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Barda N, Lustig Y, Indenbaum V, Zibly D, Joseph G, Asraf K, Weiss-Ottolenghi Y, Amit S, Kliker L, Abu-Kadar B, Ben-Ami E, Canetti M, Koren R, Katz-Likvornik S, Halpern O, Mendelson E, Doolman R, Harats D, Kreiss Y, Mandelboim M, Regev-Yochay G. Corrigendum to "Immunogenicity of Omicron BA.1-adapted BNT162b2 vaccines: randomized trial, 3-month follow-up" [Clin Microbiol Infect] 29 (7) (2023) 918-923. Clin Microbiol Infect 2024; 30:409-413. [PMID: 38128780 PMCID: PMC11021213 DOI: 10.1016/j.cmi.2023.12.015] [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: 12/23/2023]
Affiliation(s)
- Noam Barda
- ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Epidemiology, Biostatistics and Community Health Services, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Victoria Indenbaum
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Daniel Zibly
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Gili Joseph
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Keren Asraf
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Yael Weiss-Ottolenghi
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Sharon Amit
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Clinical Microbiology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Limor Kliker
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Bian Abu-Kadar
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Eytan Ben-Ami
- Phase 1 clinical trials Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Michal Canetti
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ravit Koren
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Shiri Katz-Likvornik
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Osnat Halpern
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Ella Mendelson
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Ram Doolman
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Dror Harats
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Michal Mandelboim
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Gili Regev-Yochay
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
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Efros O, Berman A, Kenet G, Lubetsky A, Doron A, Shlomai G, Klang E, Soffer S, Barda N, Leibowitz A. Elevated International Normalized Ratio and Mortality in Hospitalized Patients Treated with Direct Oral Anticoagulants. Am J Med 2024; 137:147-153.e2. [PMID: 37926222 DOI: 10.1016/j.amjmed.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/21/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Direct oral anticoagulants (DOACs) are associated with a prolongation of the prothrombin time and an increased international normalized ratio (INR). The clinical significance of these changes is unclear. This study aimed to examine the association between an elevated INR on admission and in-hospital death and long-term survival in patients treated with DOACs. METHODS Data were retrospectively retrieved from records of hospitalized patients at the Sheba Medical Center between November 2008 and July 2023. Patients were selected based on DOAC treatment, coagulation profile, and INR test done within 48 hours of hospitalization. The outcomes were in-hospital mortality and mortality in the year following hospitalization. RESULTS The study included 11,399 hospitalized patients treated with DOACs. Patients with elevated INR had a 180% higher risk of in-hospital mortality (adjusted odds ratio 2.80; 95% confidence interval, 2.30-3.39) and a 57% increased risk of death during the following year (adjusted hazard ratio 1.57; 95% confidence interval, 1.44-1.71). Similar results were observed in subgroup analyses for each DOAC. CONCLUSIONS An elevated INR on admission is associated with a higher risk for in-hospital death and increased risk for mortality during the first year following hospitalization in hospitalized patients treated with DOACs. This highlights that elevated INR levels in patients on DOACs should not be dismissed as laboratory variations due to DOAC treatment, as they may serve as a prognostic marker.
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Affiliation(s)
- Orly Efros
- National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Faculty of Medicine, Tel Aviv University, Israel.
| | - Aya Berman
- Dan Petah-Tikva District at Clalit Health Services, Petah-Tikva, Israel; Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Gili Kenet
- National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Faculty of Medicine, Tel Aviv University, Israel; Amalia Biron Research Institute of Thrombosis & Hemostasis
| | - Aharon Lubetsky
- National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Faculty of Medicine, Tel Aviv University, Israel
| | - Alon Doron
- School of Medicine, Faculty of Medicine, Tel Aviv University, Israel
| | - Gadi Shlomai
- School of Medicine, Faculty of Medicine, Tel Aviv University, Israel; The Division of Endocrinology, Diabetes, and Metabolism; Department of Internal Medicine "D" and Hypertension Unit
| | - Eyal Klang
- School of Medicine, Faculty of Medicine, Tel Aviv University, Israel; Arc Innovation Center, Sheba Medical Center, Ramat-Gan, Israel
| | - Shelly Soffer
- Ben-Gurion University of the Negev, Be'er Sheva, Israel; Internal Medicine B, Assuta Medical Center, Ashdod, Israel
| | - Noam Barda
- Arc Innovation Center, Sheba Medical Center, Ramat-Gan, Israel; Software and Information Systems Engineering; Epidemiology, Biostatistics and Community Health Services, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Avshalom Leibowitz
- School of Medicine, Faculty of Medicine, Tel Aviv University, Israel; Department of Internal Medicine "D" and Hypertension Unit
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Barak-Corren Y, Tsurel D, Keidar D, Gofer I, Shahaf D, Leventer-Roberts M, Barda N, Reis BY. The value of parental medical records for the prediction of diabetes and cardiovascular disease: a novel method for generating and incorporating family histories. J Am Med Inform Assoc 2023; 30:1915-1924. [PMID: 37535812 PMCID: PMC10654871 DOI: 10.1093/jamia/ocad154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/16/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE To determine whether data-driven family histories (DDFH) derived from linked EHRs of patients and their parents can improve prediction of patients' 10-year risk of diabetes and atherosclerotic cardiovascular disease (ASCVD). MATERIALS AND METHODS A retrospective cohort study using data from Israel's largest healthcare organization. A random sample of 200 000 subjects aged 40-60 years on the index date (January 1, 2010) was included. Subjects with insufficient history (<1 year) or insufficient follow-up (<10 years) were excluded. Two separate XGBoost models were developed-1 for diabetes and 1 for ASCVD-to predict the 10-year risk for each outcome based on data available prior to the index date of January 1, 2010. RESULTS Overall, the study included 110 734 subject-father-mother triplets. There were 22 153 cases of diabetes (20%) and 11 715 cases of ASCVD (10.6%). The addition of parental information significantly improved prediction of diabetes risk (P < .001), but not ASCVD risk. For both outcomes, maternal medical history was more predictive than paternal medical history. A binary variable summarizing parental disease state delivered similar predictive results to the full parental EHR. DISCUSSION The increasing availability of EHRs for multiple family generations makes DDFH possible and can assist in delivering more personalized and precise medicine to patients. Consent frameworks must be established to enable sharing of information across generations, and the results suggest that sharing the full records may not be necessary. CONCLUSION DDFH can address limitations of patient self-reported family history, and it improves clinical predictions for some conditions, but not for all, and particularly among younger adults.
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Affiliation(s)
- Yuval Barak-Corren
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - David Tsurel
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, USA
- Clalit Research Institute, Ramat Gan, Israel
- The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Daphna Keidar
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, USA
- Clalit Research Institute, Ramat Gan, Israel
| | - Ilan Gofer
- Clalit Research Institute, Ramat Gan, Israel
| | - Dafna Shahaf
- The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maya Leventer-Roberts
- Clalit Research Institute, Ramat Gan, Israel
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Noam Barda
- Clalit Research Institute, Ramat Gan, Israel
| | - Ben Y Reis
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Gonen T, Barda N, Asraf K, Joseph G, Weiss-Ottolenghi Y, Doolman R, Kreiss Y, Lustig Y, Regev-Yochay G. Immunogenicity and Reactogenicity of Coadministration of COVID-19 and Influenza Vaccines. JAMA Netw Open 2023; 6:e2332813. [PMID: 37682571 PMCID: PMC10492184 DOI: 10.1001/jamanetworkopen.2023.32813] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/01/2023] [Indexed: 09/09/2023] Open
Abstract
Importance COVID-19 and seasonal influenza vaccines were previously given separately, although their coadministration is warranted for vaccination adherence. Limited data on their coadministration have been published. Objective To compare the reactogenicity and immunogenicity of COVID-19 and influenza vaccinations administered together with those of COVID-19 vaccination alone. Design, Setting, and Participants This prospective cohort study included health care workers at a large tertiary medical center in Israel who received the Influvac Tetra (Abbott) influenza vaccine (2022/2023), the Omicron BA.4/BA.5-adapted bivalent (Pfizer/BioNTech) vaccine, or both. Vaccination began in September 2022, and data were collected until January 2023. Vaccines were offered to all employees and were coadministered or given separately. Adverse reaction questionnaires were sent, and serologic samples were also collected. Exposures Receiving COVID-19 vaccine, influenza vaccine, or both. Main Outcomes and Measures The main outcomes for the reactogenicity analysis were symptoms following vaccine receipt, assessed by a digital questionnaire: any local symptoms; fever; weakness or fatigue; any systemic symptoms; and their duration. The immunogenicity analysis' outcome was postvaccination anti-spike IgG titer. Results This study included 2 cohorts for 2 separate analyses. The reactogenicity analysis included 588 participants (of 649 questionnaire responders): 85 in the COVID-19 vaccine-alone group (median [IQR] age, 71 [58-74] years; 56 [66%] female); 357 in the influenza vaccine-alone group (median [IQR] age, 55 [40-65] years; 282 [79%] female); and 146 in the coadministration group (median [IQR] age, 61 [50-71] years; 81 [55%] female). The immunogenicity analysis included 151 participants: 74 participants in the COVID-19 vaccine group (median [IQR] age, 67 [56-73] years; 45 [61%] female) and 77 participants in the coadministration group (median [IQR] age, 60 [49-73] years; 42 [55%] female). Compared with COVID-19 vaccination alone, the risk of systemic symptoms was similar in the coadministration group (odds ratio, 0.82; 95% CI, 0.43-1.56). Geometric mean titers in the coadministration group were estimated to be 0.84 (95% CI, 0.69-1.04) times lower than in the COVID-19 vaccine-alone group. Conclusions and Relevance In this cohort study of health care workers who received a COVID-19 vaccine, an influenza vaccine, or both, coadministration was not associated with substantially inferior immune response or to more frequent adverse events compared with COVID-19 vaccine administration alone, supporting the coadministration of these vaccines.
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Affiliation(s)
- Tal Gonen
- Sheba Pandemic Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Noam Barda
- Sheba Pandemic Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- Epidemiology, Biostatistics and Community Health Services, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Keren Asraf
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Gili Joseph
- Sheba Pandemic Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yael Weiss-Ottolenghi
- Sheba Pandemic Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ram Doolman
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yaniv Lustig
- Sheba Pandemic Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Gili Regev-Yochay
- Sheba Pandemic Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Efros O, Beckerman P, Basson AA, Cohen R, Klang E, Frenkel Nir Y, Soffer S, Barda N, Grossman E. Fluctuations in Serum Creatinine Levels During Hospitalization and Long-Term End-Stage Kidney Disease and Mortality. JAMA Netw Open 2023; 6:e2326996. [PMID: 37535358 PMCID: PMC10401303 DOI: 10.1001/jamanetworkopen.2023.26996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
Importance Acute kidney injury is associated with poor outcomes, but the clinical implication of reversible serum creatinine level fluctuations during hospitalization not necessarily defined as acute kidney injury is poorly understood. Objective To investigate the long-term outcomes of patients without previously diagnosed kidney disease who present with decreased kidney function and are subsequently discharged with apparently normal kidney function. Design, Setting, and Participants A retrospective cohort study was conducted of patients hospitalized in a large tertiary hospital in Israel between September 1, 2007, and July 31, 2022. The study included patients admitted to an internal medicine ward. Patients had not undergone dialysis during the index hospitalization, had at least 3 creatinine tests performed during hospitalization, and had a discharge estimated glomerular filtration rate (eGFR) exceeding 60 mL/min/1.73 m2. Patients with preexisting chronic kidney disease were excluded. Exposure Glomerular filtration rate was estimated from serum creatinine values using the updated 2022 Chronic Kidney Disease Epidemiology Collaboration formula, and eGFR greater than 60 mL/min/1.73 m2 was regarded as normal. Exposure was defined based on the association between the first and last values determined during hospitalization. Main Outcomes and Measures All-cause mortality in the year following the index hospitalization and end-stage kidney disease (ESKD) in the 10 years following the index hospitalization. Results A total of 40 558 patients were included. Median age was 69 (IQR, 56-80) years, with 18 004 women (44%) and 22 554 men (56%). A total of 34 332 patients (85%) were admitted with a normal eGFR and 6226 (15%) with decreased eGFR. Patients with decreased eGFR on presentation had an 18% increased mortality in the year following hospitalization (adjusted hazard ratio [AHR], 1.18; 95% CI, 1.11-1.24) and a 267% increased risk of ESKD in the 10 years following hospitalization (AHR, 3.67; 95% CI, 2.43-5.54), despite having been discharged with apparently normal kidney function. The highest risk was noted in patients who presented to the hospital with an eGFR of 0 to 45 mL/min/1.73 m2. Conclusions and Relevance The findings of this cohort study suggest that patients who present with decreased kidney function and are discharged without clinically evident residual kidney disease may be at increased long-term risk for ESKD and mortality.
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Affiliation(s)
- Orly Efros
- National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pazit Beckerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Nephrology and Hypertension, Sheba Medical Center, Ramat Gan, Israel
| | - Ayelet A Basson
- TIMNA-Israel National Big Data Platform for Health Research, Ministry of Health, Jerusalem, Israel
| | - Roy Cohen
- TIMNA-Israel National Big Data Platform for Health Research, Ministry of Health, Jerusalem, Israel
| | - Eyal Klang
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Frenkel Nir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medical Management, Sheba Medical Center, Ramat Gan, Israel
| | - Shelly Soffer
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel
- Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Noam Barda
- ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel
- Software and Information Systems Engineering, Ben Gurion University, Be'er Sheva, Israel
- Epidemiology, Biostatistics, and Community Health Services, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Ehud Grossman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Medicine Wing, Sheba Medical Center, Ramat Gan, Israel
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Barda N, Lustig Y, Indenbaum V, Zibly D, Joseph G, Asraf K, Weiss-Ottolenghi Y, Amit S, Kliker L, Abd Elkader B, Ben-Ami E, Canetti M, Koren R, Katz-Likvornik S, Halpern O, Mendelson E, Doolman R, Harats D, Kreiss Y, Mandelboim M, Regev-Yochay G. Immunogenicity of Omicron BA.1-adapted BNT162b2 vaccines: randomized trial, 3-month follow-up. Clin Microbiol Infect 2023; 29:918-923. [PMID: 36921715 PMCID: PMC10010049 DOI: 10.1016/j.cmi.2023.03.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES The capability of the SARS-CoV-2 Omicron variant to escape immunity conferred by mRNA vaccines has led to the development of Omicron-adapted vaccines. In this study, we aimed to compare the immune response with the ancestral strain and with the BA.1 Omicron variant after administration of the original vaccine and the Omicron-adapted vaccine. METHODS This is an ongoing phase 3, double-blinded randomized controlled trial, comparing the original BNT161b2 vaccine, monovalent Omicron BA.1-adapted BNT161b2 vaccine, and bivalent combinations. Each vaccine was given at a 30 μg and 60 μg dose. Primary outcomes considered included neutralization titers of SARS-CoV-2 ancestral strain and Omicron BA.1. Exploratory endpoints included neutralization titers for Omicron BA.5, and the incidence of COVID-19 cases. RESULTS Overall, 122 individuals (22, 19, 20, 20, 20, 20, and 21 in each arm) completed a 90-day follow-up. Three months after vaccination, adjusting for baseline levels, neutralizing antibody titers were 0.63 (95% CI: 0.3-1.32) and 0.54 (0.24-1.2) for monovalent/60 μg, 0.9 (0.42-1.92) and 2.69 (1.17-6.17) times for monovalent-Omi.BA.1/30 μg, 1.28 (0.6-2.75) and 2.79 (1.21-6.41) times for monovalent-Omi.BA.1/60 μg, 0.96 (0.46-1.97) and 2.07 (0.93-4.58) times for bivalent-Omi.BA.1/30 μg, and 0.79 (0.38-1.63) and 1.95 (0.88-4.32) times for bivalent-Omi.BA.1/60 μg when compared with BNT162b2/30 μg against the ancestral strain and BA.1 variant, respectively. DISCUSSION BA.1-adapted mRNA vaccines lead to a stronger neutralizing antibody response against the Omicron BA.1 sub-variant.
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Affiliation(s)
- Noam Barda
- ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel; Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Epidemiology, Biostatistics and Community Health Services, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Yaniv Lustig
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Victoria Indenbaum
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Daniel Zibly
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Gili Joseph
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Keren Asraf
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yael Weiss-Ottolenghi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Sharon Amit
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Clinical Microbiology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Limor Kliker
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Bayan Abd Elkader
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Eytan Ben-Ami
- Phase 1 Clinical Trials Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Michal Canetti
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ravit Koren
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Shiri Katz-Likvornik
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Osnat Halpern
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Ella Mendelson
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Ram Doolman
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Dror Harats
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Michal Mandelboim
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Tel Hashomer, Ramat Gan, Israel
| | - Gili Regev-Yochay
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
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Gilboa M, Gonen T, Barda N, Cohn S, Indenbaum V, Weiss-Ottolenghi Y, Amit S, Asraf K, Joseph G, Levin T, Kanaaneh Y, Aydenzon A, Canetti M, Freedman L, Zuckerman N, Mendelson E, Doolman R, Kreiss Y, Regev-Yochay G, Lustig Y. Factors Associated With Protection From SARS-CoV-2 Omicron Variant Infection and Disease Among Vaccinated Health Care Workers in Israel. JAMA Netw Open 2023; 6:e2314757. [PMID: 37219906 DOI: 10.1001/jamanetworkopen.2023.14757] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Importance A correlation between antibody levels and risk of infection has been demonstrated for the wild-type, Alpha, and Delta SARS-COV-2 variants. High rates of breakthrough infections by the Omicron variant emphasized the need to investigate whether the humoral response elicited by mRNA vaccines is also associated with reduced risk of Omicron infection and disease. Objective To investigate whether the high antibody levels in individuals who have received at least 3 doses of an mRNA vaccine are associated with reduced risk of Omicron infection and disease. Design, Setting, and Participants This prospective cohort study used serial real time-polymerase chain reaction (RT-PCR) and serological test data from January and May 2022 to assess the association of preinfection immunoglobin G (IgG) and neutralizing antibody titers with incidence of Omicron variant infection, incidence of symptomatic disease, and infectivity. Participants included health care workers who had received 3 or 4 doses of an mRNA COVID-19 vaccine. Data were analyzed from May to August 2022. Exposures Levels of SARS-CoV-2 anti-receptor binding domain IgG and neutralizing antibodies. Main Outcomes and Measures The main outcomes were incidence of Omicron infection, incidence of symptomatic disease, and infectivity. Outcomes were measured using SARS-COV-2 PCR and antigen testing and daily online surveys regarding symptomatic disease. Results This study included 3 cohorts for 3 different analyses: 2310 participants were included in the protection from infection analysis (4689 exposure events; median [IQR] age, 50 [40-60] years; 3590 [76.6%] among female health care workers), 667 participants (median [IQR] age, 46.28 (37.44,54.8); 516 [77.4%] female) in the symptomatic disease analysis, and 532 participants (median [IQR] age, 48 [39-56] years; 403 [75.8%] female) in the infectivity analysis. Lower odds of infection were observed for each 10-fold increase in preinfection IgG (odds ratio [OR], 0.71; 95% CI, 0.56-0.90) and for each 2-fold increase in neutralizing antibody titers (OR, 0.89; 95% CI, 0.83-0.95). The odds of substantial symptomatic disease were reduced for each 10-fold increase in IgG levels (OR, 0.48; 95% CI, 0.29-0.78) and for each 2-fold increase in neutralizing antibodies levels (OR, 0.86; 95% CI, 0.76-0.96). Infectivity, assessed by mean cycle threshold value, was not significantly decreased with increasing IgG or neutralizing antibodies titers. Conclusions and Relevance In this cohort study of vaccinated health care workers, IgG and neutralizing antibody titer levels were associated with protection against infection with the Omicron variant and against symptomatic disease.
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Affiliation(s)
- Mayan Gilboa
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tal Gonen
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Noam Barda
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
- ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel
- Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Shelly Cohn
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Victoria Indenbaum
- Central Virology Laboratory, Public Health Directorate, Ministry of Health, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Weiss-Ottolenghi
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Sharon Amit
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Clinical Microbiology, Sheba Medical Center, Ramat Gan, Israel
| | - Keren Asraf
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Ramat-Gan, Israel
| | - Gili Joseph
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Tal Levin
- Central Virology Laboratory, Public Health Directorate, Ministry of Health, Sheba Medical Center, Ramat Gan, Israel
| | - Yara Kanaaneh
- Central Virology Laboratory, Public Health Directorate, Ministry of Health, Sheba Medical Center, Ramat Gan, Israel
| | - Alex Aydenzon
- Central Virology Laboratory, Public Health Directorate, Ministry of Health, Sheba Medical Center, Ramat Gan, Israel
| | - Michal Canetti
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Laurence Freedman
- Biostatistics and Biomathematics Unit, Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
| | - Neta Zuckerman
- Central Virology Laboratory, Public Health Directorate, Ministry of Health, Sheba Medical Center, Ramat Gan, Israel
| | - Ella Mendelson
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Directorate, Ministry of Health, Sheba Medical Center, Ramat Gan, Israel
| | - Ram Doolman
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Ramat-Gan, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- General Management, Sheba Medical Center, Ramat Gan, Israel
| | - Gili Regev-Yochay
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Ramat Gan, Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Directorate, Ministry of Health, Sheba Medical Center, Ramat Gan, Israel
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Canetti M, Barda N, Gilboa M, Indenbaum V, Mandelboim M, Gonen T, Asraf K, Weiss-Ottolenghi Y, Amit S, Doolman R, Mendelson E, Harats D, Freedman LS, Kreiss Y, Lustig Y, Regev-Yochay G. Author Correction: Immunogenicity and efficacy of fourth BNT162b2 and mRNA1273 COVID-19 vaccine doses; three months follow-up. Nat Commun 2023; 14:1593. [PMID: 36949080 PMCID: PMC10032242 DOI: 10.1038/s41467-023-37338-7] [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: 03/24/2023] Open
Affiliation(s)
- Michal Canetti
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Noam Barda
- ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Mayan Gilboa
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Victoria Indenbaum
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Michal Mandelboim
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Tal Gonen
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Keren Asraf
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Yael Weiss-Ottolenghi
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sharon Amit
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Clinical Microbiology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ram Doolman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Ella Mendelson
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Dror Harats
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Laurence S Freedman
- Biostatistics and Biomathematics Unit, Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Gili Regev-Yochay
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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9
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Regev-Yochay G, Lustig Y, Joseph G, Gilboa M, Barda N, Gens I, Indenbaum V, Halpern O, Katz-Likvornik S, Levin T, Kanaaneh Y, Asraf K, Amit S, Rubin C, Ziv A, Koren R, Mandelboim M, Tokayer NH, Meltzer L, Doolman R, Mendelson E, Alroy-Preis S, Kreiss Y. Correlates of protection against COVID-19 infection and intensity of symptomatic disease in vaccinated individuals exposed to SARS-CoV-2 in households in Israel (ICoFS): a prospective cohort study. Lancet Microbe 2023; 4:e309-e318. [PMID: 36963419 PMCID: PMC10030121 DOI: 10.1016/s2666-5247(23)00012-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Identifying COVID-19 correlates of protection and immunity thresholds is important for policy makers and vaccine development. We aimed to identify correlates of protection of BNT162b2 (Pfizer-BioNTech) vaccination against COVID-19. METHODS In this prospective cohort study, households within a radius of 40 km of the Sheba Medical Center in Israel in which a new SARS-CoV-2 infection (defined as the index case) was detected within the previous 24 h were approached between July 25 and Nov 15, 2021. We included adults (aged >18 years) who had received one or two vaccine doses, had an initial negative SARS-CoV-2 PCR and no previous infection reported, and had a valid IgG and neutralising antibody result. The exposure of interest was baseline immune status, including IgG antibody concentration, neutralising antibody titre, and T-cell activation. The outcomes of interest were PCR-positive SARS-CoV-2 infection between day 2 and day 21 of follow-up and intensity of disease symptoms (self-reported via a telephone questionnaire) among participants who had a confirmed infection. Multivariable logistic and ordered logit ordinal regressions were used for the adjusted analysis. To identify immunological thresholds for clinical protection, we estimated the conditional probability of infection and moderate or severe disease for individuals with pre-exposure IgG and neutralising antibody concentrations above each value observed in the study data. FINDINGS From 16 675 detected index cases in the study region, 5718 household members agreed to participate, 1461 of whom were eligible to be included in our study. 333 (22·8%) of 1461 household members who were not infected with SARS-CoV-2 at baseline were infected within 21 days of follow-up. The baseline (pre-exposure) IgG and neutralising antibodies were higher in participants who remained uninfected than in those who became infected (geometric mean IgG antibody concentration 168·2 binding antibody units [BAU] per mL [95% CI 158·3-178·7] vs 130·5 BAU/mL [118·3-143·8] and geometric mean neutralising antibody titre 197·5 [181·9-214·4] vs 136 ·7 [120·3-155·4]). Increasing IgG and neutralising antibody concentrations were also significantly associated with a reduced probability of increasing disease severity. Odds of infection were significantly reduced each time baseline IgG antibody concentration increased by a factor of ten (odds ratio [OR] 0·43 [95% CI 0·26-0·70]) and each time baseline neutralising antibody titre increased by a factor of two (0·82 [0·74-0·92]). In our cohort, the probability of infection if IgG antibody concentrations were higher than 500 BAU/mL was 11% and the probability of moderate disease severity was 1%; the probability of infection if neutralising antibody titres were above or equal to 1024 was 8% and the probability of moderate disease severity was 2%. T-cell activation rates were not significantly associated with reduced probability of infection (OR 1·04, 95% CI 0·83-1·30). INTERPRETATION Both IgG and neutralising antibodies are correlates of protection against SARS-CoV-2 infection. Our data suggest that IgG concentrations higher than 500 BAU/mL and neutralising antibody titres of 1024 or more are thresholds for immunological protection from SARS-CoV-2 delta variant infection. Potentially, updated protective thresholds against emerging variants of concern could be calculated, which could support decision makers on administration of new vaccination strategies and on the optimal period between vaccine doses. FUNDING Israeli Ministry of Health.
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Affiliation(s)
- Gili Regev-Yochay
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Gili Joseph
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Mayan Gilboa
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Noam Barda
- ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel; Department of Software and Information Systems Engineering, and Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Ilana Gens
- Public Health Services, Israeli Ministry of Health, Jerusalem, Israel
| | - Victoria Indenbaum
- Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Osnat Halpern
- Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Shiri Katz-Likvornik
- Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Tal Levin
- Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Yara Kanaaneh
- Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Keren Asraf
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Ramat Gan, Israel
| | - Sharon Amit
- Clinical Microbiology, Sheba Medical Center, Ramat Gan, Israel; Clinical Microbiology, Sheba Medical Center, Ramat Gan, Israel
| | - Carmit Rubin
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Arnona Ziv
- Data Management Unit, Gerner Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Ravit Koren
- Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Michal Mandelboim
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | - Noam H Tokayer
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Lilac Meltzer
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Ram Doolman
- Data Management Unit, Gerner Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Ella Mendelson
- Central Virology Laboratory, Public Health Services, Ministry of Health, Ramat Gan, Israel
| | | | - Yitshak Kreiss
- General Management, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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10
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Hayek S, Libresco G, Barda N, Chao C, Xu L, Cannavale KL, Izraeli S, Armenian SH. Chronic health conditions among long-term survivors of adolescent and young adult (AYA) cancer: A comparison of outcomes in Israel and the United States. Cancer 2023; 129:1763-1776. [PMID: 36929478 DOI: 10.1002/cncr.34740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/17/2023] [Accepted: 02/13/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND There is a paucity of information on health outcomes of adolescent and young adult (AYA) cancer survivors living outside North America and Europe. This study compared outcomes in AYA cancer survivors in Israel with individuals without cancer and similar demographics and access to health care, and to AYA cancer survivors living in the United States. METHODS This study included 12,674 2-year survivors of AYA (aged 15-39 years) cancer diagnosed between 2000 and 2018 at Clalit Health Services (CHS) in Israel. CHS participants without cancer (N = 50,696) were matched 4:1 to survivors on age, sex, ethnicity, and membership duration. Poisson regression was used to determine incidence rate ratios (IRRs) for chronic conditions. The US Kaiser Permanente Southern California AYA cohort (N = 6778) was used to estimate weighted (age, sex) standardized incidence ratios (SIRs) for CHS survivors. RESULTS CHS AYA cancer survivors were more likely to have any chronic condition (IRR, 1.6 95% CI, 1.5-1.7), compared with participants without cancer. Survivors had an increased risk across nearly all conditions examined, with especially elevated risks for osteoporosis (IRR, 4.7; 95% CI, 4.1-5.5) and cardiomyopathy (IRR, 4.2 95% CI, 3.4-5.3). Compared with the Kaiser Permanente Southern California cohort, CHS survivors had an overall lower (SIR, 0.68; 95% CI, 0.65-0.72) incidence of developing any health condition, with noticeably lower incidence of hyperlipidemia (SIR, 0.7; 95% CI, 0.64-0.75). CONCLUSION AYA cancer survivors in Israel are at increased risk for developing chronic conditions compared with individuals without cancer, but the overall incidence was lower than in US survivors. These findings may allow for refinement of surveillance recommendations for AYA survivors, taking into consideration regional differences in sociodemographic characteristics and cancer care. PLAIN LANGUAGE SUMMARY The burden of chronic conditions was consistently greater in Israeli adolescent and young adult cancer survivors compared with individuals without cancer, with clear differences in risk of specific conditions by cancer diagnosis. However, the overall incidence of chronic conditions in Israeli survivors was generally lower than in US survivors.
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Affiliation(s)
- Samah Hayek
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel.,Department of Epidemiology, School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Libresco
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
| | - Noam Barda
- ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel.,Software and Information Systems Engineering, Ben-Gurion University, Be'er Sheva, Israel.,Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Chun Chao
- Kaiser Permanente Southern California, Pasadena, California, USA
| | - Lanfang Xu
- MedHealth Statistical Consulting, Solon, Ohio, USA
| | | | - Shai Izraeli
- Division of Pediatric Hematology, Oncology, Schneider Children's Medical Center, Tel-Aviv, Israel.,Department of Molecular Genetics and Biochemistry, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Systems Biology, Beckman Research Institute, City of Hope, Duarte, California, USA
| | - Saro H Armenian
- Department of Population Sciences, City of Hope, Duarte, California, USA.,Department of Pediatrics, City of Hope, Duarte, California, USA
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Barda N. The ups and downs of observational vaccine research. Lancet Infect Dis 2023:S1473-3099(23)00119-6. [PMID: 36913962 PMCID: PMC10005785 DOI: 10.1016/s1473-3099(23)00119-6] [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] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 03/12/2023]
Affiliation(s)
- Noam Barda
- Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be'er Sheva 8410501, Israel; Epidemiology, Biostatistics and Community Health Services, Ben-Gurion University of the Negev, Be'er Sheva 8410501, Israel; ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
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12
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Lahat A, Klang E, Rahman N, Halabi N, Avidan B, Barda N. Utility of early colonoscopy for acute lower gastrointestinal bleeding: a retrospective cohort study. Therap Adv Gastroenterol 2023; 16:17562848221147757. [PMID: 36644128 PMCID: PMC9837264 DOI: 10.1177/17562848221147757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/09/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Early colonoscopy (within 8-24 h) is recommended in different guidelines for acute lower gastrointestinal bleeding (LGIB). Despite this recommendation, evidence for its effectiveness are conflicting, and early colonoscopy is often not performed. OBJECTIVES We aimed to evaluate the utility of early colonoscopy by examining the findings during the procedure, and by comparing in-hospital and long-term outcomes between patients who did and did not undergo early colonoscopy. DESIGN This is a retrospective cohort study based on the electronic medical records of a large tertiary hospital in Israel. METHODS All patients hospitalized with acute LGIB to acute wards between 2012 and 2022 were included. First, structured and free-text procedure notes from patients who did undergo early colonoscopy were examined. Second, we compared in-hospital and long-term outcomes between patients who did and did not undergo early colonoscopy while adjusting for possible confounders using multivariable regression of the type appropriate for each outcome. RESULTS Overall, 953 patients were included, of which 90 underwent early colonoscopy. The majority (54%) were found insufficiently prepared. Common findings were diverticulosis (38%) and colon polyps (20%). The procedure was effective for hemostasis in only 13% of the cases. Early colonoscopy was not significantly associated with increased survival (exponentiated coefficient = 1.19, 95% CI: 0.76, 1.87), decreased length of hospitalization (exponentiated coefficient = 1.08, 95% CI: 0.97, 1.21), or increased blood hemoglobin at discharge (coefficient =-0.27, 95% CI: -0.58, 0.03). CONCLUSIONS Early colonoscopy was often not effective and was not associated with significantly improved outcomes.
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Affiliation(s)
| | - Eyal Klang
- ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel,Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nisim Rahman
- ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel
| | - Nitzan Halabi
- ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel
| | - Benjamin Avidan
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Barda
- ARC Innovation Center, Sheba Medical Center, Ramat Gan, Israel,Department of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be’er Sheva, Israel,Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
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13
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Canetti M, Barda N, Gilboa M, Indenbaum V, Mandelboim M, Gonen T, Asraf K, Weiss-Ottolenghi Y, Amit S, Doolman R, Mendelson E, Harats D, Freedman LS, Kreiss Y, Lustig Y, Regev-Yochay G. Immunogenicity and efficacy of fourth BNT162b2 and mRNA1273 COVID-19 vaccine doses; three months follow-up. Nat Commun 2022; 13:7711. [PMID: 36513665 PMCID: PMC9745767 DOI: 10.1038/s41467-022-35480-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Booster doses for the ongoing COVID-19 pandemic are under consideration in many countries. We report a three-month follow-up of 700 participants in a fourth vaccine dose study, comparing BNT162b2 and mRNA1273, administered four months after a third BNT162b2 dose. The primary outcomes are the levels of IgG, neutralizing antibodies, and microneutralization and the secondary outcomes are the levels of IgA and T cell activation, and clinical outcomes of SARS-CoV-2 infection and substantial symptomatic disease. Waning of the immune response is evident during follow-up, with an 11% (β = 0.89, 95% CI, 0.88-0.9) and 21% (β = 0.79, 95% CI, 0.76-0.82) multiplicative decay per week of IgG and neutralizing antibodies, respectively, in the mRNA1273 group, and of 14% (β = 0.86, 95% CI, 0.86-0.87) and 26% (β = 0.74, 95% CI, 0.72-0.76), respectively, in the BNT162b2 group. Direct neutralization of Omicron variants is low relative to ancestral strains. Cumulatively over the study period, both vaccines show little efficacy against infection but were highly efficacious against substantial symptomatic disease [89% [(IRR 0.11, 95% CI, 0.02-0.37) and 71% (IRR 0.29, 95% CI, 0.13-0.57) for mRNA1273 and BNT162b2, respectively]. These results are informative for further boosting policy-making. Trial registration numbers (clinicaltrials.gov): NCT05231005 and NCT05230953.
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Affiliation(s)
- Michal Canetti
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Noam Barda
- ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Mayan Gilboa
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Victoria Indenbaum
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Michal Mandelboim
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Tal Gonen
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Keren Asraf
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Yael Weiss-Ottolenghi
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sharon Amit
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Clinical Microbiology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ram Doolman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Ella Mendelson
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Dror Harats
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Laurence S Freedman
- Biostatistics and Biomathematics Unit, Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Gili Regev-Yochay
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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14
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Dagan N, Barda N. Effectiveness of first-generation severe acute respiratory syndrome coronavirus 2 mRNA vaccines against the Omicron variant. Clin Microbiol Infect 2022; 28:1526-1527. [PMID: 36038121 PMCID: PMC9420321 DOI: 10.1016/j.cmi.2022.08.017] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/18/2022] [Accepted: 08/20/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Noa Dagan
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel,Software and Information Systems Engineering, Ben Gurion University, Be'er, Sheva, Israel,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA,Corresponding author. Noa Dagan, Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, 5252247, Israel
| | - Noam Barda
- Software and Information Systems Engineering, Ben Gurion University, Be'er, Sheva, Israel,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA,Accelerate Redesign Collaborate Innovation Center, Sheba Medical Center, Ramat-Gan, Israel
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15
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Canetti M, Barda N, Gilboa M, Indenbaum V, Asraf K, Gonen T, Weiss-Ottolenghi Y, Amit S, Doolman R, Mendelson E, Freedman LS, Kreiss Y, Lustig Y, Regev-Yochay G. Six-Month Follow-up after a Fourth BNT162b2 Vaccine Dose. N Engl J Med 2022; 387:2092-2094. [PMID: 36351266 PMCID: PMC9730934 DOI: 10.1056/nejmc2211283] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Noam Barda
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Mayan Gilboa
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | | | - Keren Asraf
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Tal Gonen
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | | | - Sharon Amit
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
| | - Ram Doolman
- Sheba Medical Center Tel Hashomer, Ramat Gan, Israel
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16
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Barda N, Canetti M, Gilboa M, Asraf K, Indenboim V, Weiss-Ottolenghi Y, Amit S, Zubli D, Doolman R, Mendelson E, Freedman LS, Kreiss Y, Lustig Y, Regev-Yochay G. The Association Between Pre-Booster Vaccination Antibody Levels and the Risk of SARS-CoV-2 Infection. Clin Infect Dis 2022; 76:1315-1317. [PMID: 36366729 DOI: 10.1093/cid/ciac886] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
The correlation between Anti-SARS-CoV-2 antibody levels and infection was reported. Here, we estimated the role of pre-fourth-dose levels using data from 1,098 health-care-workers. The risk of infection was reduced by 46% (95% CI: 29-59%) with a 10-fold increase in pre-booster levels. Pre-booster antibody levels could be used to optimally time boosters.
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Affiliation(s)
- Noam Barda
- ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be’er Sheva , Israel
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
| | - Michal Canetti
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
| | - Mayan Gilboa
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
| | - Keren Asraf
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan , Israel
| | - Victoria Indenboim
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health , Tel-Hashomer, Ramat Gan , Israel
| | - Yael Weiss-Ottolenghi
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
| | - Sharon Amit
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
- Clinical Microbiology, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
| | - Daniel Zubli
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
| | - Ram Doolman
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health , Tel-Hashomer, Ramat Gan , Israel
| | - Ella Mendelson
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan , Israel
| | - Laurence S Freedman
- Biostatistics and Biomathematics Unit, Gertner Institute of Epidemiology and Health Policy Research , Sheba Medical Center, Tel Hashomer , Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
- General Management , Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health , Tel-Hashomer, Ramat Gan , Israel
| | - Gili Regev-Yochay
- The Sheba Pandemic Preparedness Research Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan , Israel
- Sackler School of Medicine, Tel-Aviv University , Tel Aviv , Israel
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17
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Miron O, Barda N, Balicer R, Kor A, Lev‐Ran S. Association of opioid use disorder with healthcare utilization and cost in a public health system. Addiction 2022; 117:2880-2886. [PMID: 35638374 PMCID: PMC9796021 DOI: 10.1111/add.15963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/01/2022] [Indexed: 12/30/2022]
Abstract
AIM To quantify the healthcare costs associated with opioid use disorder among members in a public healthcare system and compare them with healthcare costs in the general population. DESIGN Retrospective cohort study. SETTING Inpatient and outpatient care settings of Israel's largest public healthcare provider (that covers 4.7 million members). PARTICIPANTS Participants included 1173 members who had a diagnosis of opioid use disorder in the years between 2013 and 2018. Each patient was matched with 10 controls based on age and sex. MEASUREMENTS The main outcome was monthly healthcare costs. FINDINGS The mean monthly healthcare cost of members with opioid use disorder was $1102 compared with $211 among controls (5.2-fold difference; 95% CI, 4.6-6.0). After excluding members with heroin related diagnoses before the index date (to focus on prescription opioids), this healthcare cost ratio did not substantially change (4.6-fold; 95% CI, 3.9-5.4). Members with opioid use disorder under the age of 65 years had a cost difference of 6.1-fold (95% CI, 5.2-7.1), whereas those 65 years and older experienced cost difference of 3.4-fold (95% CI, 2.6-4.5), compared with controls. The category with the highest cost for members with opioid use disorder was inpatient services, which was 8.7-fold (95%CI, 7.2-10.4) greater than among controls. CONCLUSIONS Healthcare costs among individuals with opioid use disorder in Israel's public health system are substantially higher than among controls, at least partially attributable to prescription opioid use disorder. Differences are greater among individuals under 65 years.
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Affiliation(s)
- Oren Miron
- Clalit Research InstituteClalit Health ServicesRamat GanIsrael
- School of Public HealthBen‐Gurion University of the NegevBeer ShevaIsrael
| | - Noam Barda
- ARC Innovation CenterSheba Medical CenterRamat‐GanIsrael
- Software and Information Systems EngineeringBen‐Gurion University of the NegevBeer ShevaIsrael
- Department of Biomedical InformaticsHarvard Medical SchoolBostonMAUSA
| | - Ran Balicer
- Clalit Research InstituteClalit Health ServicesRamat GanIsrael
- School of Public HealthBen‐Gurion University of the NegevBeer ShevaIsrael
| | - Ariel Kor
- Israel Center on AddictionNetanyaIsrael
- Yale University School of MedicineNew HavenCTUSA
| | - Shaul Lev‐Ran
- Israel Center on AddictionNetanyaIsrael
- Department of Psychiatry, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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18
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Barda N, Canetti M, Gilboa M, Indenboim V, Asraf K, Weiss-Ottolenghi Y, Amit S, Zibly D, Doolman R, Mendelson E, Harats D, Freedman LS, Kreiss Y, Lustig Y, Regev-Yochay G. Comparing immunogenicity and efficacy of two different mRNA-based COVID-19 vaccines as a fourth dose; six-month follow-up, Israel, 27 December 2021 to 24 July 2022. Euro Surveill 2022; 27:2200701. [PMID: 36177870 PMCID: PMC9524052 DOI: 10.2807/1560-7917.es.2022.27.39.2200701] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/29/2022] [Indexed: 06/01/2023] Open
Abstract
We assess the immunogenicity and efficacy of Spikevax and Comirnaty as fourth dose COVID-19 vaccines. Six months post-fourth-dose, IgG levels were higher than pre-fourth dose at 1.58-fold (95% CI: 1.27-1.97) in Spikevax and 1.16-fold (95% CI: 0.98-1.37) in Comirnaty vaccinees. Nearly 60% (159/274) of vaccinees contracted SARS-CoV-2. Infection hazard ratios (HRs) for Spikevax (0.82; 95% CI: 0.62-1.09) and Comirnaty (0.86; 95% CI: 0.65-1.13) vaccinees were similar, as were substantial-disease HRs, i.e. 0.28 (95% CI: 0.13-0.62) and 0.51 (95% CI: 0.27-0.96), respectively.
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Affiliation(s)
- Noam Barda
- ARC Innovation Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Software and Information Systems Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Epidemiology, Biostatistics and Community Health Services, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Michal Canetti
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Mayan Gilboa
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Victoria Indenboim
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Keren Asraf
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Yael Weiss-Ottolenghi
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sharon Amit
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Clinical Microbiology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Daniel Zibly
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ram Doolman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Ella Mendelson
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Dworman Automated-Mega Laboratory, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Dror Harats
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Laurence S Freedman
- Biostatistics and Biomathematics Unit, Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Yitshak Kreiss
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- General Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Yaniv Lustig
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Tel-Hashomer, Ramat Gan, Israel
| | - Gili Regev-Yochay
- The Infection Prevention & Control Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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19
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Kliker L, Zuckerman N, Atari N, Barda N, Gilboa M, Nemet I, Abd Elkader B, Fratty IS, Jaber H, Mendelson E, Alroy-Preis S, Kreiss Y, Regev-Yochay G, Mandelboim M. COVID-19 vaccination and BA.1 breakthrough infection induce neutralising antibodies which are less efficient against BA.4 and BA.5 Omicron variants, Israel, March to June 2022. Euro Surveill 2022; 27:2200559. [PMID: 35904058 PMCID: PMC9336169 DOI: 10.2807/1560-7917.es.2022.27.30.2200559] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Indexed: 01/09/2023] Open
Abstract
This work evaluated neutralising antibody titres against wild type (WT) SARS-CoV-2 and four Omicron variants (BA.1, BA.2, BA.4 and BA.5) in healthcare workers who had breakthrough BA.1 infection. Omicron breakthrough infection in individuals vaccinated three or four times before infection resulted in increased neutralising antibodies against the WT virus. The fourth vaccine dose did not further improve the neutralising efficiency over the third dose against all Omicron variants, especially BA.4 and BA.5. An Omicron-specific vaccine may be indicated.
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Affiliation(s)
- Limor Kliker
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Neta Zuckerman
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel
| | - Nofar Atari
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel
| | - Noam Barda
- Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Ital Nemet
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel
| | - Bayan Abd Elkader
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel
| | - Ilana S Fratty
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel,Public Health Services, Ministry of Health, Jerusalem, Israel
| | | | - Ella Mendelson
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Gili Regev-Yochay
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,Sheba Medical Center, Tel-Hashomer, Israel
| | - Michal Mandelboim
- Central Virology Laboratory, Public Health Services, Ministry of Health and Sheba Medical Center, Tel-Hashomer, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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20
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Cohen-Stavi CJ, Magen O, Barda N, Yaron S, Peretz A, Netzer D, Giaquinto C, Judd A, Leibovici L, Hernán MA, Lipsitch M, Reis BY, Balicer RD, Dagan N. BNT162b2 Vaccine Effectiveness against Omicron in Children 5 to 11 Years of Age. N Engl J Med 2022; 387:227-236. [PMID: 35767475 PMCID: PMC9258754 DOI: 10.1056/nejmoa2205011] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [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: 12/29/2022]
Abstract
BACKGROUND Limited evidence is available on the real-world effectiveness of the BNT162b2 vaccine against coronavirus disease 2019 (Covid-19) and specifically against infection with the omicron variant among children 5 to 11 years of age. METHODS Using data from the largest health care organization in Israel, we identified a cohort of children 5 to 11 years of age who were vaccinated on or after November 23, 2021, and matched them with unvaccinated controls to estimate the vaccine effectiveness of BNT162b2 among newly vaccinated children during the omicron wave. Vaccine effectiveness against documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and symptomatic Covid-19 was estimated after the first and second vaccine doses. The cumulative incidence of each outcome in the two study groups through January 7, 2022, was estimated with the use of the Kaplan-Meier estimator, and vaccine effectiveness was calculated as 1 minus the risk ratio. Vaccine effectiveness was also estimated in age subgroups. RESULTS Among 136,127 eligible children who had been vaccinated during the study period, 94,728 were matched with unvaccinated controls. The estimated vaccine effectiveness against documented infection was 17% (95% confidence interval [CI], 7 to 25) at 14 to 27 days after the first dose and 51% (95% CI, 39 to 61) at 7 to 21 days after the second dose. The absolute risk difference between the study groups at days 7 to 21 after the second dose was 1905 events per 100,000 persons (95% CI, 1294 to 2440) for documented infection and 599 events per 100,000 persons (95% CI, 296 to 897) for symptomatic Covid-19. The estimated vaccine effectiveness against symptomatic Covid-19 was 18% (95% CI, -2 to 34) at 14 to 27 days after the first dose and 48% (95% CI, 29 to 63) at 7 to 21 days after the second dose. We observed a trend toward higher vaccine effectiveness in the youngest age group (5 or 6 years of age) than in the oldest age group (10 or 11 years of age). CONCLUSIONS Our findings suggest that as omicron was becoming the dominant variant, two doses of the BNT162b2 messenger RNA vaccine provided moderate protection against documented SARS-CoV-2 infection and symptomatic Covid-19 in children 5 to 11 years of age. (Funded by the European Union through the VERDI project and others.).
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Affiliation(s)
- Chandra J Cohen-Stavi
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Ori Magen
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Noam Barda
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Shlomit Yaron
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Alon Peretz
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Doron Netzer
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Carlo Giaquinto
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Ali Judd
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Leonard Leibovici
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Miguel A Hernán
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Marc Lipsitch
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Ben Y Reis
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Ran D Balicer
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
| | - Noa Dagan
- From the Clalit Research Institute, Innovation Division (C.J.C.-S., O.M., R.D.B., N.D.), and the Community Medicine Division (S.Y., A.P., D.N.), Clalit Health Services, and the Faculty of Medicine, Tel-Aviv University (L.L.), Tel Aviv, the Research Authority, Rabin Medical Center, Petah-Tiqva (L.L.), the ARC (Accelerate Redesign Collaborate) Innovation Center, Chaim Sheba Medical Center at Tel HaShomer, Ramat-Gan (N.B.), Software and Information Systems Engineering (N.B., N.D.), and the School of Public Health (R.D.B.), Ben Gurion University of the Negev, Be'er Sheva, and the School of Public Health, University of Haifa, Haifa (A.P.) - all in Israel; the Departments of Biomedical Informatics (N.B., B.Y.R., N.D.) and Pediatrics (B.Y.R.), Harvard Medical School, CAUSALab, Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, Harvard Medical School and Clalit Research Institute (B.Y.R., R.D.B., N.D.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston; the Department of Women and Child Health, University of Padua, Padua, Italy (C.G.); and the Medical Research Council Clinical Trials Unit, University College London, London (A.J.)
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21
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Bielopolski D, Libresco G, Barda N, Dagan N, Steinmetz T, Yahav D, Charytan DM, Balicer RD, Rozen-Zvi B. BNT162b2 vaccine effectiveness in chronic kidney disease patients – an observational study. Clin Kidney J 2022; 15:1838-1846. [PMID: 36147707 PMCID: PMC9384353 DOI: 10.1093/ckj/sfac166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
chronic kidney disease (CKD) is a risk factor for severe COVID-19. We aimed to evaluate real-life effectiveness of the BNT162b2 mRNA vaccine for a range of outcomes in patients with CKD compared to matched controls.
Methods
Data from Israel's largest healthcare organization were retrospectively used. Vaccinated CKD (eGFR<60ml/min/1.73m2) and maintenance dialysis patients were matched to vaccinated controls without CKD (eGFR> = 60ml/min/1.73m2) according to demographic and clinical characteristics. Study outcomes included documented infection with SARS-CoV-2, symptomatic infection, COVID-19 related hospitalization, severe disease, and death. Vaccine effectiveness was estimated as the risk ratio [RR] at days 7-28 following the second vaccine dose, using the Kaplan–Meier estimator. Effectiveness measures were also evaluated separately for various stages of CKD.
Results
There were 67,861 CKD patients not treated with dialysis, 2,606 hemodialysis patients, and 70,467 matched controls. The risk of sever disease (RR1.84, 95% CI 0.95-2.67) and death (RR 2.00, 95% CI 0.99-5.20) was increased in non-dialysis CKD patients compared with controls without CKD following vaccination.
For the subgroup of patients with eGFR below 30 ml/min/1.73m2, the risk of severe disease and death was increased compared to controls (RR 6.42, 95% CI 1.85-17.51 and RR 8.81, 95% CI 1.63-13.81, respectively). The risks for all study outcomes was increased in hemodialysis patients, compared with controls.
Conclusion
Two doses of the BNT162b2 vaccine were found less efficient for patients with eGFR<30ml/min/1.73m2. Risk in hemodialysis patients is increased for all outcomes. These results suggest prioritizing patients with eGFR<30ml/min/1.73m2 for booster shots, pre and post exposure prophylaxis, and early COVID-19 therapy.
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Affiliation(s)
| | - Gilad Libresco
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel
| | - Noam Barda
- ARC Innovation Center, Sheba Medical Center, Ramat-Gan, Israel
- Department of Software and Information Systems Engineering, Ben Gurion University, Be'er Sheva, Israel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Noa Dagan
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel
- Department of Software and Information Systems Engineering, Ben Gurion University, Be'er Sheva, Israel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Ramat-Gan, Israel
| | - Tali Steinmetz
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dafna Yahav
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Infectious Diseases Unit, Rabin Medical Center, Petah-Tikva, Israel
| | - David M Charytan
- Nephrology Division, New York University Langone Medical Center and Grossman School of Medicine, New York, NY, USA
| | - Ran D Balicer
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel
- Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Ramat-Gan, Israel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Benaya Rozen-Zvi
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Hayek S, Libresco G, Barda N, Chao C, Lanfang X, Cannavale KL, Izraeli S, Armenian S. The burden of long-term complications among adolescent and young adult cancer survivors: An international comparison of two large cohorts. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e24059] [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: 11/20/2022] Open
Abstract
e24059 Background: There is a paucity of information on health outcomes of adolescent and young adult (AYA) cancer survivors outside of Northern Europe or North America. We compared long-term health outcomes of Israeli AYA cancer survivors to non-cancer individuals with similar demographics and access to healthcare, estimated the risk of developing chronic health conditions by cancer type, and compared the comorbidity burden in Israeli AYA survivors to AYA cancer survivors from the U.S. Methods: This was a retrospective cohort of 2-year cancer survivors diagnosed with invasive cancer between 15 to 39 years of age from 2000 to 2018 in Clalit Health Services (CHS), the largest payer-provider healthcare organization in Israel. Non-cancer CHS participants were matched 4:1 to cancer survivors on age, sex, ethnicity, and membership duration. Health conditions were limited to those requiring medical intervention. Incidence rates for health conditions were determined for the two cohorts, and Poisson regression was used to determine the incidence rate ratio (IRR) with associated 95% confidence intervals (CI). A sub-population of CHS AYA survivors was used to compare the incidence of chronic health conditions from the Israeli cohort to AYA cancer survivors from Kaiser Permanente Southern California (KPSC), using Standardized Incidence Rate (SIR). Results: There were 12,674 CHS AYA cancer survivors and 50,696 non-cancer participants. Among survivors, the mean age at diagnosis was 31.02 years (SD: 6.2), 61.7% were female, and 78.4% were Jewish. The most common cancer diagnoses were lymphoma (16.5%), breast (16.4%), and thyroid (14.0%). Cancer survivors were significantly more likely to have any (IRR 1.60 95%CI: 1.54-1.67) or multiple (IRR 1.82 95%CI: 1.72-1.94) chronic health conditions compared to non-cancer participants. Survivors had an increased risk across nearly all examined outcomes, with an especially higher risk for premature ovarian failure (IRR 6.02 95%CI: 2.14-16.91), osteoporosis (IRR 4.74 95%CI: 4.06-5.53), and cardiomyopathy (IRR 4.20 95%CI: 3.35-5.27). We also found clear differences in the risk of specific health conditions by cancer type. Compared to the KPSC cohort, CHS cancer survivors had an overall lower (SIR 0.82 95%CI: 0.79-0.84) incidence of developing any health condition, with noticeably lower incidences of hypertension, hyperlipidemia, chronic liver disease, but higher incidences of cardiopulmonary diseases and osteoporosis. Conclusions: AYA cancer survivors in Israel are at increased risk for developing chronic conditions, compared matched non-cancer individuals, but the overall incidence of was lower when compared to survivors living in the U.S. These findings may allow for refinement of surveillance recommendations for AYA survivors, taking into consideration regional differences in socio-demographics and cancer care.
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Affiliation(s)
| | | | - Noam Barda
- Clalit Research Institute, Tel Aviv, Israel
| | - Chun Chao
- Kaiser Permanente Southern California, Pasadena, CA
| | - Xu Lanfang
- Kaiser Permanente Southern California, Pasadena, CA
| | - Kimberly L. Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Shai Izraeli
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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Shepshelovich D, Barda N, Goldvaser H, Dagan N, Zer A, Diker-Cohen T, Balicer R, Gafter-Gvili A. Incidence of lung cancer following pneumonia in smokers: a population-based study. QJM 2022; 115:287-291. [PMID: 33576784 DOI: 10.1093/qjmed/hcab030] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pneumonia is more common in smokers compared with non-smokers. A high 1-year prevalence of lung cancer following hospitalization for pneumonia was demonstrated in heavy smokers. AIM To assess the association between hospitalization for pneumonia among ever-smokers and subsequent lung cancer risk. DESIGN Retrospective analysis. METHODS The study cohort included all ever-smokers aged 55-80 hospitalized for pneumonia between the years 2010-15 covered by a large medical insurer in Israel. Controls were matched to cases by age in a 4:1 ratio. The primary outcome was the association between hospitalization for pneumonia and subsequent 1-year incidence of lung cancer, adjusted for gender, smoking status (past/current) and pack years. Pre-specified sensitivity analyses excluded heavy smokers (smoking history of more than 30 pack years) and patients diagnosed with lung cancer within 30 days of hospitalization, as they probably had clinical or radiological findings suggestive of lung cancer, making them ineligible for screening. RESULTS Lung cancer was identified in 275 of 12 807 (2.1%) patients following hospitalization for pneumonia and in 44 of 51 228 (0.1%) controls (adjusted odds ratio 22.46, 95% CI 16.29-30.96, P < 0.001). Among patients hospitalized for pneumonia, 1-year lung cancer incidence remained high after excluding heavy smokers and patients diagnosed within 30 days of the index date (1.3% and 1.4%, respectively). CONCLUSIONS Hospitalization for pneumonia is associated with high 1-year incidence of lung cancer in ever-smokers, supporting the important role of the widely used practice of performing follow up imaging post-pneumonia to exclude occult malignancy.
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Affiliation(s)
- D Shepshelovich
- From the Sackler School of Medicine, Tel Aviv University, Ramat Aviv 6997801, Tel Aviv, Israel
- Rabin Medical Center, Medicine A, Beilinson Hospital, 39 Jabotinsky Street, Petach Tikva 49100, Israel
| | - N Barda
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 101 Arlozorov Street, Tel Aviv 62098, P.O. Box 16250, Israel
| | - H Goldvaser
- From the Sackler School of Medicine, Tel Aviv University, Ramat Aviv 6997801, Tel Aviv, Israel
- Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinsky Street, Petach Tikva 49100, Israel
| | - N Dagan
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 101 Arlozorov Street, Tel Aviv 62098, P.O. Box 16250, Israel
| | - A Zer
- From the Sackler School of Medicine, Tel Aviv University, Ramat Aviv 6997801, Tel Aviv, Israel
- Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, 39 Jabotinsky Street, Petach Tikva 49100, Israel
| | - T Diker-Cohen
- From the Sackler School of Medicine, Tel Aviv University, Ramat Aviv 6997801, Tel Aviv, Israel
- Rabin Medical Center, Medicine A, Beilinson Hospital, 39 Jabotinsky Street, Petach Tikva 49100, Israel
| | - R Balicer
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 101 Arlozorov Street, Tel Aviv 62098, P.O. Box 16250, Israel
- Department of Epidemiology, Ben Gurion University of the Negev, P.O.B. 653 Beer-Sheva 8410501 Israel
| | - A Gafter-Gvili
- From the Sackler School of Medicine, Tel Aviv University, Ramat Aviv 6997801, Tel Aviv, Israel
- Rabin Medical Center, Medicine A, Beilinson Hospital, 39 Jabotinsky Street, Petach Tikva 49100, Israel
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Mahanaimy M, Finkel U, Barda N, Rottman E, Balicer R, Berliner Senderey A, Feldman B. Association of Renin-Angiotensin-Aldosterone Inhibitors with COVID-19 Infection and Disease Severity among Individuals with Hypertension. Isr Med Assoc J 2022; 24:310-316. [PMID: 35598055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The association between use of renin-angiotensin-aldosterone (RAAS) inhibitors and both SARS-CoV-2 infection and the development of severe COVID-19 has been presented in the recent medical literature with inconsistent results. OBJECTIVES To assess the association between RAAS inhibitor use and two outcomes: infection with SARS-CoV-2 (Model 1) and severe COVID-19 among those infected (Model 2). METHODS We accessed used electronic health records of individuals from Israel who were receiving anti-hypertensive medications for this retrospective study. For Model 1 we used a case-control design. For Model 2 we used a cohort design. In both models, inverse probability weighting adjusted for identified confounders as part of doubly robust outcome regression. RESULTS We tested 38,554 individuals for SARS-CoV-2 who had hypertension and were being treated with medication; 691 had a positive test result. Among those with a positive test, 119 developed severe illness. There was no association between RAAS inhibitor use and a positive test. Use of RAAS inhibitors was associated with a decreased risk for severe COVID-19 (adjusted odds ratio [OR] 0.47, 95% confidence interval [95%CI] 0.29-0.77) compared with users of non-RAAS anti-hypertensive medication. The association remained significant when use of angiotensin-converting-enzyme inhibitors (adjusted OR 0.46, 95%CI 0.27-0.77) and angiotensin II receptor blockers (adjusted OR 0.39, 95%CI 0.16-0.95) were analyzed separately. CONCLUSIONS Among individuals with hypertension using RAAS inhibitors, we found a lower risk of severe disease compared to those using non-RAAS anti-hypertensive medications. This finding suggests that RAAS inhibitors may have a protective effect on COVID-19 severity among individuals with medically treated hypertension.
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Affiliation(s)
- Moria Mahanaimy
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Israel
| | - Uriah Finkel
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Israel
| | - Noam Barda
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Israel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
- Department of Computer, and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Eytan Rottman
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Israel
- Institute of Diabetes, Technology, and Research, Clalit Health Services, Israel
| | - Ran Balicer
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Israel
- Department of Epidemiology, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | | | - Becca Feldman
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Israel
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25
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Waxman JG, Makov-Assif M, Reis BY, Netzer D, Balicer RD, Dagan N, Barda N. Comparing COVID-19-related hospitalization rates among individuals with infection-induced and vaccine-induced immunity in Israel. Nat Commun 2022; 13:2202. [PMID: 35459237 PMCID: PMC9033865 DOI: 10.1038/s41467-022-29858-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/30/2022] [Indexed: 11/09/2022] Open
Abstract
With the COVID-19 pandemic ongoing, accurate assessment of population immunity and the effectiveness of booster and enhancer vaccine doses is critical. We compare COVID-19-related hospitalization incidence rates in 2,412,755 individuals across four exposure levels: non-recent vaccine immunity (two BNT162b2 COVID-19 vaccine doses five or more months prior), boosted vaccine immunity (three BNT162b2 doses), infection-induced immunity (previous COVID-19 without a subsequent BNT162b2 dose), and enhanced infection-induced immunity (previous COVID-19 with a subsequent BNT162b2 dose). Rates, adjusted for potential demographic, clinical and health-seeking-behavior confounders, were assessed from July-November 2021 when the Delta variant was predominant. Compared with non-recent vaccine immunity, COVID-19-related hospitalization incidence rates were reduced by 89% (87–91%) for boosted vaccine immunity, 66% (50–77%) for infection-induced immunity and 75% (61–83%) for enhanced infection-induced immunity. We demonstrate that infection-induced immunity (enhanced or not) provides more protection against COVID-19-related hospitalization than non-recent vaccine immunity, but less protection than booster vaccination. Additionally, our results suggest that vaccinating individuals with infection-induced immunity further enhances their protection. The relative degree of immunity to SARS-CoV-2 provided by combinations of natural infection, vaccination, and booster doses is unknown. Here, the authors show that infection-induced immunity provides more protection against COVID-19-related hospitalization than non-recent vaccine immunity, but less than booster vaccination.
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Affiliation(s)
- Jacob G Waxman
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel.
| | - Maya Makov-Assif
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel
| | - Ben Y Reis
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA
| | - Doron Netzer
- Community Medical Services Division, Clalit Health Services, Tel Aviv, Israel
| | - Ran D Balicer
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel.,The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA.,School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Noa Dagan
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel.,The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA.,Software and Information Systems Engineering, Ben Gurion University, Be'er Sheva, Israel.,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Noam Barda
- Software and Information Systems Engineering, Ben Gurion University, Be'er Sheva, Israel.,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.,Arc Innovation Center, Sheba Medical Center, Ramat-Gan, Israel
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26
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Auster O, Finkel U, Dagan N, Barda N, Laufer A, Balicer RD, Ben-Shachar S. Short-term Adverse Events After the Third Dose of the BNT162b2 mRNA COVID-19 Vaccine in Adults 60 Years or Older. JAMA Netw Open 2022; 5:e227657. [PMID: 35435973 PMCID: PMC9016488 DOI: 10.1001/jamanetworkopen.2022.7657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This survey study assesses the occurrence of short-term adverse events in adults 60 years or older who received a booster dose of the BNT162B2 mRNA vaccine.
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Affiliation(s)
- Oren Auster
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel
| | - Uriah Finkel
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel
| | - Noa Dagan
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel
- Software and Information Systems Engineering, Ben Gurion University, Be'er Sheva, Israel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
- The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, at Harvard Medical School and Clalit Research Institute, Boston, Massachusetts
| | - Noam Barda
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel
- Software and Information Systems Engineering, Ben Gurion University, Be'er Sheva, Israel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
- The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, at Harvard Medical School and Clalit Research Institute, Boston, Massachusetts
| | - Alon Laufer
- Clalit Health Services, Tel Aviv, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| | - Ran D. Balicer
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel
- Clalit Health Services, Tel Aviv, Israel
- School of Public Health, Ben Gurion University, Be'er Sheva, Israel
| | - Shay Ben-Shachar
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel
- The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration, at Harvard Medical School and Clalit Research Institute, Boston, Massachusetts
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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27
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Khan SS, Barda N, Greenland P, Dagan N, Lloyd-Jones DM, Balicer R, Rasmussen-Torvik LJ. Validation of Heart Failure-Specific Risk Equations in 1.3 Million Israeli Adults and Usefulness of Combining Ambulatory and Hospitalization Data from a Large Integrated Health Care Organization. Am J Cardiol 2022; 168:105-109. [PMID: 35031113 PMCID: PMC8930701 DOI: 10.1016/j.amjcard.2021.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 12/23/2022]
Abstract
Heart failure (HF) prevalence is increasing worldwide and is associated with significant morbidity and mortality. Guidelines emphasize prevention in those at-risk, but HF-specific risk prediction equations developed in United States population-based cohorts lack external validation in large, real-world datasets outside of the United States. The purpose of this study was to assess the model performance of the pooled cohort equations to prevent HF (PCP-HF) within a contemporary electronic health record for 5- and 10-year risk. Using a retrospective cohort study design of Israeli residents between 2008 and 2018 with continuous membership until end of follow-up, HF, or death, we quantified 5- and 10-year estimated risks of HF using the PCP-HF equations, which integrate demographics (age, gender, and race) and risk factors (body mass index, systolic blood pressure, glucose, medication use for hypertension or diabetes, and smoking status). Of 1,394,411 patients included, 56% were women with mean age of 49.6 (SD 13.2) years. Incident HF occurred in 1.2% and 4.5% of participants over 5 and 10 years of follow-up. The PCP-HF model had excellent discrimination for 5- and 10-year predictions of incident HF (C Statistic 0.82 [0.82 to 0.82] and 0.84 [0.84 to 0.84]), respectively. In conclusion, HF-specific risk equations (PCP-HF) accurately predict the risk of incident HF in ambulatory and hospitalized patients using routinely available clinical data.
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Affiliation(s)
- Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Noam Barda
- Clalit Research Institute, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Noa Dagan
- Clalit Research Institute, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel; School of Public Health, Ben-Gurion University, Beer-Sheba, Israel
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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28
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Hayek S, Shaham G, Ben-Shlomo Y, Kepten E, Dagan N, Nevo D, Lipsitch M, Reis BY, Balicer RD, Barda N. Indirect protection of children from SARS-CoV-2 infection through parental vaccination. Science 2022; 375:1155-1159. [PMID: 35084938 DOI: 10.1126/science.abm3087] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Children not vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may still benefit from vaccines through protection from vaccinated contacts. We estimated the protection provided to children through parental vaccination with the BNT162b2 vaccine. We studied households without prior infection consisting of two parents and unvaccinated children, estimating the effect of parental vaccination on the risk of infection for unvaccinated children. We studied two periods separately-an early period (17 January 2021 to 28 March 2021; Alpha variant, two doses versus no vaccination) and a late period (11 July 2021 to 30 September 2021; Delta variant, booster dose versus two vaccine doses). We found that having a single vaccinated parent was associated with a 26.0 and a 20.8% decreased risk in the early and late periods, respectively, and having two vaccinated parents was associated with a 71.7 and a 58.1% decreased risk, respectively. Thus, parental vaccination confers substantial protection on unvaccinated children in the household.
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Affiliation(s)
- Samah Hayek
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
| | - Galit Shaham
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
| | - Yatir Ben-Shlomo
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
| | - Eldad Kepten
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
| | - Noa Dagan
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
- Software and Information Systems Engineering, Ben Gurion University, Be'er Sheva, Israel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA
| | - Daniel Nevo
- Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, and Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ben Y Reis
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Noam Barda
- Clalit Research Institute, Clalit Health Services, Ramat Gan, Israel
- Software and Information Systems Engineering, Ben Gurion University, Be'er Sheva, Israel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA
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29
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Leader A, Dagan N, Barda N, Goldberg I, Raanani P, Spectre G, Balicer R, Gafter-Gvili A. Previously undiagnosed cancer in patients with arterial thrombotic events - A population-based cohort study. J Thromb Haemost 2022; 20:635-647. [PMID: 34818468 DOI: 10.1111/jth.15600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emerging data suggest increased arterial thrombosis risk in the months preceding a cancer diagnosis. OBJECTIVES To assess whether patients without documented vascular risk factors or pre-existing cardiovascular disease have a higher relative risk of cancer 12 months after arterial thrombotic events (ATE), compared to unselected patients. PATIENTS/METHODS A population-based cohort study of Clalit Health Services (CHS) database included CHS members ≥25 years without prior cancer or ATE (n = 2 804 584). An iterative matching process selected 10 potential controls chronologically for each consecutive exposed, age- and sex-matched (actual controls drawn 1:1 from a lot). Study exposure, ATE, was defined as ischemic stroke, transient ischemic attack, myocardial infarction or systemic arterial thromboembolism during hospitalization. The outcome was newly-diagnosed cancer within 12 months, based on Israeli national cancer registry. Cox proportional hazards multivariate regression calculated hazard ratio (HR) for outcomes, adjusted for cancer risk factors. Analysis also performed for three subgroups: age ≤50 years; no cardiovascular risk factors; no prior cardiovascular disease. RESULTS The full ATE and matched control cohorts included 43 108 patients. The 12-month cumulative incidence of cancer (95% confidence interval) was 0.020 (0.019-0.022) in the ATE cohort and 0.012 (0.011-0.013) in controls, corresponding to an adjusted HR of 1.665 (1.489-1.862). The relative risk of cancer was high in all subgroups up to a HR of 3.754 (1.912-7.372) in patients without cardiovascular risk factors. CONCLUSION There is an increased risk of previously undiagnosed cancer at 12 months after ATE, especially in patients without documented vascular risk factors or pre-existent cardiovascular disease.
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Affiliation(s)
- Avi Leader
- Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Dagan
- Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Noam Barda
- Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Idan Goldberg
- Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galia Spectre
- Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Balicer
- Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Anat Gafter-Gvili
- Institute of Hematology, Rabin Medical Center, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Medicine A, Rabin Medical Center, Petah Tikva, Israel
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30
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Katz MA, Harlev EB, Chazan B, Chowers M, Greenberg D, Peretz A, Tshori S, Levy J, Yacobi M, Hirsch A, Amichay D, Weinberger R, Dor AB, Taraday EK, Reznik D, Chayat CB, Sagas D, Zvi HB, Berdinstein R, Rashid G, Avni YS, Mandelboim M, Zuckerman N, Rainy N, Akriv A, Dagan N, Kepten E, Barda N, Balicer RD. Early effectiveness of BNT162b2 Covid-19 vaccine in preventing SARS-CoV-2 infection in healthcare personnel in six Israeli hospitals (CoVEHPI). Vaccine 2022; 40:512-520. [PMID: 34903372 PMCID: PMC8662353 DOI: 10.1016/j.vaccine.2021.11.092] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 08/09/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Methodologically rigorous studies on Covid-19 vaccine effectiveness (VE) in preventing SARS-CoV-2 infection are critically needed to inform national and global policy on Covid-19 vaccine use. In Israel, healthcare personnel (HCP) were initially prioritized for Covid-19 vaccination, creating an ideal setting to evaluate early real-world VE in a closely monitored population. METHODS We conducted a prospective study among HCP in 6 hospitals to estimate the effectiveness of the BNT162b2 mRNA Covid-19 vaccine in preventing SARS-CoV-2 infection. Participants filled out weekly symptom questionnaires, provided weekly nasal specimens, and three serology samples - at enrollment, 30 days and 90 days. We estimated VE against PCR-confirmed SARS-CoV-2 infection using the Cox Proportional Hazards model and against a combined PCR/serology endpoint using Fisher's exact test. RESULTS Of the 1567 HCP enrolled between December 27, 2020 and February 15, 2021, 1250 previously uninfected participants were included in the primary analysis; 998 (79.8%) were vaccinated with their first dose prior to or at enrollment, all with Pfizer BNT162b2 mRNA vaccine. There were four PCR-positive events among vaccinated participants, and nine among unvaccinated participants. Adjusted two-dose VE against any PCR-confirmed infection was 94.5% (95% CI: 82.6%-98.2%); adjusted two-dose VE against a combined endpoint of PCR and seroconversion for a 60-day follow-up period was 94.5% (95% CI: 63.0%-99.0%). Five PCR-positive samples from study participants were sequenced; all were alpha variant. CONCLUSIONS Our prospective VE study of HCP in Israel with rigorous weekly surveillance found very high VE for two doses of Pfizer BNT162b2 mRNA vaccine against SARS-CoV-2 infection in recently vaccinated HCP during a period of predominant alpha variant circulation. FUNDING Clalit Health Services.
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Affiliation(s)
- Mark A Katz
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel; School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; University of Michigan, School of Public Health, Ann Arbor, MI, USA
| | - Efrat Bron Harlev
- Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Bibiana Chazan
- Infectious Diseases and Infection Control Unit, Ha'Emek Medical Center, Afula, Israel; Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michal Chowers
- Infectious Diseases, Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - David Greenberg
- Pediatric Infectious Disease Unit the Pediatric Division, Soroka University Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Alon Peretz
- Occupational Medicine Clinic, Rabin Medical Center, Petah Tikva, Israel
| | - Sagi Tshori
- Research Authority, Kaplan Medical Center, Rehovot, Israel; The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joseph Levy
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Mili Yacobi
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Avital Hirsch
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Doron Amichay
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; Clalit Central Laboratory, Clalit Health Services, Tel Aviv, Israel
| | - Ronit Weinberger
- Clalit Central Laboratory, Clalit Health Services, Tel Aviv, Israel
| | - Anat Ben Dor
- Clalit Central Laboratory, Clalit Health Services, Tel Aviv, Israel
| | | | - Dana Reznik
- Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Chen Barazani Chayat
- Multidisciplinary Laboratory, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Dana Sagas
- Clinical Microbiology Laboratory, Ha'Emek Medical Center, Afula, Israel
| | - Haim Ben Zvi
- Microbiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Rita Berdinstein
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Microbiology Department, Kaplan Medical Center, Rehovot, Israel
| | - Gloria Rashid
- Department of Clinical Laboratories, Meir Medical Center, Kfar Saba, Israel
| | | | - Michal Mandelboim
- Central Virology Laboratory, Chaim Sheba Medical Center, Ministry of Health, Ramat Gan, Israel; Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Neta Zuckerman
- Central Virology Laboratory, Chaim Sheba Medical Center, Ministry of Health, Ramat Gan, Israel
| | - Nir Rainy
- Laboratory Division, Shamir Medical Center, Zerifin, Israel
| | - Amichay Akriv
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Noa Dagan
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel; Software and Information Systems Engineering, Ben Gurion University, Beer Sheva, Israel; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; Ivan and Francesca Berkowitz Family Living Laboratory at Harvard Medical School, Boston, MA, USA
| | - Eldad Kepten
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel
| | - Noam Barda
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel; Software and Information Systems Engineering, Ben Gurion University, Beer Sheva, Israel; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; Ivan and Francesca Berkowitz Family Living Laboratory at Harvard Medical School, Boston, MA, USA
| | - Ran D Balicer
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat Gan, Israel; School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Barda N, Dagan N. The role of observational studies based on secondary data in studying SARS-CoV-2 vaccines. Clin Microbiol Infect 2021; 28:313-314. [PMID: 34906720 PMCID: PMC8665840 DOI: 10.1016/j.cmi.2021.12.006] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Noam Barda
- Software and Information Systems Engineering, Ben Gurion University, Be'er Sheva, Israel; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
| | - Noa Dagan
- Software and Information Systems Engineering, Ben Gurion University, Be'er Sheva, Israel; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel; The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA
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32
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Affiliation(s)
- Noa Dagan
- Clalit Research Institute, Tel Aviv, Israel
| | - Noam Barda
- Clalit Research Institute, Tel Aviv, Israel
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33
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Barda N, Dagan N, Cohen C, Hernán MA, Lipsitch M, Kohane IS, Reis BY, Balicer RD. Effectiveness of a third dose of the BNT162b2 mRNA COVID-19 vaccine for preventing severe outcomes in Israel: an observational study. Lancet 2021; 398:2093-2100. [PMID: 34756184 PMCID: PMC8555967 DOI: 10.1016/s0140-6736(21)02249-2] [Citation(s) in RCA: 578] [Impact Index Per Article: 192.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/17/2021] [Accepted: 10/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many countries are experiencing a resurgence of COVID-19, driven predominantly by the delta (B.1.617.2) variant of SARS-CoV-2. In response, these countries are considering the administration of a third dose of mRNA COVID-19 vaccine as a booster dose to address potential waning immunity over time and reduced effectiveness against the delta variant. We aimed to use the data repositories of Israel's largest health-care organisation to evaluate the effectiveness of a third dose of the BNT162b2 mRNA vaccine for preventing severe COVID-19 outcomes. METHODS Using data from Clalit Health Services, which provides mandatory health-care coverage for over half of the Israeli population, individuals receiving a third vaccine dose between July 30, 2020, and Sept 23, 2021, were matched (1:1) to demographically and clinically similar controls who did not receive a third dose. Eligible participants had received the second vaccine dose at least 5 months before the recruitment date, had no previous documented SARS-CoV-2 infection, and had no contact with the health-care system in the 3 days before recruitment. Individuals who are health-care workers, live in long-term care facilities, or are medically confined to their homes were excluded. Primary outcomes were COVID-19-related admission to hospital, severe disease, and COVID-19-related death. The third dose effectiveness for each outcome was estimated as 1 - risk ratio using the Kaplan-Meier estimator. FINDINGS 1 158 269 individuals were eligible to be included in the third dose group. Following matching, the third dose and control groups each included 728 321 individuals. Participants had a median age of 52 years (IQR 37-68) and 51% were female. The median follow-up time was 13 days (IQR 6-21) in both groups. Vaccine effectiveness evaluated at least 7 days after receipt of the third dose, compared with receiving only two doses at least 5 months ago, was estimated to be 93% (231 events for two doses vs 29 events for three doses; 95% CI 88-97) for admission to hospital, 92% (157 vs 17 events; 82-97) for severe disease, and 81% (44 vs seven events; 59-97) for COVID-19-related death. INTERPRETATION Our findings suggest that a third dose of the BNT162b2 mRNA vaccine is effective in protecting individuals against severe COVID-19-related outcomes, compared with receiving only two doses at least 5 months ago. FUNDING The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute.
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Affiliation(s)
- Noam Barda
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel; Software and Information Systems Engineering, Ben Gurion University of the Negev, Be'er Sheva, Israel; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA
| | - Noa Dagan
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel; Software and Information Systems Engineering, Ben Gurion University of the Negev, Be'er Sheva, Israel; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA
| | - Cyrille Cohen
- The Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Miguel A Hernán
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; CAUSALab, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Marc Lipsitch
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA; Center for Communicable Disease Dynamics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Isaac S Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA; The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Ben Y Reis
- The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA; Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Ran D Balicer
- Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv, Israel; School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel; The Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute, Boston, MA, USA.
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Witberg G, Barda N, Hoss S, Richter I, Wiessman M, Aviv Y, Grinberg T, Auster O, Dagan N, Balicer RD, Kornowski R. Myocarditis after Covid-19 Vaccination in a Large Health Care Organization. N Engl J Med 2021; 385:2132-2139. [PMID: 34614329 PMCID: PMC8531986 DOI: 10.1056/nejmoa2110737] [Citation(s) in RCA: 383] [Impact Index Per Article: 127.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Reports have suggested an association between the development of myocarditis and the receipt of messenger RNA (mRNA) vaccines against coronavirus disease 2019 (Covid-19), but the frequency and severity of myocarditis after vaccination have not been extensively explored. METHODS We searched the database of Clalit Health Services, the largest health care organization (HCO) in Israel, for diagnoses of myocarditis in patients who had received at least one dose of the BNT162b2 mRNA vaccine (Pfizer-BioNTech). The diagnosis of myocarditis was adjudicated by cardiologists using the case definition used by the Centers for Disease Control and Prevention. We abstracted the presentation, clinical course, and outcome from the patient's electronic health record. We performed a Kaplan-Meier analysis of the incidence of myocarditis up to 42 days after the first vaccine dose. RESULTS Among more than 2.5 million vaccinated HCO members who were 16 years of age or older, 54 cases met the criteria for myocarditis. The estimated incidence per 100,000 persons who had received at least one dose of vaccine was 2.13 cases (95% confidence interval [CI], 1.56 to 2.70). The highest incidence of myocarditis (10.69 cases per 100,000 persons; 95% CI, 6.93 to 14.46) was reported in male patients between the ages of 16 and 29 years. A total of 76% of cases of myocarditis were described as mild and 22% as intermediate; 1 case was associated with cardiogenic shock. After a median follow-up of 83 days after the onset of myocarditis, 1 patient had been readmitted to the hospital, and 1 had died of an unknown cause after discharge. Of 14 patients who had left ventricular dysfunction on echocardiography during admission, 10 still had such dysfunction at the time of hospital discharge. Of these patients, 5 underwent subsequent testing that revealed normal heart function. CONCLUSIONS Among patients in a large Israeli health care system who had received at least one dose of the BNT162b2 mRNA vaccine, the estimated incidence of myocarditis was 2.13 cases per 100,000 persons; the highest incidence was among male patients between the ages of 16 and 29 years. Most cases of myocarditis were mild or moderate in severity. (Funded by the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute.).
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Affiliation(s)
- Guy Witberg
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Noam Barda
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Sara Hoss
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Ilan Richter
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Maya Wiessman
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Yaron Aviv
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Tzlil Grinberg
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Oren Auster
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Noa Dagan
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Ran D Balicer
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
| | - Ran Kornowski
- From the Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), the Faculty of Medicine, Tel Aviv University (G.W., S.H., I.R., M.W., Y.A., T.G., R.K.), and the Innovation Division, Clalit Research Institute, Clalit Health Services (N.B., O.A., N.D., R.D.B.), Tel Aviv, and the Department of Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben Gurion University, Be'er Sheva - all in Israel; and the Department of Biomedical Informatics, Harvard Medical School (N.B., N.D.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., R.D.B.) - both in Boston
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Affiliation(s)
| | - Noam Barda
- Clalit Research Institute, Tel Aviv, Israel
| | | | | | | | - Marc Lipsitch
- Harvard T.H. Chan School of Public Health, Boston, MA
| | - Noa Dagan
- Clalit Research Institute, Tel Aviv, Israel
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Makov-Assif M, Krispin S, Ben-Shlomo Y, Holander T, Dagan N, Balicer R, Barda N. The association between real-time reverse transcriptase polymerase chain reaction cycle threshold values, symptoms and disease severity among COVID-19 patients in the community: a retrospective cohort study. Infect Dis (Lond) 2021; 54:205-212. [PMID: 34743662 DOI: 10.1080/23744235.2021.1998606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND COVID-19 continues to spread throughout the world. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) is used to diagnose COVID-19, with its cycle threshold (Ct) value inversely related to the viral load. The association between Ct values and COVID-19 related outcomes has been studied in the hospital setting but less so in the community. We aimed to estimate the association between Ct values and the severity of community-diagnosed COVID-19 to provide evidence on the utility of Ct testing in this setting. METHODS This was a retrospective cohort study based on data from Israel's largest health organization. The study population included 34,658 individuals who tested positive for COVID-19 by RT-PCR and had available Ct values between June 1st and December 21st, 2020. Outcomes included COVID-19 related symptoms, hospitalization, severe disease, and death. Ct values were modelled both as discrete and continuous exposures. RESULTS After adjusting for known risk factors for severe COVID-19, low Ct values were associated with symptomatic disease (odds ratio [OR]: 1.51; 95% confidence interval [CI]:1.21-1.84), hospitalization (OR: 1.27; 95%CI: 1.12-1.49), severe disease (OR: 1.80; 95%CI: 1.43-2.27), and death (OR: 1.64; 95%CI: 1.06-2.59). By modelling the exposure as continuous, we noticed a dose-response relationship, with the risk gradually rising with lower Ct values. CONCLUSIONS This study found a significant association between low Ct values and severe COVID-19 related outcomes, with a dose-response relationship. This suggests that Ct values could be helpful in identifying high-risk patients diagnosed in the community.
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Affiliation(s)
- Maya Makov-Assif
- Innovation Division, Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Sydney Krispin
- Innovation Division, Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Yatir Ben-Shlomo
- Innovation Division, Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Tal Holander
- Innovation Division, Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Noa Dagan
- Innovation Division, Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel.,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Ran Balicer
- Innovation Division, Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel.,Faculty of Health Sciences, School of Public Health, Ben Gurion University of the Negev, Sheva, Be'er, Israel
| | - Noam Barda
- Innovation Division, Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel.,Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
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Barda N, Dagan N, Ben-Shlomo Y, Kepten E, Waxman J, Ohana R, Hernán MA, Lipsitch M, Kohane I, Netzer D, Reis BY, Balicer RD. Safety of the BNT162b2 mRNA Covid-19 Vaccine in a Nationwide Setting. N Engl J Med 2021; 385:1078-1090. [PMID: 34432976 PMCID: PMC8427535 DOI: 10.1056/nejmoa2110475] [Citation(s) in RCA: 616] [Impact Index Per Article: 205.3] [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] [Indexed: 12/18/2022]
Abstract
BACKGROUND Preapproval trials showed that messenger RNA (mRNA)-based vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had a good safety profile, yet these trials were subject to size and patient-mix limitations. An evaluation of the safety of the BNT162b2 mRNA vaccine with respect to a broad range of potential adverse events is needed. METHODS We used data from the largest health care organization in Israel to evaluate the safety of the BNT162b2 mRNA vaccine. For each potential adverse event, in a population of persons with no previous diagnosis of that event, we individually matched vaccinated persons to unvaccinated persons according to sociodemographic and clinical variables. Risk ratios and risk differences at 42 days after vaccination were derived with the use of the Kaplan-Meier estimator. To place these results in context, we performed a similar analysis involving SARS-CoV-2-infected persons matched to uninfected persons. The same adverse events were studied in the vaccination and SARS-CoV-2 infection analyses. RESULTS In the vaccination analysis, the vaccinated and control groups each included a mean of 884,828 persons. Vaccination was most strongly associated with an elevated risk of myocarditis (risk ratio, 3.24; 95% confidence interval [CI], 1.55 to 12.44; risk difference, 2.7 events per 100,000 persons; 95% CI, 1.0 to 4.6), lymphadenopathy (risk ratio, 2.43; 95% CI, 2.05 to 2.78; risk difference, 78.4 events per 100,000 persons; 95% CI, 64.1 to 89.3), appendicitis (risk ratio, 1.40; 95% CI, 1.02 to 2.01; risk difference, 5.0 events per 100,000 persons; 95% CI, 0.3 to 9.9), and herpes zoster infection (risk ratio, 1.43; 95% CI, 1.20 to 1.73; risk difference, 15.8 events per 100,000 persons; 95% CI, 8.2 to 24.2). SARS-CoV-2 infection was associated with a substantially increased risk of myocarditis (risk ratio, 18.28; 95% CI, 3.95 to 25.12; risk difference, 11.0 events per 100,000 persons; 95% CI, 5.6 to 15.8) and of additional serious adverse events, including pericarditis, arrhythmia, deep-vein thrombosis, pulmonary embolism, myocardial infarction, intracranial hemorrhage, and thrombocytopenia. CONCLUSIONS In this study in a nationwide mass vaccination setting, the BNT162b2 vaccine was not associated with an elevated risk of most of the adverse events examined. The vaccine was associated with an excess risk of myocarditis (1 to 5 events per 100,000 persons). The risk of this potentially serious adverse event and of many other serious adverse events was substantially increased after SARS-CoV-2 infection. (Funded by the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute.).
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Affiliation(s)
- Noam Barda
- From the Clalit Research Institute, Innovation Division (N.B., N.D., Y.B.-S., E.K., J.W., R.O., R.D.B.), and the Community Medical Services Division (D.N.), Clalit Health Services, Tel Aviv, and Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben-Gurion University of the Negev, Be'er Sheva - both in Israel; the Department of Biomedical Informatics (N.B., N.D., I.K.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., I.K., B.Y.R., R.D.B.), Harvard Medical School (B.Y.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), CAUSALab (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston
| | - Noa Dagan
- From the Clalit Research Institute, Innovation Division (N.B., N.D., Y.B.-S., E.K., J.W., R.O., R.D.B.), and the Community Medical Services Division (D.N.), Clalit Health Services, Tel Aviv, and Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben-Gurion University of the Negev, Be'er Sheva - both in Israel; the Department of Biomedical Informatics (N.B., N.D., I.K.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., I.K., B.Y.R., R.D.B.), Harvard Medical School (B.Y.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), CAUSALab (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston
| | - Yatir Ben-Shlomo
- From the Clalit Research Institute, Innovation Division (N.B., N.D., Y.B.-S., E.K., J.W., R.O., R.D.B.), and the Community Medical Services Division (D.N.), Clalit Health Services, Tel Aviv, and Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben-Gurion University of the Negev, Be'er Sheva - both in Israel; the Department of Biomedical Informatics (N.B., N.D., I.K.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., I.K., B.Y.R., R.D.B.), Harvard Medical School (B.Y.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), CAUSALab (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston
| | - Eldad Kepten
- From the Clalit Research Institute, Innovation Division (N.B., N.D., Y.B.-S., E.K., J.W., R.O., R.D.B.), and the Community Medical Services Division (D.N.), Clalit Health Services, Tel Aviv, and Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben-Gurion University of the Negev, Be'er Sheva - both in Israel; the Department of Biomedical Informatics (N.B., N.D., I.K.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., I.K., B.Y.R., R.D.B.), Harvard Medical School (B.Y.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), CAUSALab (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston
| | - Jacob Waxman
- From the Clalit Research Institute, Innovation Division (N.B., N.D., Y.B.-S., E.K., J.W., R.O., R.D.B.), and the Community Medical Services Division (D.N.), Clalit Health Services, Tel Aviv, and Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben-Gurion University of the Negev, Be'er Sheva - both in Israel; the Department of Biomedical Informatics (N.B., N.D., I.K.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., I.K., B.Y.R., R.D.B.), Harvard Medical School (B.Y.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), CAUSALab (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston
| | - Reut Ohana
- From the Clalit Research Institute, Innovation Division (N.B., N.D., Y.B.-S., E.K., J.W., R.O., R.D.B.), and the Community Medical Services Division (D.N.), Clalit Health Services, Tel Aviv, and Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben-Gurion University of the Negev, Be'er Sheva - both in Israel; the Department of Biomedical Informatics (N.B., N.D., I.K.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., I.K., B.Y.R., R.D.B.), Harvard Medical School (B.Y.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), CAUSALab (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston
| | - Miguel A Hernán
- From the Clalit Research Institute, Innovation Division (N.B., N.D., Y.B.-S., E.K., J.W., R.O., R.D.B.), and the Community Medical Services Division (D.N.), Clalit Health Services, Tel Aviv, and Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben-Gurion University of the Negev, Be'er Sheva - both in Israel; the Department of Biomedical Informatics (N.B., N.D., I.K.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., I.K., B.Y.R., R.D.B.), Harvard Medical School (B.Y.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), CAUSALab (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston
| | - Marc Lipsitch
- From the Clalit Research Institute, Innovation Division (N.B., N.D., Y.B.-S., E.K., J.W., R.O., R.D.B.), and the Community Medical Services Division (D.N.), Clalit Health Services, Tel Aviv, and Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben-Gurion University of the Negev, Be'er Sheva - both in Israel; the Department of Biomedical Informatics (N.B., N.D., I.K.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., I.K., B.Y.R., R.D.B.), Harvard Medical School (B.Y.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), CAUSALab (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston
| | - Isaac Kohane
- From the Clalit Research Institute, Innovation Division (N.B., N.D., Y.B.-S., E.K., J.W., R.O., R.D.B.), and the Community Medical Services Division (D.N.), Clalit Health Services, Tel Aviv, and Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben-Gurion University of the Negev, Be'er Sheva - both in Israel; the Department of Biomedical Informatics (N.B., N.D., I.K.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., I.K., B.Y.R., R.D.B.), Harvard Medical School (B.Y.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), CAUSALab (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston
| | - Doron Netzer
- From the Clalit Research Institute, Innovation Division (N.B., N.D., Y.B.-S., E.K., J.W., R.O., R.D.B.), and the Community Medical Services Division (D.N.), Clalit Health Services, Tel Aviv, and Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben-Gurion University of the Negev, Be'er Sheva - both in Israel; the Department of Biomedical Informatics (N.B., N.D., I.K.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., I.K., B.Y.R., R.D.B.), Harvard Medical School (B.Y.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), CAUSALab (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston
| | - Ben Y Reis
- From the Clalit Research Institute, Innovation Division (N.B., N.D., Y.B.-S., E.K., J.W., R.O., R.D.B.), and the Community Medical Services Division (D.N.), Clalit Health Services, Tel Aviv, and Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben-Gurion University of the Negev, Be'er Sheva - both in Israel; the Department of Biomedical Informatics (N.B., N.D., I.K.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., I.K., B.Y.R., R.D.B.), Harvard Medical School (B.Y.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), CAUSALab (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston
| | - Ran D Balicer
- From the Clalit Research Institute, Innovation Division (N.B., N.D., Y.B.-S., E.K., J.W., R.O., R.D.B.), and the Community Medical Services Division (D.N.), Clalit Health Services, Tel Aviv, and Software and Information Systems Engineering (N.B., N.D.) and the School of Public Health, Faculty of Health Sciences (R.D.B.), Ben-Gurion University of the Negev, Be'er Sheva - both in Israel; the Department of Biomedical Informatics (N.B., N.D., I.K.), and the Ivan and Francesca Berkowitz Family Living Laboratory Collaboration at Harvard Medical School and Clalit Research Institute (N.B., N.D., I.K., B.Y.R., R.D.B.), Harvard Medical School (B.Y.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), CAUSALab (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.Y.R.) - all in Boston
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Efros O, Beit Halevi T, Meisel E, Soffer S, Barda N, Cohen O, Kenet G, Lubetsky A. The Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Patients Hospitalized with Acute Pulmonary Embolism. J Clin Med 2021; 10:jcm10184058. [PMID: 34575170 PMCID: PMC8469500 DOI: 10.3390/jcm10184058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/26/2021] [Accepted: 09/03/2021] [Indexed: 01/22/2023] Open
Abstract
Early risk stratification is essential for determining the appropriate therapeutic management approach of pulmonary embolism (PE). This study aimed to evaluate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in patients hospitalized with acute pulmonary embolism by investigating its association with mortality in a large-scale population diagnosed and hospitalized with acute PE. We retrieved all consecutive patients hospitalized in an internal medicine department or an intensive care unit in a tertiary medical center from December 2007 to April 2021 with a discharge diagnosis of pulmonary embolism. A total of 2072 patients were included. Patients with above-median NLR (i.e., 5.12) had a higher 30-day mortality risk (adjusted odds ratio (aOR), 2.82; 95% confidence interval (CI) 2.14–3.70) and higher one-year mortality risk (aOR, 2.51; 95% CI 2.04–3.08). Similar trends were demonstrated in a sub-analysis of patients without cancer and hemodynamically stable (i.e., systolic blood pressure over 90 mmHg). Furthermore, the median hospital length of stay in patients with an elevated NLR was higher, and so was the in-hospital mortality rate. Elevated NLR in acute PE is associated with a worse short-term and long-term prognosis and with a longer duration of hospitalization.
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Affiliation(s)
- Orly Efros
- National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Ramat-Gan 5262000, Israel; (O.C.); (G.K.); (A.L.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6927846, Israel; (T.B.H.); (E.M.)
- Correspondence:
| | - Tal Beit Halevi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6927846, Israel; (T.B.H.); (E.M.)
| | - Eshcar Meisel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6927846, Israel; (T.B.H.); (E.M.)
- Department of Internal Medicine “D”, Sheba Medical Center, Ramat-Gan 5262000, Israel
| | - Shelly Soffer
- Assuta Medical Center, Ashdod 7747629, Israel;
- Ben-Gurion University of the Negev, Be’er Sheva 8410501, Israel
| | - Noam Barda
- Clalit Research Institute, Clalit Health Services, Ramat-Gan 6578898, Israel;
- Department of Biomedical Informatics, Harvard Medical School, Boston, MS 02115, USA
| | - Omri Cohen
- National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Ramat-Gan 5262000, Israel; (O.C.); (G.K.); (A.L.)
| | - Gili Kenet
- National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Ramat-Gan 5262000, Israel; (O.C.); (G.K.); (A.L.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6927846, Israel; (T.B.H.); (E.M.)
- Amalia Biron Research Institute of Thrombosis & Hemostasis, Sheba Medical Center, Ramat-Gan 5262000, Israel
| | - Aharon Lubetsky
- National Hemophilia Center and Thrombosis & Hemostasis Institute, Sheba Medical Center, Ramat-Gan 5262000, Israel; (O.C.); (G.K.); (A.L.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6927846, Israel; (T.B.H.); (E.M.)
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39
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Hayek S, Ben‐Shlomo Y, Balicer R, Byrne K, Katz M, Kepten E, Raz I, Roitman E, Zychma M, Barda N. Preinfection glycaemic control and disease severity among patients with type 2 diabetes and COVID-19: A retrospective, cohort study. Diabetes Obes Metab 2021; 23:1995-2000. [PMID: 33822446 PMCID: PMC8251473 DOI: 10.1111/dom.14393] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Samah Hayek
- Clalit Research InstituteClalit Health ServicesRamat GanIsrael
| | | | - Ran Balicer
- Clalit Research InstituteClalit Health ServicesRamat GanIsrael
- School of Public HealthBen‐Gurion UniversityBeer‐ShebaIsrael
| | | | - Mark Katz
- Clalit Research InstituteClalit Health ServicesRamat GanIsrael
| | - Eldad Kepten
- Clalit Research InstituteClalit Health ServicesRamat GanIsrael
| | | | - Eytan Roitman
- Clalit Research InstituteClalit Health ServicesRamat GanIsrael
| | - Marcin Zychma
- Novo Nordisk International OperationsZürichSwitzerland
| | - Noam Barda
- Clalit Research InstituteClalit Health ServicesRamat GanIsrael
- Department of Biomedical InformaticsHarvard Medical SchoolBostonMassachusettsUSA
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Klinger D, Hill BL, Barda N, Halperin E, Gofrit ON, Greenblatt CL, Rappoport N, Linial M, Bercovier H. Bladder Cancer Immunotherapy by BCG Is Associated with a Significantly Reduced Risk of Alzheimer's Disease and Parkinson's Disease. Vaccines (Basel) 2021; 9:vaccines9050491. [PMID: 34064775 PMCID: PMC8151667 DOI: 10.3390/vaccines9050491] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/16/2022] Open
Abstract
Bacillus Calmette–Guerin (BCG) is a live attenuated form of Mycobacterium bovis that was developed 100 years ago as a vaccine against tuberculosis (TB) and has been used ever since to vaccinate children globally. It has also been used as the first-line treatment in patients with nonmuscle invasive bladder cancer (NMIBC), through repeated intravesical applications. Numerous studies have shown that BCG induces off-target immune effects in various pathologies. Accumulating data argue for the critical role of the immune system in the course of neurodegenerative diseases such as Alzheimer’s disease (AD) and Parkinson’s disease (PD). In this study, we tested whether repeated exposure to BCG during the treatment of NMIBC is associated with the risk of developing AD and PD. We presented a multi-center retrospective cohort study with patient data collected between 2000 and 2019 that included 12,185 bladder cancer (BC) patients, of which 2301 BCG-treated patients met all inclusion criteria, with a follow-up of 3.5 to 7 years. We considered the diagnosis date of AD and nonvascular dementia cases for BC patients. The BC patients were partitioned into those who underwent a transurethral resection of the bladder tumor followed by BCG therapy, and a disjoint group that had not received such treatment. By applying Cox proportional hazards (PH) regression and competing for risk analyses, we found that BCG treatment was associated with a significantly reduced risk of developing AD, especially in the population aged 75 years or older. The older population (≥75 years, 1578 BCG treated, and 5147 controls) showed a hazard ratio (HR) of 0.726 (95% CI: 0.529–0.996; p-value = 0.0473). While in a hospital-based cohort, BCG treatment resulted in an HR of 0.416 (95% CI: 0.203–0.853; p-value = 0.017), indicating a 58% lower risk of developing AD. The risk of developing PD showed the same trend with a 28% reduction in BCG-treated patients, while no BCG beneficial effect was observed for other age-related events such as Type 2 diabetes (T2D) and stroke. We attributed BCG’s beneficial effect on neurodegenerative diseases to a possible activation of long-term nonspecific immune effects. We proposed a prospective study in elderly people for testing intradermic BCG inoculation as a potential protective agent against AD and PD.
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Affiliation(s)
- Danielle Klinger
- Department of Biological Chemistry, Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem 91904, Israel;
| | - Brian L. Hill
- Department of Computer Science, University of California Los Angeles, Los Angeles, CA 90095-1596, USA; (B.L.H.); (E.H.)
| | - Noam Barda
- Clalit Research Institute, Innovation Division, Clalit Health Services, Ramat-Gan 6578898, Israel;
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, USA
| | - Eran Halperin
- Department of Computer Science, University of California Los Angeles, Los Angeles, CA 90095-1596, USA; (B.L.H.); (E.H.)
| | - Ofer N. Gofrit
- Department of Urology, Hadassah University Hospital, Jerusalem 91904, Israel;
| | - Charles L. Greenblatt
- Department of Microbiology and Molecular Genetics, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91904, Israel; (C.L.G.); (H.B.)
| | - Nadav Rappoport
- Department of Software and Information Systems Engineering, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel;
| | - Michal Linial
- Department of Biological Chemistry, Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem 91904, Israel;
- Correspondence: ; Tel.: +972-54-882-0035
| | - Hervé Bercovier
- Department of Microbiology and Molecular Genetics, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91904, Israel; (C.L.G.); (H.B.)
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Abstract
BACKGROUND As mass vaccination campaigns against coronavirus disease 2019 (Covid-19) commence worldwide, vaccine effectiveness needs to be assessed for a range of outcomes across diverse populations in a noncontrolled setting. In this study, data from Israel's largest health care organization were used to evaluate the effectiveness of the BNT162b2 mRNA vaccine. METHODS All persons who were newly vaccinated during the period from December 20, 2020, to February 1, 2021, were matched to unvaccinated controls in a 1:1 ratio according to demographic and clinical characteristics. Study outcomes included documented infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), symptomatic Covid-19, Covid-19-related hospitalization, severe illness, and death. We estimated vaccine effectiveness for each outcome as one minus the risk ratio, using the Kaplan-Meier estimator. RESULTS Each study group included 596,618 persons. Estimated vaccine effectiveness for the study outcomes at days 14 through 20 after the first dose and at 7 or more days after the second dose was as follows: for documented infection, 46% (95% confidence interval [CI], 40 to 51) and 92% (95% CI, 88 to 95); for symptomatic Covid-19, 57% (95% CI, 50 to 63) and 94% (95% CI, 87 to 98); for hospitalization, 74% (95% CI, 56 to 86) and 87% (95% CI, 55 to 100); and for severe disease, 62% (95% CI, 39 to 80) and 92% (95% CI, 75 to 100), respectively. Estimated effectiveness in preventing death from Covid-19 was 72% (95% CI, 19 to 100) for days 14 through 20 after the first dose. Estimated effectiveness in specific subpopulations assessed for documented infection and symptomatic Covid-19 was consistent across age groups, with potentially slightly lower effectiveness in persons with multiple coexisting conditions. CONCLUSIONS This study in a nationwide mass vaccination setting suggests that the BNT162b2 mRNA vaccine is effective for a wide range of Covid-19-related outcomes, a finding consistent with that of the randomized trial.
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Affiliation(s)
- Noa Dagan
- From the Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv (N.D., N.B., E.K., O.M., S.P., M.A.K., R.D.B.), and the School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva (O.M., M.A.K., R.D.B.) - both in Israel; University of Michigan School of Public Health, Ann Arbor (M.A.K.); and the Department of Biomedical Informatics (N.D., N.B.), Harvard Medical School (B.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and of Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology (M.A.H.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.R.) - all in Boston
| | - Noam Barda
- From the Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv (N.D., N.B., E.K., O.M., S.P., M.A.K., R.D.B.), and the School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva (O.M., M.A.K., R.D.B.) - both in Israel; University of Michigan School of Public Health, Ann Arbor (M.A.K.); and the Department of Biomedical Informatics (N.D., N.B.), Harvard Medical School (B.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and of Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology (M.A.H.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.R.) - all in Boston
| | - Eldad Kepten
- From the Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv (N.D., N.B., E.K., O.M., S.P., M.A.K., R.D.B.), and the School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva (O.M., M.A.K., R.D.B.) - both in Israel; University of Michigan School of Public Health, Ann Arbor (M.A.K.); and the Department of Biomedical Informatics (N.D., N.B.), Harvard Medical School (B.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and of Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology (M.A.H.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.R.) - all in Boston
| | - Oren Miron
- From the Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv (N.D., N.B., E.K., O.M., S.P., M.A.K., R.D.B.), and the School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva (O.M., M.A.K., R.D.B.) - both in Israel; University of Michigan School of Public Health, Ann Arbor (M.A.K.); and the Department of Biomedical Informatics (N.D., N.B.), Harvard Medical School (B.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and of Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology (M.A.H.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.R.) - all in Boston
| | - Shay Perchik
- From the Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv (N.D., N.B., E.K., O.M., S.P., M.A.K., R.D.B.), and the School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva (O.M., M.A.K., R.D.B.) - both in Israel; University of Michigan School of Public Health, Ann Arbor (M.A.K.); and the Department of Biomedical Informatics (N.D., N.B.), Harvard Medical School (B.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and of Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology (M.A.H.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.R.) - all in Boston
| | - Mark A Katz
- From the Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv (N.D., N.B., E.K., O.M., S.P., M.A.K., R.D.B.), and the School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva (O.M., M.A.K., R.D.B.) - both in Israel; University of Michigan School of Public Health, Ann Arbor (M.A.K.); and the Department of Biomedical Informatics (N.D., N.B.), Harvard Medical School (B.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and of Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology (M.A.H.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.R.) - all in Boston
| | - Miguel A Hernán
- From the Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv (N.D., N.B., E.K., O.M., S.P., M.A.K., R.D.B.), and the School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva (O.M., M.A.K., R.D.B.) - both in Israel; University of Michigan School of Public Health, Ann Arbor (M.A.K.); and the Department of Biomedical Informatics (N.D., N.B.), Harvard Medical School (B.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and of Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology (M.A.H.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.R.) - all in Boston
| | - Marc Lipsitch
- From the Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv (N.D., N.B., E.K., O.M., S.P., M.A.K., R.D.B.), and the School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva (O.M., M.A.K., R.D.B.) - both in Israel; University of Michigan School of Public Health, Ann Arbor (M.A.K.); and the Department of Biomedical Informatics (N.D., N.B.), Harvard Medical School (B.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and of Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology (M.A.H.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.R.) - all in Boston
| | - Ben Reis
- From the Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv (N.D., N.B., E.K., O.M., S.P., M.A.K., R.D.B.), and the School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva (O.M., M.A.K., R.D.B.) - both in Israel; University of Michigan School of Public Health, Ann Arbor (M.A.K.); and the Department of Biomedical Informatics (N.D., N.B.), Harvard Medical School (B.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and of Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology (M.A.H.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.R.) - all in Boston
| | - Ran D Balicer
- From the Clalit Research Institute, Innovation Division, Clalit Health Services, Tel Aviv (N.D., N.B., E.K., O.M., S.P., M.A.K., R.D.B.), and the School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva (O.M., M.A.K., R.D.B.) - both in Israel; University of Michigan School of Public Health, Ann Arbor (M.A.K.); and the Department of Biomedical Informatics (N.D., N.B.), Harvard Medical School (B.R.), the Departments of Epidemiology and Biostatistics (M.A.H.), and the Center for Communicable Disease Dynamics, Departments of Epidemiology and of Immunology and Infectious Diseases (M.L.), Harvard T.H. Chan School of Public Health, Harvard-MIT Division of Health Sciences and Technology (M.A.H.), and the Predictive Medicine Group, Computational Health Informatics Program, Boston Children's Hospital (B.R.) - all in Boston
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Barda N, Yona G, Rothblum GN, Greenland P, Leibowitz M, Balicer R, Bachmat E, Dagan N. Addressing bias in prediction models by improving subpopulation calibration. J Am Med Inform Assoc 2021; 28:549-558. [PMID: 33236066 DOI: 10.1093/jamia/ocaa283] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 07/23/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To illustrate the problem of subpopulation miscalibration, to adapt an algorithm for recalibration of the predictions, and to validate its performance. MATERIALS AND METHODS In this retrospective cohort study, we evaluated the calibration of predictions based on the Pooled Cohort Equations (PCE) and the fracture risk assessment tool (FRAX) in the overall population and in subpopulations defined by the intersection of age, sex, ethnicity, socioeconomic status, and immigration history. We next applied the recalibration algorithm and assessed the change in calibration metrics, including calibration-in-the-large. RESULTS 1 021 041 patients were included in the PCE population, and 1 116 324 patients were included in the FRAX population. Baseline overall model calibration of the 2 tested models was good, but calibration in a substantial portion of the subpopulations was poor. After applying the algorithm, subpopulation calibration statistics were greatly improved, with the variance of the calibration-in-the-large values across all subpopulations reduced by 98.8% and 94.3% in the PCE and FRAX models, respectively. DISCUSSION Prediction models in medicine are increasingly common. Calibration, the agreement between predicted and observed risks, is commonly poor for subpopulations that were underrepresented in the development set of the models, resulting in bias and reduced performance for these subpopulations. In this work, we empirically evaluated an adapted version of the fairness algorithm designed by Hebert-Johnson et al. (2017) and demonstrated its use in improving subpopulation miscalibration. CONCLUSION A postprocessing and model-independent fairness algorithm for recalibration of predictive models greatly decreases the bias of subpopulation miscalibration and thus increases fairness and equality.
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Affiliation(s)
- Noam Barda
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel.,School of Public Health, Ben-Gurion University, Beer-Sheba, Israel.,Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Gal Yona
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Guy N Rothblum
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Philip Greenland
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Morton Leibowitz
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
| | - Ran Balicer
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel.,School of Public Health, Ben-Gurion University, Beer-Sheba, Israel
| | - Eitan Bachmat
- Department of Computer Science, Ben-Gurion University, Beer-Sheba, Israel
| | - Noa Dagan
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel.,Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.,Department of Computer Science, Ben-Gurion University, Beer-Sheba, Israel
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43
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Efros O, Barda N, Meisel E, Leibowitz A, Fardman A, Rahav G, Klempfner R, Grossman E. Myocardial injury in hospitalized patients with COVID-19 infection-Risk factors and outcomes. PLoS One 2021; 16:e0247800. [PMID: 33635914 PMCID: PMC7909655 DOI: 10.1371/journal.pone.0247800] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/14/2021] [Indexed: 02/06/2023] Open
Abstract
Myocardial injury in hospitalized patients is associated with poor prognosis. This study aimed to evaluate risk factors for myocardial injury in hospitalized patients with coronavirus disease 2019 (COVID-19) and its prognostic value. We retrieved all consecutive patients who were hospitalized in internal medicine departments in a tertiary medical center from February 9th, 2020 to August 28th with a diagnosis of COVID-19. A total of 559 adult patients were hospitalized in the Sheba Medical Center with a diagnosis of COVID-19, 320 (57.24%) of whom were tested for troponin levels within 24-hours of admission, and 91 (28.44%) had elevated levels. Predictors for elevated troponin levels were age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.06), female sex (OR, 3.03; 95% CI 1.54-6.25), low systolic blood pressure (OR, 5.91; 95% CI 2.42-14.44) and increased creatinine level (OR, 2.88; 95% CI 1.44-5.73). The risk for death (hazard ratio [HR] 4.32, 95% CI 2.08-8.99) and a composite outcome of invasive ventilation support and death (HR 1.96, 95% CI 1.15-3.37) was significantly higher among patients who had elevated troponin levels. In conclusion, in hospitalized patients with COVID-19, elevated troponin levels are associated with poor prognosis. Hence, troponin levels may be used as an additional tool for risk stratification and a decision guide in patients hospitalized with COVID-19.
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Affiliation(s)
- Orly Efros
- Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Noam Barda
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
| | - Eshcar Meisel
- Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avshalom Leibowitz
- Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alexander Fardman
- Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Galia Rahav
- Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Robert Klempfner
- Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ehud Grossman
- Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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44
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Modai J, Barda N, Avda Y, Shpunt I, Leibovici D, Shilo Y. Do patients with ureterolithiasis treated conservatively return to follow up? Can J Urol 2021; 28:10536-10541. [PMID: 33625344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
UNLABELLED INTRODUCTION Distal ureteral stones (DUS) are common in patients presenting to the emergency department (ED) with renal colic. The majority of DUS will pass spontaneously and therefore conservative care is common. Follow up is imperative as some of these stones might not pass and potentially lead to complications. The aim of our study was to evaluate the rate of compliance with follow up and to find predictive variables for it. MATERIALS AND METHODS We retrospectively surveyed the medical records of all patients who had a non-contrast computed tomography (NCCT) at our ED between 01/03/16 and 31/5/17. We included patients with a DUS smaller than 10 mm that were treated conservatively. We obtained demographic, clinical, laboratory and imaging data. Compliance to follow up was evaluated by surveying the medical records and by calling the patients. We then compared the characteristics of patients who returned for follow up to those who did not. RESULTS A total of 230 consecutive patients were included in our cohort: 194 (84%) patients were male and the average age was 46 y (21-82); 138 patients (60%) returned for a follow up visit while 92 patients (40%) did not. Univariate analysis revealed stone size and admission to hospital to be predictive of compliance to follow up while multivariate analysis revealed only hospital admission to be predictive of compliance. CONCLUSIONS Only 60% of the patients with DUS treated conservatively return for a follow up visit. Hospital admission, which likely reflects appropriate patients counseling by a urologist and adequate follow up scheduling, was found to be associated with increased compliance with follow up.
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Barda N, Riesel D, Akriv A, Levy J, Finkel U, Yona G, Greenfeld D, Sheiba S, Somer J, Bachmat E, Rothblum GN, Shalit U, Netzer D, Balicer R, Dagan N. Developing a COVID-19 mortality risk prediction model when individual-level data are not available. Nat Commun 2020; 11:4439. [PMID: 32895375 PMCID: PMC7477233 DOI: 10.1038/s41467-020-18297-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/13/2020] [Indexed: 12/29/2022] Open
Abstract
At the COVID-19 pandemic onset, when individual-level data of COVID-19 patients were not yet available, there was already a need for risk predictors to support prevention and treatment decisions. Here, we report a hybrid strategy to create such a predictor, combining the development of a baseline severe respiratory infection risk predictor and a post-processing method to calibrate the predictions to reported COVID-19 case-fatality rates. With the accumulation of a COVID-19 patient cohort, this predictor is validated to have good discrimination (area under the receiver-operating characteristics curve of 0.943) and calibration (markedly improved compared to that of the baseline predictor). At a 5% risk threshold, 15% of patients are marked as high-risk, achieving a sensitivity of 88%. We thus demonstrate that even at the onset of a pandemic, shrouded in epidemiologic fog of war, it is possible to provide a useful risk predictor, now widely used in a large healthcare organization.
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Affiliation(s)
- Noam Barda
- Clalit Research Institute, Innovation Division, Clalit Health Services, Toval 40, Ramat-Gan, Israel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Ben-Gurion blvd. 1, Be'er Sheva, Israel
- Department of Computer Science, Ben Gurion University of the Negev, Ben-Gurion blvd. 1, Be'er Sheva, Israel
| | - Dan Riesel
- Clalit Research Institute, Innovation Division, Clalit Health Services, Toval 40, Ramat-Gan, Israel
| | - Amichay Akriv
- Clalit Research Institute, Innovation Division, Clalit Health Services, Toval 40, Ramat-Gan, Israel
| | - Joseph Levy
- Clalit Research Institute, Innovation Division, Clalit Health Services, Toval 40, Ramat-Gan, Israel
| | - Uriah Finkel
- Clalit Research Institute, Innovation Division, Clalit Health Services, Toval 40, Ramat-Gan, Israel
| | - Gal Yona
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Herzl 234, Rehovot, Israel
| | - Daniel Greenfeld
- Faculty of Industrial Engineering and Management, Technion University, Haifa, Israel
| | - Shimon Sheiba
- Faculty of Industrial Engineering and Management, Technion University, Haifa, Israel
| | - Jonathan Somer
- Faculty of Industrial Engineering and Management, Technion University, Haifa, Israel
| | - Eitan Bachmat
- Department of Computer Science, Ben Gurion University of the Negev, Ben-Gurion blvd. 1, Be'er Sheva, Israel
| | - Guy N Rothblum
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Herzl 234, Rehovot, Israel
| | - Uri Shalit
- Faculty of Industrial Engineering and Management, Technion University, Haifa, Israel
| | - Doron Netzer
- Community Medical Services Division, Clalit Health Services, Arlozorov 101, Tel Aviv, Israel
| | - Ran Balicer
- Clalit Research Institute, Innovation Division, Clalit Health Services, Toval 40, Ramat-Gan, Israel
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Ben-Gurion blvd. 1, Be'er Sheva, Israel
| | - Noa Dagan
- Clalit Research Institute, Innovation Division, Clalit Health Services, Toval 40, Ramat-Gan, Israel.
- School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Ben-Gurion blvd. 1, Be'er Sheva, Israel.
- Department of Computer Science, Ben Gurion University of the Negev, Ben-Gurion blvd. 1, Be'er Sheva, Israel.
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Thompson MG, Kwong JC, Regan AK, Katz MA, Drews SJ, Azziz-Baumgartner E, Klein NP, Chung H, Effler PV, Feldman BS, Simmonds K, Wyant BE, Dawood FS, Jackson ML, Fell DB, Levy A, Barda N, Svenson LW, Fink RV, Ball SW, Naleway A. Influenza Vaccine Effectiveness in Preventing Influenza-associated Hospitalizations During Pregnancy: A Multi-country Retrospective Test Negative Design Study, 2010-2016. Clin Infect Dis 2020; 68:1444-1453. [PMID: 30307490 DOI: 10.1093/cid/ciy737] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 10/05/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To date, no study has examined influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza-associated hospitalizations during pregnancy. METHODS The Pregnancy Influenza Vaccine Effectiveness Network (PREVENT) consisted of public health or healthcare systems with integrated laboratory, medical, and vaccination records in Australia, Canada (Alberta and Ontario), Israel, and the United States (California, Oregon, and Washington). Sites identified pregnant women aged 18 through 50 years whose pregnancies overlapped with local influenza seasons from 2010 through 2016. Administrative data were used to identify hospitalizations with acute respiratory or febrile illness (ARFI) and clinician-ordered real-time reverse transcription polymerase chain reaction (rRT-PCR) testing for influenza viruses. Overall IVE was estimated using the test-negative design and adjusting for site, season, season timing, and high-risk medical conditions. RESULTS Among 19450 hospitalizations with an ARFI discharge diagnosis (across 25 site-specific study seasons), only 1030 (6%) of the pregnant women were tested for influenza viruses by rRT-PCR. Approximately half of these women had pneumonia or influenza discharge diagnoses (54%). Influenza A or B virus infections were detected in 598/1030 (58%) of the ARFI hospitalizations with influenza testing. Across sites and seasons, 13% of rRT-PCR-confirmed influenza-positive pregnant women were vaccinated compared with 22% of influenza-negative pregnant women; the adjusted overall IVE was 40% (95% confidence interval = 12%-59%) against influenza-associated hospitalization during pregnancy. CONCLUSION Between 2010 and 2016, influenza vaccines offered moderate protection against laboratory-confirmed influenza-associated hospitalizations during pregnancy, which may further inform the benefits of maternal influenza vaccination programs.
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Affiliation(s)
- Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey C Kwong
- Institute for Clinical Evaluative Sciences.,Public Health Ontario.,Department of Family and Community Medicine, University of Toronto.,Dalla Lana School of Public Health, University of Toronto.,University Health Network, Toronto, Ontario, Canada
| | - Annette K Regan
- School of Public Health, Curtin University, Perth.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Subiaco, Western Australia, Australia
| | - Mark A Katz
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv.,School of Public Health, Medical School for International Health, Ben Gurion University, Bersheva, Israel.,University of Michigan School of Public Health, Ann Arbor
| | - Steven J Drews
- University of Alberta.,ProvLab Alberta, Edmonton, Canada
| | | | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland
| | | | - Paul V Effler
- Communicable Disease Control Directorate, Department of Health Western Australia, Perth, Australia
| | - Becca S Feldman
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv
| | - Kimberley Simmonds
- Cumming School of Medicine, University of Calgary.,Alberta Health, Edmonton, Canada
| | | | - Fatimah S Dawood
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Deshayne B Fell
- Institute for Clinical Evaluative Sciences.,School of Epidemiology and Public Health, University of Ottawa.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Avram Levy
- Department of Microbiology, QEII Medical Centre, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Noam Barda
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv
| | - Lawrence W Svenson
- Alberta Health, Edmonton, Canada.,Division of Preventive Medicine.,School of Public Health, University of Alberta, Edmonton.,Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | | | | | - Allison Naleway
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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Dagan N, Elnekave E, Barda N, Bregman-Amitai O, Bar A, Orlovsky M, Bachmat E, Balicer RD. Automated opportunistic osteoporotic fracture risk assessment using computed tomography scans to aid in FRAX underutilization. Nat Med 2020; 26:77-82. [PMID: 31932801 DOI: 10.1038/s41591-019-0720-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 11/26/2019] [Indexed: 12/20/2022]
Abstract
Methods for identifying patients at high risk for osteoporotic fractures, including dual-energy X-ray absorptiometry (DXA)1,2 and risk predictors like the Fracture Risk Assessment Tool (FRAX)3-6, are underutilized. We assessed the feasibility of automatic, opportunistic fracture risk evaluation based on routine abdomen or chest computed tomography (CT) scans. A CT-based predictor was created using three automatically generated bone imaging biomarkers (vertebral compression fractures (VCFs), simulated DXA T-scores and lumbar trabecular density) and CT metadata of age and sex. A cohort of 48,227 individuals (51.8% women) aged 50-90 with available CTs before 2012 (index date) were assessed for 5-year fracture risk using FRAX with no bone mineral density (BMD) input (FRAXnb) and the CT-based predictor. Predictions were compared to outcomes of major osteoporotic fractures and hip fractures during 2012-2017 (follow-up period). Compared with FRAXnb, the major osteoporotic fracture CT-based predictor presented better receiver operating characteristic area under curve (AUC), sensitivity and positive predictive value (PPV) (+1.9%, +2.4% and +0.7%, respectively). The AUC, sensitivity and PPV measures of the hip fracture CT-based predictor were noninferior to FRAXnb at a noninferiority margin of 1%. When FRAXnb inputs are not available, the initial evaluation of fracture risk can be done completely automatically based on a single abdomen or chest CT, which is often available for screening candidates7,8.
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Affiliation(s)
- Noa Dagan
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel. .,Department of Computer Science, Ben-Gurion University, Beer Sheva, Israel. .,School of Public Health, Ben-Gurion University, Beer Sheva, Israel.
| | - Eldad Elnekave
- Department of Diagnostic Radiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Zebra Medical Vision, Ltd, Shefayim, Israel
| | - Noam Barda
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel.,Department of Computer Science, Ben-Gurion University, Beer Sheva, Israel.,School of Public Health, Ben-Gurion University, Beer Sheva, Israel
| | | | - Amir Bar
- Zebra Medical Vision, Ltd, Shefayim, Israel
| | | | - Eitan Bachmat
- Department of Computer Science, Ben-Gurion University, Beer Sheva, Israel
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel.,School of Public Health, Ben-Gurion University, Beer Sheva, Israel
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Naleway AL, Ball S, Kwong JC, Wyant BE, Katz MA, Regan AK, Russell ML, Klein NP, Chung H, Simmonds KA, Azziz-Baumgartner E, Feldman BS, Levy A, Fell DB, Drews SJ, Garg S, Effler P, Barda N, Irving SA, Shifflett P, Jackson ML, Thompson MG. Estimating Vaccine Effectiveness Against Hospitalized Influenza During Pregnancy: Multicountry Protocol for a Retrospective Cohort Study. JMIR Res Protoc 2019; 8:e11333. [PMID: 30664495 PMCID: PMC6360380 DOI: 10.2196/11333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 01/19/2023] Open
Abstract
Background Although pregnant women are believed to have elevated risks of severe influenza infection and are targeted for influenza vaccination, no study to date has examined influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza-associated hospitalizations during pregnancy, primarily because this outcome poses many methodological challenges. Objective The Pregnancy Influenza Vaccine Effectiveness Network (PREVENT) was formed in 2016 as an international collaboration with the Centers for Disease Control and Prevention; Abt Associates; and study sites in Australia, Canada, Israel, and the United States. The primary goal of this collaboration is to estimate IVE in preventing acute respiratory or febrile illness (ARFI) hospitalizations associated with laboratory-confirmed influenza virus infection during pregnancy. Secondary aims include (1) describing the incidence, clinical course, and severity of influenza-associated ARFI hospitalization during pregnancy; (2) comparing the characteristics of ARFI-hospitalized pregnant women who were tested for influenza with those who were not tested; (3) describing influenza vaccination coverage in pregnant women; and (4) comparing birth outcomes among women with laboratory-confirmed influenza-associated hospitalization versus other noninfluenza ARFI hospitalizations. Methods For an initial assessment of IVE, sites identified a retrospective cohort of pregnant women aged from 18 to 50 years whose pregnancies overlapped with local influenza seasons from 2010 to 2016. Pregnancies were defined as those that ended in a live birth or stillbirth of at least 20 weeks gestation. The analytic sample for the primary IVE analysis was restricted to pregnant women who were hospitalized for ARFI during site-specific influenza seasons and clinically tested for influenza virus infection using real-time reverse transcription polymerase chain reaction. Results We identified approximately 2 million women whose pregnancies overlapped with influenza seasons; 550,344 had at least one hospitalization during this time. After restricting to women who were hospitalized for ARFI and tested for influenza, the IVE analytic sample included 1005 women. Conclusions In addition to addressing the primary question about the effectiveness of influenza vaccination, PREVENT data will address other important knowledge gaps including understanding the incidence, clinical course, and severity of influenza-related hospitalizations during pregnancy. The data infrastructure and international partnerships created for these analyses may be useful and informative for future influenza studies. International Registered Report Identifier (IRRID) DERR1-10.2196/11333
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Affiliation(s)
- Allison L Naleway
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR, United States
| | - Sarah Ball
- Abt Associates, Inc, Cambridge, MA, United States
| | | | | | - Mark A Katz
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Annette K Regan
- School of Public Health, Curtin University, Perth, Australia
| | | | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, CA, United States
| | | | | | | | - Becca S Feldman
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Avram Levy
- PathWest Laboratory Medicine Western Australia, Perth, Australia
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Steven J Drews
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Shikha Garg
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Paul Effler
- Western Australia Department of Health, Perth, Australia
| | - Noam Barda
- Chief Physician's Office, Clalit Health Services, Clalit Research Institute, Tel Aviv, Israel
| | - Stephanie A Irving
- Kaiser Permanente Northwest, Center for Health Research, Portland, OR, United States
| | | | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Mark G Thompson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Abelson S, Collord G, Ng SWK, Weissbrod O, Mendelson Cohen N, Niemeyer E, Barda N, Zuzarte PC, Heisler L, Sundaravadanam Y, Luben R, Hayat S, Wang TT, Zhao Z, Cirlan I, Pugh TJ, Soave D, Ng K, Latimer C, Hardy C, Raine K, Jones D, Hoult D, Britten A, McPherson JD, Johansson M, Mbabaali F, Eagles J, Miller JK, Pasternack D, Timms L, Krzyzanowski P, Awadalla P, Costa R, Segal E, Bratman SV, Beer P, Behjati S, Martincorena I, Wang JCY, Bowles KM, Quirós JR, Karakatsani A, La Vecchia C, Trichopoulou A, Salamanca-Fernández E, Huerta JM, Barricarte A, Travis RC, Tumino R, Masala G, Boeing H, Panico S, Kaaks R, Krämer A, Sieri S, Riboli E, Vineis P, Foll M, McKay J, Polidoro S, Sala N, Khaw KT, Vermeulen R, Campbell PJ, Papaemmanuil E, Minden MD, Tanay A, Balicer RD, Wareham NJ, Gerstung M, Dick JE, Brennan P, Vassiliou GS, Shlush LI. Prediction of acute myeloid leukaemia risk in healthy individuals. Nature 2018; 559:400-404. [PMID: 29988082 PMCID: PMC6485381 DOI: 10.1038/s41586-018-0317-6] [Citation(s) in RCA: 506] [Impact Index Per Article: 84.3] [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] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 05/03/2018] [Indexed: 02/07/2023]
Abstract
The incidence of acute myeloid leukaemia (AML) increases with age and mortality exceeds 90% when diagnosed after age 65. Most cases arise without any detectable early symptoms and patients usually present with the acute complications of bone marrow failure1. The onset of such de novo AML cases is typically preceded by the accumulation of somatic mutations in preleukaemic haematopoietic stem and progenitor cells (HSPCs) that undergo clonal expansion2,3. However, recurrent AML mutations also accumulate in HSPCs during ageing of healthy individuals who do not develop AML, a phenomenon referred to as age-related clonal haematopoiesis (ARCH)4-8. Here we use deep sequencing to analyse genes that are recurrently mutated in AML to distinguish between individuals who have a high risk of developing AML and those with benign ARCH. We analysed peripheral blood cells from 95 individuals that were obtained on average 6.3 years before AML diagnosis (pre-AML group), together with 414 unselected age- and gender-matched individuals (control group). Pre-AML cases were distinct from controls and had more mutations per sample, higher variant allele frequencies, indicating greater clonal expansion, and showed enrichment of mutations in specific genes. Genetic parameters were used to derive a model that accurately predicted AML-free survival; this model was validated in an independent cohort of 29 pre-AML cases and 262 controls. Because AML is rare, we also developed an AML predictive model using a large electronic health record database that identified individuals at greater risk. Collectively our findings provide proof-of-concept that it is possible to discriminate ARCH from pre-AML many years before malignant transformation. This could in future enable earlier detection and monitoring, and may help to inform intervention.
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Affiliation(s)
- Sagi Abelson
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
| | - Grace Collord
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Stanley W K Ng
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Omer Weissbrod
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Netta Mendelson Cohen
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Elisabeth Niemeyer
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Noam Barda
- Clalit Research Institute, Tel Aviv, Israel
| | | | | | | | - Robert Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Shabina Hayat
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ting Ting Wang
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Zhen Zhao
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
| | - Iulia Cirlan
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
| | - Trevor J Pugh
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - David Soave
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Karen Ng
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Calli Latimer
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK
| | - Claire Hardy
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK
| | - Keiran Raine
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK
| | - David Jones
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK
| | - Diana Hoult
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Abigail Britten
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | | | - Mattias Johansson
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | | | - Jenna Eagles
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | | | | | - Lee Timms
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | | | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Rui Costa
- European Molecular Biology Laboratory, European Bioinformatics Institute EMBL-EBI, Wellcome Genome Campus, Hinxton, UK
| | - Eran Segal
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | - Scott V Bratman
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Philip Beer
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK
| | - Sam Behjati
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Inigo Martincorena
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK
| | - Jean C Y Wang
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, University Health Network, Toronto, Ontario, Canada
| | - Kristian M Bowles
- Department of Molecular Haematology, Norwich Medical School, The University of East Anglia, Norwich, UK
- Department of Haematology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Athens, Greece
| | - Carlo La Vecchia
- Hellenic Health Foundation, Athens, Greece
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Elena Salamanca-Fernández
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
| | - José M Huerta
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Aurelio Barricarte
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research, Pamplona, Spain
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Civic-M. P. Arezzo Hospital, Azienda Sanitaria Provinciale, Ragusa, Italy
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany
| | - Salvatore Panico
- Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alwin Krämer
- Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Matthieu Foll
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - James McKay
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | | | - Núria Sala
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program and Translational Research Laboratory, Catalan Institute of Oncology, ICO-IDIBELL, Barcelona, Spain
| | | | - Roel Vermeulen
- Division of Environmental Epidemiology and Veterinary Public Health, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Peter J Campbell
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - Elli Papaemmanuil
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK
- Center for Molecular Oncology and Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark D Minden
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Medical Oncology and Hematology, University Health Network, Toronto, Ontario, Canada
| | - Amos Tanay
- Department of Computer Science and Applied Mathematics, Weizmann Institute of Science, Rehovot, Israel
| | | | | | - Moritz Gerstung
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK.
- European Molecular Biology Laboratory, European Bioinformatics Institute EMBL-EBI, Wellcome Genome Campus, Hinxton, UK.
| | - John E Dick
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada.
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada.
| | - Paul Brennan
- International Agency for Research on Cancer, World Health Organization, Lyon, France.
| | - George S Vassiliou
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, UK.
- Department of Haematology, University of Cambridge, Cambridge, UK.
- Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK.
| | - Liran I Shlush
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario, Canada.
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel.
- Division of Hematology, Rambam Healthcare Campus, Haifa, Israel.
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50
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Epstein D, Berger G, Barda N, Marcusohn E, Barak-Corren Y, Muhsen K, Balicer RD, Azzam ZS. The incidence of acute pulmonary embolism following syncope in anticoagulant-naïve patients: A retrospective cohort study. PLoS One 2018; 13:e0193725. [PMID: 29513729 PMCID: PMC5841762 DOI: 10.1371/journal.pone.0193725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/16/2017] [Accepted: 02/19/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A recently published, large prospective study showed unexpectedly high prevalence of acute pulmonary embolism (APE) among patients hospitalized for syncope. In such a case, a high incidence of recurrent pulmonary embolism is expected among patients who were discharged without APE workup. OBJECTIVES To determine the incidence of symptomatic APE among patients hospitalized for a first episode of syncope and discharged without APE workup or anticoagulation. METHODS This retrospective cohort study included patients hospitalized at Rambam Health Care Campus between January 2006 and February 2017 with a primary admission diagnosis of syncope, who were not investigated for APE and were not taking anticoagulants. The patients were followed up for up to three years after discharge. The occurrence of venous thromboembolism (VTE) during the follow-up period was documented. RESULTS The median follow-up duration was 33 months. 1,126 subjects completed a three-year follow-up. During this period, 38 patients (3.38%) developed VTE, 17 (1.51%) of them had APE. The cumulative incidence of VTE and APE was 1.9% (95% CI 1.3%-2.5%) and 0.9% (95% CI 0.4%-1.3%) respectively. Only seven subjects developed APE during the first year of follow-up. The median times from the event of syncope to the development of APE and VTE were 18 and 19 months respectively. CONCLUSIONS The cumulative incidence of VTE during a three-year follow-up period after an episode of syncope is low. In the absence of clinical suspicion, a routine diagnostic workup for APE in patients with syncope cannot be recommended.
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Affiliation(s)
- Danny Epstein
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
| | - Gidon Berger
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
- Division of Pulmonary Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Noam Barda
- Clalit Research Institute, Chief Physician’s Office, Clalit Health Services, Tel Aviv, Israel
| | - Erez Marcusohn
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
| | - Yuval Barak-Corren
- Predictive Medicine Group, Boston Children’s Hospital, Boston, United States of America
- Shaare Tzedek Medical Center, Jerusalem, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran D. Balicer
- Clalit Research Institute, Chief Physician’s Office, Clalit Health Services, Tel Aviv, Israel
- Epidemiology Department, Ben Gurion University of the Negev, Be’er Sheba, Israel
| | - Zaher S. Azzam
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
- The Rappaport's Faculty of Medicine, The Technion Institute, Haifa, Israel
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