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Marinda E, Mathentamo Q, Coulson N, Parker S, Dmc Katoto P, Houston G, Magampa M, Pillay N, Ngungu M, Wiysonge CS, van Rooyen H. Impact evaluation of a youth led intervention to increase COVID-19 vaccine uptake in Kwazulu-Natal, South Africa. Vaccine 2024; 42:2089-2098. [PMID: 38423816 DOI: 10.1016/j.vaccine.2024.02.052] [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: 05/04/2023] [Revised: 02/14/2024] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND COVID-19 vaccination rates in South Africa remain low at 51% of the adult population being fully vaccinated, defined as having two shorts of the COVID-19 vaccine with or without a booster. To improve vaccine uptake, a community-based intervention was tested in a high vaccine hesitancy community in South Africa. Trained community youths used social media, face to face interactions, door to door and neighbourhood outreach activities to deliver the intervention. METHODS To assess if the intervention had an impact, data was collected before the intervention and after the intervention in two districts, Wentworth an intervention site and Newlands East a control site. Both districts are in KwaZulu Natal Province, South Africa. The following outcomes, changes on perceptions and knowledge about COVID-19, intention to get vaccinated for those who were not fully vaccinated and vaccination uptake were assessed using difference-in-difference methods applied through Augmented Inverse-Probability Weighting and contrasts of Potential Outcome Means (POM). RESULTS One thousand, one hundred and fifty (1 150) participants agreed to take part in the study at baseline, and 916 (80%) were followed up after the 9-week intervention period. Intention to get vaccinated for COVID-19 was higher (difference-in-difference, DID 20%, 95% CI 6% - 35% higher), more people were fully vaccinated (DID 10%, 95% CI 0% - 20%) or partially vaccinated (DID 16%, 95% CI 6% - 26%) in Wentworth the intervention site compared to Newlands East, the control site. There were noticeable increases on the percentage of study participants indicating trust on the Government's COVID 19 programme, from 24% at baseline to 48% after the intervention in the intervention group than in the control group, 26% baseline and 29% at follow-up. There was a 10% (absolute) increase on the percentage of participants' saying they believed health care workers provided reliable information, 58% at baseline and 68% at follow-up in the intervention group, but there was little change in the control group 56% and 57% for baseline and follow-up respectively. CONCLUSION The youth-led intervention implemented in Wentworth, a community with a high rate of vaccine hesitancy, was effective in increasing vaccination uptake. Given the low COVID-19 vaccine coverage in South Africa and across the African region, as well as the new emerging variant of concern (XBB 1.5), there is an urgent need to scale up such intervention at the community level to address persistent misinformation and promote vaccine equality.
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Affiliation(s)
- Edmore Marinda
- Human Sciences Research Council, Pretoria, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg 2050, South Africa.
| | | | - Nancy Coulson
- The Sarraounia Public Health Trust, Johannesburg 2193, South Africa; Wits Mining Institute, University of the Witwatersrand, Johannesburg 2050, South Africa
| | | | - Patrick Dmc Katoto
- Cochrane South Africa, South African Medical Research Council, Cape Town 7501, South Africa; Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa; Centre for General Medicine and Global Health, Department of Medicine, University of Cape Town, Cape Town 7505, South Africa
| | | | | | - Nirvana Pillay
- School of Public Health, University of the Witwatersrand, Johannesburg 2050, South Africa; The Sarraounia Public Health Trust, Johannesburg 2193, South Africa
| | - Mercy Ngungu
- Human Sciences Research Council, Pretoria, South Africa
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town 7501, South Africa; HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban, 4001, South Africa
| | - Heidi van Rooyen
- Human Sciences Research Council, Pretoria, South Africa; SAMRC-Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2050, South Africa
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Katoto PD, Tamuzi JL, Brand AS, Marangu DM, Byamungu LN, Wiysonge CS, Gray G. Effectiveness of COVID-19 Pfizer-BioNTech (BNT162b2) mRNA vaccination in adolescents aged 12-17 years: A systematic review and meta-analysis. Hum Vaccin Immunother 2023:2214495. [PMID: 37277959 DOI: 10.1080/21645515.2023.2214495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
The rapid emergence of COVID-19 variants of concern (VOCs) has hindered vaccine uptake. To inform policy, we investigated the effectiveness of the BNT162b2 vaccination among adolescents against symptomatic and severe COVID-19 diseases using mostly real-world data (15 studies). We searched international databases until May 2022 and used Cochrane's risk of bias tools for critical appraisal. Random effects models were used to examine overall vaccine effectiveness (VE) across studies (general inverse-variance) and the effect of circulating VOCs on VE (log relative ratio and VE). Meta-regression assessed the effect of age and time on VE (restricted-maximum likelihood). BNT162b2 VE against PCR-confirmed SARS-CoV-2 was 82.7% (95%CI: 78.37-87.31%). VE was higher for severe (88%) than non-severe (35%) outcomes and declining over time improved following booster dose in omicron era [73%(95%CI:65-81%)]. Fully vaccinated adolescents are protected from COVID-19 circulating VOCs by BNT162b2 especially for the need of critical care or life support.
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Affiliation(s)
- Patrick Dmc Katoto
- Office of the President and CEO, South African Medical Research Council, Cape Town, South Africa
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Centre for Tropical Diseases and Global Health, Department of Medicine, Catholic University of Bukavu, DR, Bukavu, Congo
| | - Jacques L Tamuzi
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Amanda S Brand
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Diana M Marangu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Liliane N Byamungu
- Department of Paediatric, Faculty of Medicine and Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Charles S Wiysonge
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Glenda Gray
- Office of the President and CEO, South African Medical Research Council, Cape Town, South Africa
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Katoto PD, Kakubu MA, Tamuzi JL, Brand AS, Ayuk A, Byamungu LN, Wiysonge CS, Gray G. Immunogenicity and reactogenicity of COVID-19 Pfizer-BioNTech (BNT162b2) mRNA vaccination in immunocompromised adolescents and young adults: a systematic review and meta-analyses. Expert Rev Vaccines 2023; 22:378-392. [PMID: 37078534 DOI: 10.1080/14760584.2023.2204154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND This study aimed to evaluate the safety and effectiveness of the BNT162b2 vaccine in immunocompromised adolescents and young adults. RESEARCH DESIGN AND METHODS The study conducted a meta-analysis of post-marketing studies examining BNT162b2 vaccination efficacy and safety among immunocompromised adolescents and young adults worldwide. The review included nine studies and 513 individuals aged between 12 and 24.3 years. The study used a random effect model to estimate pooled proportions, log relative risk, and mean difference, and assessed heterogeneity using the I2 test. The study also examined publication bias using Egger's regression and Begg's rank correlation and assessed bias risk using ROBINS-I. RESULTS The pooled proportions of combined local and systemic reactions after the first and second doses were 30% and 32%, respectively. Adverse events following immunization (AEFI) were most frequent in rheumatic diseases (40%) and least frequent in cystic fibrosis (27%), although hospitalizations for AEFIs were rare. The pooled estimations did not show a statistically significant difference between immunocompromised individuals and healthy controls for neutralizing antibodies, measured IgG, or vaccine effectiveness after the primary dose. However, the evidence quality is low to moderate due to a high risk of bias, and no study could rule out the risk of selection bias, ascertainment bias, or selective outcome reporting. CONCLUSIONS This study provides preliminary evidence that the BNT162b2 vaccine is safe and effective in immunocompromised adolescents and young adults, but with low to moderate evidence quality due to bias risk. The study calls for improved methodological quality in studies involving specific populations.
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Affiliation(s)
- Patrick Dmc Katoto
- South African Medical Research Council, Cape Town, South Africa
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Centre for Tropical Diseases and Global Health, Department of Medicine, Catholic University of Bukavu, DR Congo
| | | | - Jacques L Tamuzi
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Amanda S Brand
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adaeze Ayuk
- Department of Paediatrics and Child Health, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Liliane N Byamungu
- Department of Paediatric, Faculty of Medicine and Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Charles S Wiysonge
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Glenda Gray
- South African Medical Research Council, Cape Town, South Africa
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Achoki T, Sartorius B, Watkins D, Glenn SD, Kengne AP, Oni T, Wiysonge CS, Walker A, Adetokunboh OO, Babalola TK, Bolarinwa OA, Claassens MM, Cowden RG, Day CT, Ezekannagha O, Ginindza TG, Iwu CCD, Iwu CJ, Karangwa I, Katoto PD, Kugbey N, Kuupiel D, Mahasha PW, Mashamba-Thompson TP, Mensah GA, Ndwandwe DE, Nnaji CA, Ntsekhe M, Nyirenda TE, Odhiambo JN, Oppong Asante K, Parry CDH, Pillay JD, Schutte AE, Seedat S, Sliwa K, Stein DJ, Tanser FC, Useh U, Zar HJ, Zühlke LJ, Mayosi BM, Hay SI, Murray CJL, Naghavi M. Health trends, inequalities and opportunities in South Africa's provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study. J Epidemiol Community Health 2022; 76:jech-2021-217480. [PMID: 35046100 PMCID: PMC8995905 DOI: 10.1136/jech-2021-217480] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the last 30 years, South Africa has experienced four 'colliding epidemics' of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019. METHODS We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990-2007 and 2007-2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance. RESULTS Across the nine provinces, inequalities in mortality and life expectancy increased over 1990-2007, largely due to differences in HIV/AIDS, then decreased over 2007-2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces. CONCLUSIONS Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic.
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Affiliation(s)
- Tom Achoki
- Research, Africa Institute for Health Policy, Nairobi, Kenya
- Center for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, Netherlands
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
| | - David Watkins
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Scott D Glenn
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Andre Pascal Kengne
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Non-communicable Diseases Research Unit, Medical Research Council South Africa, Cape Town, South Africa
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Charles Shey Wiysonge
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Alexandra Walker
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Olatunji O Adetokunboh
- Centre of Excellence for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Tesleem Kayode Babalola
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Community Health and Primary Care, University of Lagos, Lagos, Nigeria
| | | | - Mareli M Claassens
- Department of Biochemistry and Microbiology, University of Namibia, Windhoek, Namibia
- Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - Richard G Cowden
- Department of Psychology, University of the Free State, Park WEst, Free State, South Africa
| | - Candy T Day
- Health Systems Research Unit, Health System Trust, Westville, South Africa
| | - Oluchi Ezekannagha
- Independent Consultant, Awka, Nigeria
- International Institute of Tropical Agriculture, Ibadan, Nigeria
| | - Themba G Ginindza
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Chidozie C D Iwu
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Chinwe Juliana Iwu
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Innocent Karangwa
- Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa
| | - Patrick Dmc Katoto
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Centre for Tropical Diseases and Global Health, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Nuworza Kugbey
- University of Environment and Sustainable Development, Somanya, Ghana
| | - Desmond Kuupiel
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Nursing, Research for Sustainable Development Consult, Sunyani, Ghana
| | - Phetole Walter Mahasha
- Grants, Innovation and Product Development Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - George A Mensah
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Center for Translation Research and Implementation Science, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Chukwudi A Nnaji
- School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Mpiko Ntsekhe
- Division of Cardiology, University of Cape Town, Rondebosch, Western Cape, South Africa
- The Cardiac Clinic, Groote Schuur Hospital, Cape Town, South Africa
| | - Thomas Elliot Nyirenda
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- European and Developing Countries Clinical Trials Partnership (EDCTP), European Commission, Cape Town, South Africa
| | - Julius Nyerere Odhiambo
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Management Science and Technology, Technical University of Kenya, Nairobi, Nairobi, Kenya
| | | | - Charles D H Parry
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Julian David Pillay
- Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Aletta Elisabeth Schutte
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Karen Sliwa
- Hatter Institute Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council, Cape Town, South Africa
| | - Frank C Tanser
- University of KwaZulu-Natal, Durban, South Africa
- Africa Health Research Institute, Berea, South Africa
| | - Ushotanefe Useh
- Health Sciences Department, North-West University, Mmbatho, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Unit on Child & Adolescent Health, Medical Research Council South Africa, Cape Town, South Africa
| | - Liesl J Zühlke
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | | | - Simon I Hay
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Christopher J L Murray
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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