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Patrizia Carrieri
- Aix Marseille University, Institut National de la Santé et de la Recherche Médicale, Institution Française Publique de Recherche, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, Marseille, France; Observatoire Régional de la Santé Provence-Alpes-Côte d'Azur, Marseille, France
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Croxford S, Yin Z, Kall M, Burns F, Simmons R, Copas A, Ireland G, Kirwan P, Chau C, Delpech V. Where do we diagnose HIV infection? Monitoring new diagnoses made in nontraditional settings in England, Wales and Northern Ireland. HIV Med 2018; 19:465-474. [PMID: 29745055 DOI: 10.1111/hiv.12627] [Citation(s) in RCA: 4] [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] [Accepted: 04/11/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objectives of the study were to describe 10-year trends in HIV diagnosis setting and to explore predictors of being diagnosed outside a sexual health clinic (SHC). METHODS Analyses of national HIV surveillance data were restricted to adults (aged ≥ 15 years) diagnosed in 2005-2014 in England, Wales and Northern Ireland. Logistic regression identified factors associated with diagnosis outside an SHC (2011-2014). RESULTS Between 2005 and 2014, 63 599 adults were newly diagnosed with HIV infection; 83% had a diagnosis setting reported. Most people were diagnosed in SHCs (69%) followed by: medical admissions/accident and emergency (A&E; 8.6%), general practice (6.4%), antenatal services (5.5%), out-patient services (3.6%), infectious disease units (2.7%) and other settings (4.0%). The proportion of people diagnosed outside SHCs increased from 2005 to 2014, overall (from 27% to 32%, respectively) and among men who have sex with men (MSM) (from 14% to 21%) and black African men (from 25% to 37%) and women (from 39% to 52%) (all trend P < 0.001). Median CD4 increased across all settings, but was highest in SHCs (384 cells/μL) and lowest in medical admissions/A&E (94 cells/μL). Predictors of being diagnosed outside SHCs included: acquiring HIV through heterosexual contact [adjusted odds ratio (aOR) 1.99; 95% confidence interval (CI) 1.81-2.18] or injecting drug use (aOR: 3.28; 95% CI: 2.56-4.19; reference: MSM), being diagnosed late (< 350 cells/μL) (aOR: 2.55; 95% CI: 2.36-2.74; reference: diagnosed promptly) and being of older age at diagnosis (35-49 years: aOR: 1.60; 95% CI: 1.39-1.83; ≥ 50 years: aOR: 2.48; 95% CI: 2.13-2.88; reference: 15-24 years). CONCLUSIONS The proportion of HIV diagnoses made outside SHCs has increased over the past decade in line with evolving HIV testing guidelines. However, the rate of late diagnosis remains high, indicating that further expansion of testing is necessary, as many people may have had missed opportunities for earlier diagnosis.
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Affiliation(s)
- S Croxford
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
- Institute for Global Health, University College London, London, UK
| | - Z Yin
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - M Kall
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
- Institute for Global Health, University College London, London, UK
| | - F Burns
- Institute for Global Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - R Simmons
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - A Copas
- Institute for Global Health, University College London, London, UK
| | - G Ireland
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - P Kirwan
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - C Chau
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - V Delpech
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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Pufall EL, Kall M, Shahmanesh M, Nardone A, Gilson R, Delpech V, Ward H. Sexualized drug use ('chemsex') and high-risk sexual behaviours in HIV-positive men who have sex with men. HIV Med 2018; 19:261-270. [PMID: 29368440 PMCID: PMC5900961 DOI: 10.1111/hiv.12574] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [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] [Accepted: 10/23/2017] [Indexed: 01/28/2023]
Abstract
Objectives The incidence of sexually transmitted infections (STIs) and HIV infection remains high in gay, bisexual, and other men who have sex with men (MSM) in the UK, and sexualized drug use (“chemsex”) and injecting drug use (“slamsex”) may play a part in this. We aimed to characterize HIV‐positive MSM engaging in chemsex/slamsex and to assess the associations with self‐reported STI diagnoses and sexual behaviours. Methods Data from a 2014 survey of people attending HIV clinics in England and Wales were linked to clinical data from national HIV surveillance records and weighted to be nationally representative. Multivariable logistic regression assessed the associations of chemsex and slamsex with self‐reported unprotected anal intercourse (UAI), serodiscordant UAI (sdUAI) (i.e. UAI with an HIV‐negative or unknown HIV status partner), sdUAI with a detectable viral load (>50 HIV‐1 RNA copies/mL), hepatitis C, and bacterial STIs. Results In the previous year, 29.5% of 392 sexually active participants engaged in chemsex, and 10.1% in slamsex. Chemsex was significantly associated with increased odds of UAI [adjusted odds ratio (AOR) 5.73; P < 0.001], sdUAI (AOR 2.34; P < 0.05), sdUAI with a detectable viral load (AOR 3.86; P < 0.01), hepatitis C (AOR 6.58; P < 0.01), and bacterial STI diagnosis (AOR 2.65; P < 0.01). Slamsex was associated with increased odds of UAI (AOR 6.11; P < 0.05), hepatitis C (AOR 9.39; P < 0.001), and bacterial STI diagnosis (AOR 6.11; P < 0.001). Conclusions Three in ten sexually active HIV‐positive MSM engaged in chemsex in the past year, which was positively associated with self‐reported depression/anxiety, smoking, nonsexual drug use, risky sexual behaviours, STIs, and hepatitis C. Chemsex may therefore play a role in the ongoing HIV and STI epidemics in the UK.
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Affiliation(s)
- E L Pufall
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - M Kall
- HIV and STI Surveillance Department, Public Health England, London, UK
| | - M Shahmanesh
- Department of Infection and Population Health, University College London, London, UK
| | - A Nardone
- HIV and STI Surveillance Department, Public Health England, London, UK
| | - R Gilson
- Department of Infection and Population Health, University College London, London, UK
| | - V Delpech
- HIV and STI Surveillance Department, Public Health England, London, UK
| | - H Ward
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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42
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Croxford S, Kitching A, Desai S, Kall M, Edelstein M, Skingsley A, Burns F, Copas A, Brown AE, Sullivan AK, Delpech V. Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: an analysis of a national observational cohort. Lancet Public Health 2016; 2:e35-e46. [PMID: 29249478 DOI: 10.1016/s2468-2667(16)30020-2] [Citation(s) in RCA: 242] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Deaths in HIV-positive people have decreased since the introduction of highly active antiretroviral therapy (HAART) in 1996. Fewer AIDS-related deaths and an ageing cohort have resulted in an increase in the proportion of HIV patients dying from non-AIDS-related disorders. Here we describe mortality and causes of death in people diagnosed with HIV in the HAART era compared with the general population. METHODS In this observational analysis, we linked cohort data collected by Public Health England (PHE) for individuals aged 15 years and older, diagnosed with HIV in England and Wales from 1997 to 2012, to the Office for National Statistics (ONS) national mortality register. Cohort inclusion began at diagnosis with follow-up clinical information collected every year from all 220 National Health Service (NHS) HIV outpatient clinics nationwide. To classify causes of death we used a modified Coding Causes of Death in HIV (CoDe) protocol, which uses death certificate data and clinical markers. We applied Kaplan-Meier analysis for survival curves and mortality rate estimation and Cox regression to establish independent predictors of all-cause mortality, adjusting for sex, infection route, age at diagnosis, region of birth, year of diagnosis, late diagnosis, and history of HAART. We used standardised mortality ratios (SMRs) to make comparisons with the general population. FINDINGS Between 1997 and 2012, 88 994 people were diagnosed with HIV, contributing 448 839 person-years of follow up. By the end of 2012, 5302 (6%) patients had died (all-cause mortality 118 per 10 000 person-years, 95% CI 115-121). In multivariable analysis, late diagnosis was a strong predictor of death (hazard ratio [HR] 3·50, 95% CI 3·13-3·92). People diagnosed more recently had a lower risk of death (2003-07: HR 0·66, 95% CI 0·62-0·70; 2008-12: HR 0·65, 95% CI 0·60-0·71). Cause of death was determinable for 4808 (91%) of 5302 patients; most deaths (2791 [58%] of 4808) were attributable to AIDS-defining illnesses. Cohort mortality was significantly higher than the general population for all causes (SMR 5·7, 95% CI 5·5-5·8), particularly non-AIDS infections (10·8, 9·8-12·0) and liver disease (3·7, 3·3-4·2). All-cause mortality was highest in the year after diagnosis (SMR 24·3, 95% CI 23·4-25·2). INTERPRETATION Despite the availability of free treatment and care in the UK, AIDS continues to account for the majority of deaths in HIV-positive people, and mortality remains higher in HIV-positive people than in the general population. These findings highlight the importance of prompt diagnosis, care engagement, and optimum management of comorbidities in reducing mortality in people with HIV. FUNDING Public Health England.
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Affiliation(s)
- Sara Croxford
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, London, UK.
| | - Aileen Kitching
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Sarika Desai
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, London, UK
| | - Meaghan Kall
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, London, UK
| | - Michael Edelstein
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Andrew Skingsley
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Fiona Burns
- Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK
| | - Andrew Copas
- Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, London, UK
| | - Alison E Brown
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Ann K Sullivan
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Valerie Delpech
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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Simmons R, Kall M, Collins S, Cairns G, Taylor S, Nelson M, Fidler S, Porter K, Fox J. A global survey of HIV-positive people's attitudes towards cure research. HIV Med 2016; 18:73-79. [PMID: 27167600 DOI: 10.1111/hiv.12391] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Involvement of people living with HIV (PLHIV) in the design of HIV cure studies is important, given the potential risks to participants. We present results of an international survey of PLHIV to define these issues and inform cure research. METHODS PLHIV were recruited in June-November 2014 through HIV websites, advocacy forums, social media and 12 UK HIV clinics. The survey included questions concerning demographics, HIV disease history, the desirability of types of cure and the patient's willingness to accept potential toxicity and treatment interruption (TI). We examined factors associated with TI and willingness to accept substantial risks. RESULTS A total of 982 PLHIV completed the survey; 87% were male, 79% white and 81% men who have sex with men (MSM). Fifty-one per cent were aged 25-44 years and 69% were UK residents. The median time since diagnosis was 7 years [interquartile range (IQR) 2-17 years]. Eighty-eight per cent were receiving antiretrovirals (91% reported undetectable viral load). Health/wellbeing improvements (96%) and an inability to transmit HIV (90%) were more desirable cure characteristics than testing HIV-negative (69%). Ninety-five per cent were interested in participating in cure studies, and 59% were willing to accept substantial risks. PLHIV with a low CD4 count [201-350 cells/μL vs. ≥ 350 cells/μL; odds ratio (OR) 2.11; 95% confidence interval (CI) 1.11-4.00] were more likely to accept risks, whereas those with limited knowledge of HIV treatments vs. excellent/good knowledge and those aged ≥ 65 years vs. 45-64 years were less likely to accept risks [OR 0.58 (95% CI 0.37-0.90) and OR 0.18 (95% CI 0.07-0.45), respectively]. TI was acceptable for 62% of participants, with the main concerns being becoming unwell (82%), becoming infectious (76%) and HIV spreading through the body (76%). CONCLUSIONS Cure research was highly acceptable to the PLHIV surveyed. Most individuals would accept risks, including TI, even in the absence of personal benefit. An optimal cure would improve health and minimize onward transmission risk.
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Affiliation(s)
- R Simmons
- MRC, Clinical Trials Unit University College, London, UK
| | - M Kall
- Public Health England, London, UK
| | | | | | - S Taylor
- Birmingham Heartlands Hospital, Birmingham, UK
| | - M Nelson
- Chelsea and Westminster Hospital, London, UK
| | | | - K Porter
- MRC, Clinical Trials Unit University College, London, UK
| | - J Fox
- Guy's and St Thomas' Hospital, London, UK
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Zenner D, Abubakar I, Conti S, Gupta RK, Yin Z, Kall M, Kruijshaar M, Rice B, Thomas HL, Pozniak A, Lipman M, Delpech V. Impact of TB on the survival of people living with HIV infection in England, Wales and Northern Ireland. Thorax 2015; 70:566-73. [PMID: 25805209 DOI: 10.1136/thoraxjnl-2014-206452] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 10/18/2014] [Accepted: 02/18/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The impact of TB disease on survival in people living with HIV in high resource settings is not well documented in the antiretroviral treatment (ART) era. We calculated TB incidence rates and compared the mortality of persons with and without HIV-TB in a UK HIV cohort in the post-ART era, to determine the impact of HIV-TB on survival in the UK. METHODS We linked the national cohort of persons (aged ≥15 years) diagnosed with HIV between 2000 and 2008 in England, Wales and Northern Ireland with the national TB register and deaths from the Office of National Statistics. We compared all-cause and AIDS-specific mortality in patients with and without TB by estimating HRs using Cox regression modelling allowing for potential predictors. RESULTS Overall, 3188 (7.2%) individuals developed TB infection among a cohort of 44 050 HIV-diagnosed persons and 149 663 person-years. The cumulative TB incidence rate was 2.13 per 100 person-years with a spike within the first 6 months after HIV diagnosis. TB coinfected patients comprised 18% of the 1880 deaths during follow-up and 79% of deaths (n=967) in the year following HIV diagnosis. TB coinfection (HR 4.77, 95% CI 4.11 to 5.54) was significantly associated with increased all-cause mortality. Analysis of AIDS-related survival showed similar results. DISCUSSION The unexpected high mortality in patients with HIV-TB in a population with good healthcare access and ART availability highlights the importance of improving active and latent TB case-finding among patients with HIV, and HIV-testing among patients with TB, to ensure appropriate and prompt treatment initiation for both diseases.
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Affiliation(s)
- Dominik Zenner
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK Research Department of Infection and Population Health, University College London, London, UK
| | - Ibrahim Abubakar
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK Research Department of Infection and Population Health, University College London, London, UK
| | - Stefano Conti
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Rishi K Gupta
- Division of Medicine, University College London, London, UK
| | - Zheng Yin
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Meaghan Kall
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Michelle Kruijshaar
- Erasmus MC University Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Brian Rice
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - H Lucy Thomas
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Anton Pozniak
- Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK
| | - Marc Lipman
- Division of Medicine, University College London, London, UK
| | - Valerie Delpech
- Respiratory Diseases Department, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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Zenner D, Conti S, Yin Z, Kall M, Kruijshaar M, Rice B, Lipman M, Pozniak A, Abubakar I, Delpech V. S58 TB co-infection is associated with poor survival among HIV infected patients in england and wales. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Town K, Lowndes CM, Chisholm S, Kall M, Webster E, Nichols T, Anderson J, Obi C, Willey B, Ison C. P30 An analysis of patient characteristics associated with gonococcal resistance to past therapeutic agents in England and Wales. Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
OBJECTIVES The aim of the study was to identify and describe the characteristics of persons born in the UK who acquire HIV infection abroad. METHODS Analyses using case reports and follow-up data from the national HIV database held at the Health Protection Agency were performed. RESULTS Fifteen per cent (2066 of 13 891) of UK-born adults diagnosed in England, Wales and Northern Ireland between 2002 and 2010 acquired HIV infection abroad. Thailand (534), the USA (117) and South Africa (108) were the countries most commonly reported. As compared with UK-born adults acquiring HIV infection in the UK, those acquiring HIV infection abroad were significantly (P < 0.01) more likely to have acquired it heterosexually (70% vs. 22%, respectively), to be of older age at diagnosis (median 42 years vs. 36 years, respectively), and to have reported sex with a commercial sex worker (5.6% vs. 1%, respectively). Among men infected in Thailand, 11% reported sex with a commercial sex worker. CONCLUSIONS A substantial number of UK-born adults are acquiring HIV infection in countries with generalized HIV epidemics, and in common holiday destinations. Of particular concern is the high proportion of men infected reporting sex with a commercial sex worker. We recommend HIV prevention and testing efforts be extended to include travellers abroad, and that sexual health advice be provided routinely in travel health consultations and in occupational health travel advice packs, particularly to those travelling to high HIV prevalence areas and destinations for sex tourism. Safer sex messages should include an awareness of the potential detrimental health and social impacts of the sex industry.
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Affiliation(s)
- B Rice
- Department of HIV and STI,Health Protection Agency Centre for Infections, London, UK.
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Smith R, Kall M, Delpech V. P1-S3.04 Death in the era of HAART: not all about AIDS. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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49
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Prosperi MCF, Mackie N, Di Giambenedetto S, Zazzi M, Camacho R, Fanti I, Torti C, Sönnerborg A, Kaiser R, Codoñer FM, Van Laethem K, Bansi L, van de Vijver DAMC, Geretti AM, De Luca A, Giacometti A, Butini L, del Gobbo R, Menzo S, Tacconi D, Corbelli G, Zanussi S, Monno L, Punzi G, Maggiolo F, Callegaro A, Calza L, Carla Re M, Pristerà R, Turconi P, Mandas A, Tini S, Zoncada A, Paolini E, Amadio G, Sighinolfi L, Zuccati G, Morfini M, Manetti R, Corsi P, Galli L, Di Pietro M, Bartalesi F, Colao G, Tosti A, Di Biagio A, Setti M, Bruzzone B, Penco G, Trezzi M, Orani A, Pardelli R, De Gennaro M, Chiodera A, Scalzini A, Palvarini L, Almi P, Todaro G, d'Arminio Monforte A, Cicconi P, Rusconi S, Gismondo MR, Gismondo MR, Micheli V, Biondi ML, Gianotti N, Capetti A, Meraviglia P, Boeri E, Mussini C, Pecorari M, Soria A, Vecchi L, Santirocchi M, Brustia D, Ravanini P, Bello FD, Romano N, Mancuso S, Calzetti C, Maserati R, Filice G, Baldanti F, Francisci D, Parruti G, Polilli E, Sacchini D, Martinelli C, Consolini R, Vatteroni L, Vivarelli A, Dionisio D, Nerli A, Lenzi L, Magnani G, Ortolani P, Andreoni M, Palamara G, Fimiani C, Palmisano L, De Luca A, Fadda G, Vullo V, Turriziani O, Montano M, Cenderello G, Gonnelli A, Zazzi M, Palumbo M, Ghisetti V, Bonora S, Foglie PD, Rossi C, Grossi P, Seminari E, Poletti F, Mondino V, Malena M, Lattuada E, Lengauer T, Däumer M, Hoffmann D, Kaiser R, Schülter E, Müller C, Oette M, Reuter S, Esser S, Fätkenheuer G, Rockstroh J, van de Vijver DAMC, Incardona F, Rosen-Zvi M, Lengauer T, Camacho R, Clotet B, Thalme A, Svedhem V, Bratt G, Gargiulo F, Lapadula G, Manca N, Paraninfo G, Quiros-Roldan E, Carosi G, Castelnuovo F, Vandamme AM, Van Laethem K, Van Wijngaerden E, Ainsworth J, Anderson J, Babiker A, Dunn D, Easterbrook P, Fisher M, Gazzard B, Garrett N, Gilson R, Gompels M, Hill T, Johnson M, Leen C, Orkin C, Phillips A, Pillay D, Porter K, Post F, Sabin C, Sadiq T, Schwenk A, Walsh J, Delpech V, Palfreeman A, Dunn D, Glabay A, Porter K, Bansi L, Hill T, Phillips A, Sabin C, Orkin C, Garrett N, Lynch J, Hand J, de Souza C, Fisher M, Perry N, Tilbury S, Churchill D, Gazzard B, Nelson M, Waxman M, Mandalia S, Delpech V, Anderson J, Kall M, Post F, Korat H, Taylor C, Ibrahim F, Campbell L, Easterbrook P, Babiker A, Dunn D, Glabay A, Porter K, Gilson R, James L, Brima N, Williams I, Schwenk A, Johnson M, Youle M, Lampe F, Smith C, Grabowska H, Chaloner C, Puradiredja DI, Bansi L, Hill T, Phillips A, Sabin C, Walsh J, Weber J, Ramzan F, Carder M, Leen C, Wilson A, Gompels M, Dooley D, Palfreeman A, Anderson J, Asboe D, Pozniak A, Cameron S, Cane P, Chadwick D, Churchill D, Clark D, Collins S, Delpech V, Pillay D, Lazarus L, Dunn D, Dolling D, Fearnhill E, Castro H, Porter K, Coughlin K, Dolling D, Zuckerman M, Anna Maria G, Booth C, Goldberg D, Gompels M, Hale A, Kaye S, Kellam P, Leigh-Brown A, Mackie N, Orkin C, Pillay D, Phillips A, Sabin C, Smit E, Templeton K, Tilston P, Tong W, Williams I, Zhang H, Zhang H, Clark D, Ushiro-Lumb I, Oliver T, Bibby D, Mitchell S, Smit E, Mbisa T, Wildfire A, Tandy R, Shepherd J, Chadwick D, MacLean A, Tong W, Bennett D, Hopkins M, Tilston P, Booth C, Garcia-Diaz A, Kaye S, Kirk S. Detection of drug resistance mutations at low plasma HIV-1 RNA load in a European multicentre cohort study. J Antimicrob Chemother 2011; 66:1886-96. [DOI: 10.1093/jac/dkr171] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mattia C. F. Prosperi
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
- Informa PRO Contract Research Organization, Rome, Italy
- Department of Pathology, Emerging Pathogens Institute, College of Medicine, University of Florida, Gainesville, USA
| | - Nicola Mackie
- Department of HIV Medicine, Imperial College Healthcare NHS Trust, London, UK
| | | | - Maurizio Zazzi
- Department of Molecular Biology, University of Siena, Siena, Italy
| | - Ricardo Camacho
- Molecular Biology Laboratory, Centro Hospitalar de Lisboa Ocidenta, Lisbon, Portugal
| | - Iuri Fanti
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Torti
- Clinic of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Anders Sönnerborg
- Division of Infectious Diseases, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Rolf Kaiser
- Institute of Virology, University of Cologne, Cologne, Germany
| | | | - Kristel Van Laethem
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Loveleen Bansi
- Division of Population Health, UCL Medical School, Royal Free Campus, London, UK
| | | | - Anna Maria Geretti
- Department of Virology, University College London Medical School, London, UK
| | - Andrea De Luca
- Clinic of Infectious Diseases, Catholic University of the Sacred Heart, Rome, Italy
- Infectious Diseases Unit, University Hospital of Siena, Siena, Italy
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Ghattas H, Fulford AJ, Kall M, Cox SE, Mkombe M, Ali NS, Rockett K, Kwiatkowski D, Stoltzfus RJ, Prentice AM. A haptoglobin gene promoter polymorphism (A‐61C) protects from anaemia in pregnant Zanzibari women. FASEB J 2007. [DOI: 10.1096/fasebj.21.6.a1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hala Ghattas
- MRC International Nutrition GroupLondon School of Hygiene and Tropical MedicineKeppel StLondonUnited Kingdom
| | - Anthony J Fulford
- MRC International Nutrition GroupLondon School of Hygiene and Tropical MedicineKeppel StLondonUnited Kingdom
| | - Meaghan Kall
- MRC International Nutrition GroupLondon School of Hygiene and Tropical MedicineKeppel StLondonUnited Kingdom
| | - Sharon E Cox
- MRC International Nutrition GroupLondon School of Hygiene and Tropical MedicineKeppel StLondonUnited Kingdom
| | - Makame Mkombe
- Public Health Laboratory ‐ Ivo de CarneriChake ChakePembaTanzania
| | - Nadra S Ali
- Public Health Laboratory ‐ Ivo de CarneriChake ChakePembaTanzania
| | - Kirk Rockett
- Wellcome Trust Centre for Human GeneticsUniversity of OxfordHeadingtonOxfordUnited Kingdom
| | - Dominic Kwiatkowski
- Wellcome Trust Centre for Human GeneticsUniversity of OxfordHeadingtonOxfordUnited Kingdom
| | | | - Andrew M Prentice
- MRC International Nutrition GroupLondon School of Hygiene and Tropical MedicineKeppel StLondonUnited Kingdom
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