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Whitaker HJ, Hassell K, Hoschler K, Power L, Stowe J, Boddington NL, Tsang C, Zhao H, Linley E, Button E, Okusi C, Aspden C, Byford R, deLusignan S, Amirthalingam G, Zambon M, Andrews NJ, Watson C. Influenza vaccination during the 2021/22 season: A data-linkage test-negative case-control study of effectiveness against influenza requiring emergency care in England and serological analysis of primary care patients. Vaccine 2024; 42:1656-1664. [PMID: 38342716 DOI: 10.1016/j.vaccine.2024.02.006] [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: 11/21/2023] [Revised: 01/15/2024] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
We present England 2021/22 end-of-season adjusted vaccine effectiveness (aVE) against laboratory confirmed influenza related emergency care use in children aged 1-17 and in adults aged 50+, and serological findings in vaccinated vs unvaccinated adults by hemagglutination inhibition assay. Influenza vaccination has been routinely offered to all children aged 2-10 years and adults aged 65 years + in England. In 2021/22, the offer was extended to children to age 15 years, and adults aged 50-64 years. Influenza activity rose during the latter half of the 2021/22 season, while remaining comparatively low due to COVID-19 pandemic control measures. Influenza A(H3N2) strains predominated. A test negative design was used to estimate aVE by vaccine type. Cases and controls were identified within a sentinel laboratory surveillance system. Vaccine histories were obtained from the National Immunisation Management Service (NIMS), an influenza and COVID-19 vaccine registry. These were linked to emergency department presentations (excluding accidents) with respiratory swabbing ≤ 14 days before or ≤ 7 days after presentation. Amongst adults, 423 positive and 32,917 negative samples were eligible for inclusion, and 145 positive and 6,438 negative samples among children. Those admitted to hospital were further identified. In serology against the circulating A(H3N2) A/Bangladesh/4005/2020-like strain, 61 % of current season adult vaccinees had titres ≥ 1:40 compared to 17 % of those unvaccinated in 2020/21 or 2021/22 (p < 0.001). We found good protection from influenza vaccination against influenza requiring emergency care in children (72.7 % [95 % CI 52.7, 84.3 %]) and modest effectiveness in adults (26.1 % [95 % CI 4.5, 42.8 %]). Adult VE was higher for A(H1N1) (81 % [95 % CI 50, 93 %]) than A(H3N2) (33 % [95 % CI 6, 53 %]). Consistent protection was observable across preschool, primary and secondary school aged children. Imperfect test specificity combined with very low prevalence may have biased estimates towards null. With limited influenza circulation, the study could not determine differences by vaccine types.
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Affiliation(s)
- Heather J Whitaker
- Statistics, Modelling and Economics Department, UK Health Security Agency, Colindale, London, UK.
| | - Katie Hassell
- Immunisation and Vaccine-preventable Diseases Division, UK Health Security Agency, Colindale, London, UK
| | - Katja Hoschler
- Virus Reference Unit, UK Health Security Agency, Colindale, London, UK
| | - Linda Power
- Immunisation and Vaccine-preventable Diseases Division, UK Health Security Agency, Colindale, London, UK
| | - Julia Stowe
- Immunisation and Vaccine-preventable Diseases Division, UK Health Security Agency, Colindale, London, UK
| | - Nicki L Boddington
- Immunisation and Vaccine-preventable Diseases Division, UK Health Security Agency, Colindale, London, UK
| | - Camille Tsang
- Immunisation and Vaccine-preventable Diseases Division, UK Health Security Agency, Colindale, London, UK
| | - Hongxin Zhao
- Immunisation and Vaccine-preventable Diseases Division, UK Health Security Agency, Colindale, London, UK
| | - Ezra Linley
- Seroepidemiology Unit, UK Health Security Agency, Manchester, UK
| | - Elizabeth Button
- Nuffield Department of General Practitioners Research and Surveillance Centre, Oxford Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Cecilia Okusi
- Nuffield Department of General Practitioners Research and Surveillance Centre, Oxford Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carole Aspden
- Nuffield Department of General Practitioners Research and Surveillance Centre, Oxford Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachel Byford
- Nuffield Department of General Practitioners Research and Surveillance Centre, Oxford Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon deLusignan
- Nuffield Department of General Practitioners Research and Surveillance Centre, Oxford Primary Care Health Sciences, University of Oxford, Oxford, UK; Royal College of General Practitioners Research and Surveillance Centre, 30, Euston Square, London, UK
| | - Gayatri Amirthalingam
- Immunisation and Vaccine-preventable Diseases Division, UK Health Security Agency, Colindale, London, UK
| | - Maria Zambon
- Virus Reference Unit, UK Health Security Agency, Colindale, London, UK
| | - Nick J Andrews
- Statistics, Modelling and Economics Department, UK Health Security Agency, Colindale, London, UK; Immunisation and Vaccine-preventable Diseases Division, UK Health Security Agency, Colindale, London, UK
| | - Conall Watson
- Immunisation and Vaccine-preventable Diseases Division, UK Health Security Agency, Colindale, London, UK
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Zhang XS, Mandal S, Mohammed H, Turner C, Florence I, Walker J, Niyomsri S, Amirthalingam G, Ramsay M, Charlett A, Vickerman P. Transmission dynamics and effect of control measures on the 2022 outbreak of mpox among gay, bisexual, and other men who have sex with men in England: a mathematical modelling study. Lancet Infect Dis 2024; 24:65-74. [PMID: 37708908 DOI: 10.1016/s1473-3099(23)00451-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/26/2023] [Accepted: 07/12/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The 2022 global outbreak of mpox (formerly known as monkeypox) spread primarily among gay, bisexual, and other men who have sex with men (GBMSM), with the initial cluster being identified in England in May, 2022. Understanding its epidemiological characteristics and the reasons for its downturn in July, 2022, will help to control future outbreaks. METHODS We collated data for all diagnosed mpox cases (3621) from England from May 1, 2022, to Nov 16, 2022. Data from 75 individuals with mpox allowed estimation of the incubation period, while data from 121 case-contact pairs were used to estimate the serial interval. Six methods, including a structured dynamic compartmental transmission model, were used to estimate the basic reproduction number (R0). The structured model assumed all male individuals with mpox were GBMSM, who were then stratified into subgroups for those at low risk and high risk for mpox. This best fitting model was used to estimate the reduction in transmissibility, and the effective infectious period (before isolating), that resulted in the outbreak downturn, and the effect of vaccination initiated from June 27, 2022. Bayesian methods were used for parameter estimation and model calibration. FINDINGS Most cases occurred in men (3544 of 3621, 97·9%). The median incubation period for mpox was 6·90 days (95% credible interval [CrI] 4·08-20·21), and the serial interval was 8·82 days (5·22-25·81). R0 estimates ranged from 1·41 to 2·17. The structured transmission model estimated that 83·8% of infections (95% CrI 83·5-85·3) resulted from sexual partnerships with GBMSM individuals at high risk of mpox. The outbreak downturn probably resulted from a 44·5% reduction in the sexual partner rate among all GBMSM (24·9-55·8) and 20·0% reduction in the effective infectious period (4·1-33·9), preventing 165 896 infections (115 584-217 730). Vaccination marginally increased the number of infections prevented (166 081, 115 745-217 947), but minimised a resurgence in cases from January, 2023, and could have averted four times more infections if initiated earlier. Our findings were sensitive to assumptions regarding the vaccine's effectiveness and the GBMSM subgroup at high risk of mpox. INTERPRETATION The mpox outbreak in England probably resulted from high sexual partner rates among some GBMSM, with reductions in partner rates reversing the outbreak, and with vaccination minimising future outbreaks. FUNDING National Institute for Health Research (UK).
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Affiliation(s)
- Xu-Sheng Zhang
- Statistics, Modelling and Economics, Data, Analytics and Surveillance, UK Health Security Agency, London, UK
| | - Sema Mandal
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK; Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency, London, UK
| | - Hamish Mohammed
- Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency, London, UK; Institute for Global Health, University College London, London, UK; National Institute for Health and Care Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with UK Health Security Agency, London, UK
| | - Charlie Turner
- Health Protection Operations, UK Health Security Agency, London, UK
| | - Isaac Florence
- Health Protection Operations, UK Health Security Agency, London, UK
| | | | | | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Mary Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Andre Charlett
- Statistics, Modelling and Economics, Data, Analytics and Surveillance, UK Health Security Agency, London, UK
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK; National Institute for Health and Care Research Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol in partnership with UK Health Security Agency, Bristol, UK.
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Ratcliffe H, Tiley KS, Longet S, Tonry C, Roarty C, Watson C, Amirthalingam G, Vichos I, Morey E, Douglas NL, Marinou S, Plested E, Aley PK, Galiza E, Faust SN, Hughes S, Murray C, Roderick MR, Shackley F, Oddie S, Lee TW, Turner DP, Raman M, Owens S, Turner PJ, Cockerill H, Lopez Bernal J, Ijaz S, Poh J, Shute J, Linley E, Borrow R, Hoschler K, Brown KE, Carroll MW, Klenerman P, Dunachie SJ, Ramsay M, Voysey M, Waterfield T, Snape MD. Serum HCoV-spike specific antibodies do not protect against subsequent SARS-CoV-2 infection in children and adolescents. iScience 2023; 26:108500. [PMID: 38089581 PMCID: PMC10711458 DOI: 10.1016/j.isci.2023.108500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/17/2023] [Accepted: 11/17/2023] [Indexed: 02/15/2024] Open
Abstract
SARS-CoV-2 infections in children are generally asymptomatic or mild and rarely progress to severe disease and hospitalization. Why this is so remains unclear. Here we explore the potential for protection due to pre-existing cross-reactive seasonal coronavirus antibodies and compare the rate of antibody decline for nucleocapsid and spike protein in serum and oral fluid against SARS-CoV-2 within the pediatric population. No differences in seasonal coronaviruses antibody concentrations were found at baseline between cases and controls, suggesting no protective effect from pre-existing immunity against seasonal coronaviruses. Antibodies against seasonal betacoronaviruses were boosted in response to SARS-CoV-2 infection. In serum, anti-nucleocapsid antibodies fell below the threshold of positivity more quickly than anti-spike protein antibodies. These findings add to our understanding of protection against infection with SARS-CoV-2 within the pediatric population, which is important when considering pediatric SARS-CoV-2 immunization policies.
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Affiliation(s)
- Helen Ratcliffe
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
| | - Karen S. Tiley
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
| | - Stephanie Longet
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Claire Tonry
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast- School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | - Cathal Roarty
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast- School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | - Chris Watson
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast- School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | | | - Iason Vichos
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
| | - Ella Morey
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
| | - Naomi L. Douglas
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
| | - Spyridoula Marinou
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
| | - Emma Plested
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
| | - Parvinder K. Aley
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
| | - Eva Galiza
- St Georges Hospital NHS Foundation Trust
| | - Saul N. Faust
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust and Faculty of Medicine and Institute of Life Sciences, University of Southampton
- National Immunisation Schedule Evaluation Consortium
| | - Stephen Hughes
- Manchester University NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| | - Clare Murray
- Manchester University NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
| | | | | | - Sam Oddie
- Bradford Teaching Hospitals NHS Foundation Trust
| | | | - David P.J. Turner
- School of Life Sciences, University of Nottingham
- Nottingham University Hospitals NHS Trust
| | | | - Stephen Owens
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust
| | - Paul J. Turner
- National Heart & Lung Institute, Imperial College London
| | | | | | | | | | | | | | | | | | | | - Miles W. Carroll
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Paul Klenerman
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Oxford BRC
| | - Susanna J. Dunachie
- National Institute for Health Research (NIHR) Oxford BRC
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - Merryn Voysey
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
| | - Thomas Waterfield
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast- School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | - Matthew D. Snape
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
- National Immunisation Schedule Evaluation Consortium
- West Suffolk NHS Foundation Trust
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Tessier E, Litt D, Ribeiro S, Abdul Aziz N, Campbell H, Amirthalingam G, Fry NK, Andrews N. Mixture modelling of Bordetella pertussis serology samples to evaluate anti-pertussis toxin immunoglobulin G titre thresholds for positivity: England 2008-2022. J Med Microbiol 2023; 72. [PMID: 38047762 DOI: 10.1099/jmm.0.001774] [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] [Indexed: 12/05/2023] Open
Abstract
Introduction. Antibody testing for evidence of a recent Bordetella pertussis infection by estimating anti-pertussis toxin immunoglobulin G (anti-PT-IgG) titres by enzyme-linked immunosorbent assays is often recommended for those with a cough lasting more than 14 days. Interpreting results varies, with studies recommending different anti-PT-IgG titre thresholds for assigning positivity. In England, early work looking at antibody titre distributions for samples submitted from April 2010 to July 2012 found an optimal threshold of greater than 70 IU ml-1 for good sensitivity, specificity and positive predictive value.Aim. The aim of this study is to use the same mixture modelling technique to determine if the 70 IU ml-1 threshold remains appropriate when assessing data before, during and after the outbreak of pertussis in 2011-2012.Methods. We reviewed titres for all serology-tested samples in England between 1 July 2008 to 30 June 2022. IgG titres were used to calculate the positivity based on the current threshold of 70 IU ml-1, the median duration of cough for individuals who tested positive and, through mixture modelling, the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of assay thresholds.Results. Positivity rates increased from 21.7 % prior to the outbreak to 30.3 % during the outbreak and dropped to 25.1 % post-outbreak; similar to estimates from the mixture model of 20.5, 33.3 and 28.7 %, respectively. Although the estimated sensitivity dropped during and after the outbreak when applying the 70 IU ml-1 threshold, the PPV remained high and therefore no change to this threshold is warranted.Conclusion. Mixture modelling is a useful tool to establish thresholds, but reassessment should also be done when there have been changes to prevalence and/or testing regimes to determine whether there have been any changes in sensitivity, specificity, PPV, and NPV and whether the threshold should be revised.
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Affiliation(s)
- Elise Tessier
- COVID-19 Vaccines and Epidemiology Division, UK Health Security Agency, London, UK
| | - David Litt
- Immunisations and Countermeasures Division, UK Health Security Agency, London, UK
| | - Sonia Ribeiro
- Immunisations and Countermeasures Division, UK Health Security Agency, London, UK
| | - Nurin Abdul Aziz
- COVID-19 Vaccines and Epidemiology Division, UK Health Security Agency, London, UK
| | - Helen Campbell
- COVID-19 Vaccines and Epidemiology Division, UK Health Security Agency, London, UK
| | | | - Norman K Fry
- Immunisations and Countermeasures Division, UK Health Security Agency, London, UK
| | - Nick Andrews
- COVID-19 Vaccines and Epidemiology Division, UK Health Security Agency, London, UK
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Buck E, Burt J, Karampatsas K, Hsia Y, Whyte G, Amirthalingam G, Skirrow H, Le Doare K. 'Unable to have a proper conversation over the phone about my concerns': a multimethods evaluation of the impact of COVID-19 on routine childhood vaccination services in London, UK. Public Health 2023; 225:229-236. [PMID: 37944278 DOI: 10.1016/j.puhe.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Investigating the completion rate of 12-month vaccinations and parental perspectives on vaccine services during COVID-19. STUDY-DESIGN Service evaluation including parental questionnaire. METHODS Uptake of 12-month vaccinations in three London general practices during three periods: pre-COVID (1/3/2018-28/2/2019, n = 826), during COVID (1/3/2019-28/2/2020, n = 775) and post-COVID first wave (1/8/2020-31/1/2021, n = 419). Questionnaire of parents whose children were registered at the practices (1/4/2019-1/22/2021, n = 1350). RESULTS Comparing pre-COVID and both COVID cohorts, the completion rates of 12-month vaccines were lower. Haemophilus influenzae type B/meningococcal group C (Hib/MenC) vaccination uptake was 5.6% lower (89.0% vs 83.4%, P=<0.001), meningococcal group B (MenB) booster uptake was 4.4% lower (87.3% vs 82.9%, P = 0.006), pneumococcal conjugate vaccine (PCV) booster uptake was 6% lower (88.0% vs 82.0%, P < 0.001) and measles, mumps and rubella (MMR) vaccine uptake was 5.2% lower (89.1% vs 83.9%, P = 0.003). Black/Black-British ethnicity children had increased odds of missing their 12-month vaccinations compared to White ethnicity children (adjusted odds ratio 0.43 [95% confidence interval 0.24-0.79, P = 0.005; 0.36 [0.20-0.65], P < 0.001; 0.48 [0.27-0.87], P = 0.01; 0.40 [0.22-0.73], P = 0.002; for Hib/MenC, MenB booster, PCV booster and MMR. Comparing pre-COVID and COVID periods, vaccinations coded as not booked increased for MMR (10%), MenB (7%) and PCV booster (8%). Parents reported changes to vaccination services during COVID-19, including difficulties booking and attending appointments and lack of vaccination reminders. CONCLUSION A sustained decrease in 12-month childhood vaccination uptake disproportionally affected Black/Black British ethnicity infants during the first wave of the pandemic. Vaccination reminders and availability of healthcare professionals to discuss parental vaccine queries are vital to maintaining uptake.
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Affiliation(s)
- Eleanor Buck
- St George's Hospital Medical School, St. George's, University of London, London, United Kingdom.
| | - J Burt
- Ashford and St Peter's Hospital NHS Foundation Trust, United Kingdom
| | - K Karampatsas
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Y Hsia
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom; School of Pharmacy, Queen's University Belfast, Belfast, United Kingdom
| | - G Whyte
- North Croydon Medical Centre, United Kingdom
| | - G Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - H Skirrow
- School of Public Health, Imperial College London, United Kingdom
| | - K Le Doare
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom; MRC/UVRI @LHSTM Uganda Research Unit, Entebbe, Uganda; Pathogen Immunity Group, UK Health Security Agency, Porton Down, United Kingdom
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Anderson EC, Blair PS, Finn A, Ingram J, Amirthalingam G, Cabral C. Maternal vaccination provision in NHS maternity trusts across England. Vaccine 2023; 41:7359-7368. [PMID: 37951792 DOI: 10.1016/j.vaccine.2023.10.069] [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: 08/07/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Vaccinations for seasonal influenza and pertussis have been recommended for pregnant women in England since 2010 and 2012, respectively. Uptake rates are suboptimal with large regional variations. To improve uptake, from 2016 onwards maternity trusts were commissioned to offer pertussis (and other) vaccinations in addition to these being available in primary care. Since 2021, Covid-19 vaccination has also been recommended for pregnant women. Overall maternal vaccination rates are routinely available, but not the relative provision by maternity trusts. We aimed to describe the national picture of maternity trust provision of maternal vaccinations, including how the maternity trust vaccination programme has progressed. METHODS Cross-sectional survey plus comparisons with 2017-18 figures for maternity trust provision of pertussis vaccination, and with UKHSA data for total pertussis vaccination. RESULTS Twelve NHS commissioners participated (from 13/06/22 to 31/03/23) providing data for 120 (of a total 124) maternity trusts across England. All 120 (100%) trusts were commissioned to deliver influenza, and 107 (89%) to deliver pertussis vaccinations, though not all actually administered the vaccines; 29% offered Covid-19 vaccinations. For 2021-22 we found a mean of 25% (range 0-81.3%) women were vaccinated for pertussis (a large increase compared with previous estimates for 2017-18); and 11% (range 0-74.2%) for influenza, via their maternity trust. Commissioners reported a negative impact of the pandemic on routine vaccination provision. There was indication of efficiency by vaccinating women attending for other appointments. There are diverse mechanisms for reporting pertussis and influenza vaccinations administered at maternity trusts back to primary care, which may be inefficient for maternity staff workload and accuracy of data transfer (especially for pertussis). CONCLUSION A high proportion of maternity trusts provide both pertussis and influenza vaccinations, despite a negative impact of the pandemic. Reasons for large between-trust variation in vaccination rates should be explored to improve uptake and equity.
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Affiliation(s)
- Emma C Anderson
- Centre for Academic Child Health, Bristol Medical School: Population Sciences, University of Bristol, Canynge Hall, Third Floor, 39 Whatley Road, Bristol BS8 2PS, United Kingdom; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom.
| | - Peter S Blair
- Centre for Academic Child Health, Bristol Medical School: Population Sciences, University of Bristol, Canynge Hall, Third Floor, 39 Whatley Road, Bristol BS8 2PS, United Kingdom.
| | - Adam Finn
- Centre for Academic Child Health, Bristol Medical School: Population Sciences, University of Bristol, Canynge Hall, Third Floor, 39 Whatley Road, Bristol BS8 2PS, United Kingdom.
| | - Jenny Ingram
- Centre for Academic Child Health, Bristol Medical School: Population Sciences, University of Bristol, Canynge Hall, Third Floor, 39 Whatley Road, Bristol BS8 2PS, United Kingdom.
| | - Gayatri Amirthalingam
- UK Health Security Agency, Nobel House, 17 Smith Square, London SW1P 3JR, United Kingdom.
| | - Christie Cabral
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom.
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Vusirikala A, Tonge S, Bell A, Linley E, Borrow R, O'Boyle S, de Lusignan S, Charlett A, Balasegaram S, Amirthalingam G. Reassurance of population immunity to diphtheria in England: Results from a 2021 national serosurvey. Vaccine 2023; 41:6878-6883. [PMID: 37821313 DOI: 10.1016/j.vaccine.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/04/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Diphtheria is rare in England because of an effective national immunisation schedule that includes 5 doses of a diphtheria-containing vaccine at 2, 3, 4 months, preschool and adolescent boosters. However, in recent years there has been a notable increase in cases due to Corynebacterium ulcerans among older adults and evidence of endemic transmission of C. diphtheriae (normally associated with travel to endemic countries). We aimed to update 2009 estimates of diphtheria immunity considering the evolving epidemiology. METHODS Residual sera collected from diagnostic laboratories and general practitioners in England in 2021 were randomly selected and tested for diphtheria antibody, to estimate proportions protected per age group. Diphtheria antibody levels were defined as susceptible (<0.01 IU/mL), basic protection (0.01-0.099 IU/mL) and full protection (≥0.1 IU/mL). Immunity estimates were standardised to the England population and compared to 2009. RESULTS Based on 3,745 residual sera tested, 89% (95%CI: 87%-90%) of the 2021 England population had at least basic diphtheria protection (vs. 90% [88%-92%] in 2009) and 50% (48%-52%) full protection (vs. 41% [38%-44%]). Higher antibody levels were observed in those aged 1 and under, 10-11, 12-15, 25-34 and 35-44 years compared to 2009. The largest proportion susceptible were observed in those aged 70+, 26% (21%-31%) vs 12% (7%-18%) in 2009. CONCLUSIONS Basic diphtheria protection is comparable between 2021 and 2009. The increase in immunity in working age adults is likely due to the school leaver booster introduced in 1994. The current vaccination schedule is maintaining sufficient population immunity. However, we recommend clinicians remain vigilant to severe diphtheria outcomes in older adults, because of their observed susceptibility.
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Affiliation(s)
- Amoolya Vusirikala
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK; UK Field Epidemiology Training Programme, UK Health Security Agency, London, UK.
| | - Simon Tonge
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Abigail Bell
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Ezra Linley
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Shennae O'Boyle
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Simon de Lusignan
- Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London NW1 2FB, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Andre Charlett
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
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Bardsley M, Loveridge P, Bednarska NG, Smith S, Morbey RA, Amirthalingam G, Elson WH, Bates C, de Lusignan S, Todkill D, Elliot AJ. The Epidemiology of Chickenpox in England, 2016-2022: An Observational Study Using General Practitioner Consultations. Viruses 2023; 15:2163. [PMID: 38005841 PMCID: PMC10674747 DOI: 10.3390/v15112163] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
Chickenpox is a common childhood disease caused by varicella-zoster virus (VZV). VZV vaccination is not part of the UK childhood immunisation programme, but its potential inclusion is regularly assessed. It is therefore important to understand the ongoing burden of VZV in the community to inform vaccine policy decisions. General practitioner (GP) chickenpox consultations were studied from 1 September 2016 to 9 December 2022. Over the study period, the mean weekly chickenpox consultation rate per 100,000 population in England was 3.4, with a regular peak occurring between weeks 13 and 15. Overall, rates decreased over time, from a mean weekly rate of 5.5 in 2017 to 4.2 in 2019. The highest mean weekly rates were among children aged 1-4 years. There was no typical epidemic peak during the COVID-19 pandemic, but in 2022, rates were proportionally higher among children aged < 1 year old compared to pre-pandemic years. Chickenpox GP consultation rates decreased in England, continuing a longer-term decline in the community. The COVID-19 pandemic impacted rates, likely caused by the introduction of non-pharmaceutical interventions to prevent SARS-CoV-2 transmission. The lasting impact of the interruption of typical disease transmission remains to be seen, but it is important to monitor the chickenpox burden to inform decisions on vaccine programmes.
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Affiliation(s)
- Megan Bardsley
- Real-Time Syndromic Surveillance Team, Field Services, Health Protection Operations, UK Health Security Agency, Birmingham B2 4BH, UK; (M.B.); (P.L.); (N.G.B.); (S.S.); (R.A.M.); (D.T.)
| | - Paul Loveridge
- Real-Time Syndromic Surveillance Team, Field Services, Health Protection Operations, UK Health Security Agency, Birmingham B2 4BH, UK; (M.B.); (P.L.); (N.G.B.); (S.S.); (R.A.M.); (D.T.)
| | - Natalia G. Bednarska
- Real-Time Syndromic Surveillance Team, Field Services, Health Protection Operations, UK Health Security Agency, Birmingham B2 4BH, UK; (M.B.); (P.L.); (N.G.B.); (S.S.); (R.A.M.); (D.T.)
| | - Sue Smith
- Real-Time Syndromic Surveillance Team, Field Services, Health Protection Operations, UK Health Security Agency, Birmingham B2 4BH, UK; (M.B.); (P.L.); (N.G.B.); (S.S.); (R.A.M.); (D.T.)
| | - Roger A. Morbey
- Real-Time Syndromic Surveillance Team, Field Services, Health Protection Operations, UK Health Security Agency, Birmingham B2 4BH, UK; (M.B.); (P.L.); (N.G.B.); (S.S.); (R.A.M.); (D.T.)
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London NW9 5EQ, UK;
| | - William H. Elson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6ED, UK; (W.H.E.); (S.d.L.)
| | | | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6ED, UK; (W.H.E.); (S.d.L.)
| | - Daniel Todkill
- Real-Time Syndromic Surveillance Team, Field Services, Health Protection Operations, UK Health Security Agency, Birmingham B2 4BH, UK; (M.B.); (P.L.); (N.G.B.); (S.S.); (R.A.M.); (D.T.)
| | - Alex J. Elliot
- Real-Time Syndromic Surveillance Team, Field Services, Health Protection Operations, UK Health Security Agency, Birmingham B2 4BH, UK; (M.B.); (P.L.); (N.G.B.); (S.S.); (R.A.M.); (D.T.)
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9
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O'Boyle S, Barton HE, D'Aeth JC, Cordery R, Fry NK, Litt D, Southgate R, Verrecchia R, Mannes T, Wang TY, Stewart DE, Olufon O, Dickinson M, Ramsay ME, Amirthalingam G. National public health response to an outbreak of toxigenic Corynebacterium diphtheriae among asylum seekers in England, 2022: a descriptive epidemiological study. Lancet Public Health 2023; 8:e766-e775. [PMID: 37777286 DOI: 10.1016/s2468-2667(23)00175-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/10/2023] [Accepted: 07/25/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND In July, 2022, an increase in diphtheria cases caused by toxigenic Corynebacterium diphtheriae (C diphtheriae) was reported among asylum seekers arriving by small boats to England. Rising case numbers presented challenges for case and contact management in initial reception centres, prompting changes to national guidance and implementation of population-based control measures. This study aimed to describe the outbreak of toxigenic C diphtheriae among asylum seekers arriving by small boats to England during 2022 by use of national surveillance data. METHODS We undertook a descriptive epidemiological analysis of cases of toxigenic C diphtheriae among asylum seekers arriving by small boats to England during 2022, incorporating genomic sequencing data, antibiotic susceptibility testing results, and epidemiological data obtained through the UK Health Security Agency's national enhanced surveillance programme. Health Protection Teams conducted risk assessments, and operational data (including details regarding offer and uptake of antibiotics and vaccinations) were obtained from National Health Service partners supporting the intervention programme. FINDINGS In 2022, C diphtheriae isolates from 86 asylum seekers arriving by small boats were submitted to the National Reference Laboratory for confirmation and testing. Toxigenic C diphtheriae was confirmed for 72 (84%) cases and one individual with typical diphtheritic lesions but from whom no C diphtheriae was isolated from clinical swabs was also included as a probable case, resulting in 73 cases of diphtheria. 71 (97%) were male, 39 (53%) were younger than 18 years, and 36 (49%) presented with cutaneous diphtheria. The prevalence of diphtheria was highest among Afghans (1·3%) compared with all other nationalities (<0·1%). Local antibiotic susceptibility testing identified six cases with a macrolide resistant strain. INTERPRETATION The increase in diphtheria coincided with a high volume of asylum seekers arriving by small boats to England during 2022, and subsequently increased clinical awareness of the disease among this population. Long-term disruption to vaccination programmes in origin countries along with barriers to accessing health care along migrant routes puts asylum seekers arriving by small boats at risk of disease. With arrivals expected to continue in 2023, the UK Health Security Agency has recommended continuation of population-based control measures in England until October, 2023, subject to ongoing review. FUNDING The UK Health Security Agency.
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Affiliation(s)
- Shennae O'Boyle
- Immunisations and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Hannah E Barton
- Immunisations and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Joshua C D'Aeth
- Vaccine Preventable Bacteria Section, Respiratory and Vaccine Preventable Bacteria Reference Unit, Reference Services, UK Health Security Agency, London, UK
| | - Rebecca Cordery
- Immunisations and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK.
| | - Norman K Fry
- Immunisations and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK; Vaccine Preventable Bacteria Section, Respiratory and Vaccine Preventable Bacteria Reference Unit, Reference Services, UK Health Security Agency, London, UK
| | - David Litt
- Immunisations and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK; Vaccine Preventable Bacteria Section, Respiratory and Vaccine Preventable Bacteria Reference Unit, Reference Services, UK Health Security Agency, London, UK
| | - Rosamund Southgate
- South East Health Protection Team, UK Health Security Agency, London, UK
| | - Robert Verrecchia
- South East Health Protection Team, UK Health Security Agency, London, UK
| | - Trish Mannes
- South East Health Protection Team, UK Health Security Agency, London, UK
| | - Tian Yun Wang
- Immunisations and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Daniel E Stewart
- Immunisations and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Oluwakemi Olufon
- Rapid Investigations Team, Field Services, UK Health Security Agency, London, UK
| | - Michelle Dickinson
- Rapid Investigations Team, Field Services, UK Health Security Agency, London, UK
| | - Mary E Ramsay
- Immunisations and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Gayatri Amirthalingam
- Immunisations and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
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10
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Whitaker HJ, Tsang RSM, Byford R, Aspden C, Button E, Sebastian Pillai P, Jamie G, Kar D, Williams J, Sinnathamby M, Marsden G, Elson WH, Leston M, Anand S, Okusi C, Fan X, Linley E, Rowe C, DArcangelo S, Otter AD, Ellis J, Hobbs FDR, Tzortziou-Brown V, Zambon M, Ramsay M, Brown KE, Amirthalingam G, Andrews NJ, de Lusignan S, Lopez Bernal J. COVID-19 vaccine effectiveness against hospitalisation and death of people in clinical risk groups during the Delta variant period: English primary care network cohort study. J Infect 2023; 87:315-327. [PMID: 37579793 DOI: 10.1016/j.jinf.2023.08.005] [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: 02/10/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND COVID-19 vaccines have been shown to be highly effective against hospitalisation and death following COVID-19 infection. COVID-19 vaccine effectiveness estimates against severe endpoints among individuals with clinical conditions that place them at increased risk of critical disease are limited. METHODS We used English primary care medical record data from the Oxford-Royal College of General Practitioners Research and Surveillance Centre sentinel network (N > 18 million). Data were linked to the National Immunisation Management Service database, Second Generation Surveillance System for virology test data, Hospital Episode Statistics, and death registry data. We estimated adjusted vaccine effectiveness (aVE) against COVID-19 infection followed by hospitalisation and death among individuals in specific clinical risk groups using a cohort design during the delta-dominant period. We also report mortality statistics and results from our antibody surveillance in this population. FINDINGS aVE against severe endpoints was high, 14-69d following a third dose aVE was 96.4% (95.1%-97.4%) and 97.9% (97.2%-98.4%) for clinically vulnerable people given a Vaxzevria and Comirnaty primary course respectively. Lower aVE was observed in the immunosuppressed group: 88.6% (79.1%-93.8%) and 91.9% (85.9%-95.4%) for Vaxzevria and Comirnaty respectively. Antibody levels were significantly lower among the immunosuppressed group than those not in this risk group across all vaccination types and doses. The standardised case fatality rate within 28 days of a positive test was 3.9/1000 in people not in risk groups, compared to 12.8/1000 in clinical risk groups. Waning aVE with time since 2nd dose was also demonstrated, for example, Comirnaty aVE against hospitalisation reduced from 96.0% (95.1-96.7%) 14-69days post-dose 2-82.9% (81.4-84.2%) 182days+ post-dose 2. INTERPRETATION In all clinical risk groups high levels of vaccine effectiveness against severe endpoints were seen. Reduced vaccine effectiveness was noted among the immunosuppressed group.
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Affiliation(s)
- Heather J Whitaker
- Statistics, Modelling and Economics Department, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Ruby S M Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Carole Aspden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Elizabeth Button
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | | | - Gavin Jamie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Debasish Kar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Mary Sinnathamby
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Gemma Marsden
- Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London NW1 2FB, UK
| | - William H Elson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Meredith Leston
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Sneha Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Cecilia Okusi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Xuejuan Fan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Ezra Linley
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester M13 9WL, UK
| | - Cathy Rowe
- Diagnostics and Genomics, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Silvia DArcangelo
- Diagnostics and Genomics, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Ashley D Otter
- Diagnostics and Genomics, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
| | - Joanna Ellis
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK; Virus Reference Laboratory, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Victoria Tzortziou-Brown
- Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London NW1 2FB, UK
| | - Maria Zambon
- Virus Reference Laboratory, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mary Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Kevin E Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Nick J Andrews
- Statistics, Modelling and Economics Department, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK; Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London NW1 2FB, UK
| | - Jamie Lopez Bernal
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK.
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11
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Tessier E, Newport D, Tran A, Nash SG, Mensah AA, Yun Wang T, Shantikumar S, Campbell H, Amirthalingam G, Todkill D. Pertussis immunisation strategies to optimise infant pertussis control: A narrative systematic review. Vaccine 2023; 41:5957-5964. [PMID: 37658001 DOI: 10.1016/j.vaccine.2023.08.073] [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: 06/22/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023]
Abstract
OBJECTIVE Countries routinely offering acellular pertussis vaccine, where long-term protection is not sustained, have the challenge of selecting an optimal schedule to minimise disease among young infants. We conducted a narrative systematic review and synthesis of information to evaluate different pertussis immunisation strategies at controlling pertussis disease, hospitalisation, deaths, and vaccine effectiveness among young infants. METHODS We conducted a review of the literature on studies about the primary, booster, and/or maternal vaccination series and synthesised findings narratively. Countries offering the first three doses of vaccine within six-months of life and a booster on or before the second year or life were defined as accelerated primary and booster schedules, respectively. Countries offering primary and booster doses later were defined as extended primary and booster schedules. All search results were screened, and articles reviewed and reconciled, by two authors. The Risk of Bias in Non-randomised Studies of Intervention tool was used to evaluate the risk of bias. FINDINGS A total of 98 studies were included in the analyses and the following recurring themes were described: timing of vaccination, vaccine coverage, waning immunity/vaccine effectiveness, direct and indirect effectiveness, switching from an accelerated to extended schedule, impact of changes in testing. The risk of bias was generally low to moderate for most studies. CONCLUSION Comparing schedules is challenging and there was insufficient evidence to that one schedule was superior to another. Countries must select a schedule that maintains high vaccine coverage and reduced the risk of delaying the delivery vaccines to protect infants.
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Affiliation(s)
| | - Daniel Newport
- Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals of Birmingham NHS Trust, Birmingham, UK
| | - Anh Tran
- UK Health Security Agency, London, UK
| | | | | | | | | | | | | | - Daniel Todkill
- UK Health Security Agency, London, UK; Warwick Medical School, University of Warwick, Coventry, UK
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12
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Ladhani SN, Dowell AC, Jones S, Hicks B, Rowe C, Begum J, Wailblinger D, Wright J, Owens S, Pickering A, Shilltoe B, McMaster P, Whittaker E, Zuo J, Powell A, Amirthalingam G, Mandal S, Lopez-Bernal J, Ramsay ME, Kissane N, Bell M, Watson H, Ho D, Hallis B, Otter A, Moss P, Cohen J. Early evaluation of the safety, reactogenicity, and immune response after a single dose of modified vaccinia Ankara-Bavaria Nordic vaccine against mpox in children: a national outbreak response. Lancet Infect Dis 2023; 23:1042-1050. [PMID: 37336224 DOI: 10.1016/s1473-3099(23)00270-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/21/2023] [Accepted: 04/16/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND In response to a national mpox (formerly known as monkeypox) outbreak in England, children exposed to a confirmed mpox case were offered modified vaccinia Ankara-Bavaria Nordic (MVA-BN), a third-generation smallpox vaccine, for post-exposure prophylaxis. We aimed to assess the safety and reactogenicity and humoral and cellular immune response, following the first reported use of MVA-BN in children. METHODS This is an assessment of children receiving MVA-BN for post-exposure prophylaxis in response to a national mpox outbreak in England. All children receiving MVA-BN were asked to complete a post-vaccination questionnaire online and provide a blood sample 1 month and 3 months after vaccination. Outcome measures for the questionnaire included reactogenicity and adverse events after vaccination. Blood samples were tested for humoural, cellular, and cytokine responses and compared with unvaccinated paediatric controls who had never been exposed to mpox. FINDINGS Between June 1 and Nov 30, 2022, 87 children had one MVA-BN dose and none developed any serious adverse events or developed mpox disease after vaccination. Post-vaccination reactogenicity questionnaires were completed by 45 (52%) of 87 children. Their median age was 5 years (IQR 5-9), 25 (56%) of 45 were male, and 22 (49%) of 45 were White. 16 (36%) reported no symptoms, 18 (40%) reported local reaction only, and 11 (24%) reported systemic symptoms with or without local reactions. Seven (8%) of 87 children provided a first blood sample a median of 6 weeks (IQR 6·0-6·5) after vaccination and five (6%) provided a second blood sample at a median of 15 weeks (14-15). All children had poxvirus IgG antibodies with titres well above the assay cutoff of OD450nm 0·1926 with mean absorbances of 1·380 at six weeks and 0·9826 at 15 weeks post-vaccination. Assessment of reactivity to 27 recombinant vaccina virus and monkeypox virus proteins showed humoral antigen recognition, primarily to monkeypox virus antigens B6, B2, and vaccina virus antigen B5, with waning of humoral responses observed between the two timepoints. All children had a robust T-cell response to whole modified vaccinia Ankara virus and a select pool of conserved pan-Poxviridae peptides. A balanced CD4+ and CD8+ T-cell response was evident at 6 weeks, which was retained at 15 weeks after vaccination. INTERPRETATION A single dose of MVA-BN for post-exposure prophylaxis was well-tolerated in children and induced robust antibody and cellular immune responses up to 15 weeks after vaccination. Larger studies are needed to fully assess the safety, immunogenicity, and effectiveness of MVA-BN in children. Our findings, however, support its on-going use to prevent mpox in children as part of an emergency public health response. FUNDING UK Health Security Agency.
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Affiliation(s)
- Shamez N Ladhani
- Immunisation Department, UK Health Security Agency, London, UK; Paediatric Infectious Diseases Research Group, St George's University of London, London, UK.
| | - Alexander C Dowell
- Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK
| | - Scott Jones
- Emerging Pathogen Serology, UK Health Security Agency, Porton Down, UK
| | - Bethany Hicks
- Emerging Pathogen Serology, UK Health Security Agency, Porton Down, UK
| | - Cathy Rowe
- Emerging Pathogen Serology, UK Health Security Agency, Porton Down, UK
| | - Jusnara Begum
- Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK
| | - Dagmar Wailblinger
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Stephen Owens
- Paediatric Immunology and Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ailsa Pickering
- Paediatric Immunology and Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Benjamin Shilltoe
- Paediatric Immunology and Infectious Diseases, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Paddy McMaster
- Paediatric Infectious Diseases, Manchester Foundation Trust, Manchester, UK
| | - Elizabeth Whittaker
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK; Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Jianmin Zuo
- Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK
| | - Annabel Powell
- Immunisation Department, UK Health Security Agency, London, UK
| | | | - Sema Mandal
- Immunisation Department, UK Health Security Agency, London, UK
| | | | - Mary E Ramsay
- Immunisation Department, UK Health Security Agency, London, UK
| | - Neave Kissane
- Paediatric Infectious Diseases Department, Evelina London Childrens' Hospital, London, UK
| | - Michael Bell
- Paediatric Infectious Diseases Department, Evelina London Childrens' Hospital, London, UK
| | - Heather Watson
- Paediatric Infectious Diseases Department, Evelina London Childrens' Hospital, London, UK
| | - David Ho
- Paediatric Infectious Diseases Department, Evelina London Childrens' Hospital, London, UK
| | - Bassam Hallis
- Emerging Pathogen Serology, UK Health Security Agency, Porton Down, UK
| | - Ashley Otter
- Emerging Pathogen Serology, UK Health Security Agency, Porton Down, UK
| | - Paul Moss
- Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK
| | - Jonathan Cohen
- Paediatric Infectious Diseases Department, Evelina London Childrens' Hospital, London, UK
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13
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Nicholson BD, Turner PJ, Fanshawe TR, Williams AJ, Amirthalingam G, Tonner S, Zambon M, Body R, Davies K, Perera R, de Lusignan S, Hayward GN, Hobbs FDR. Evaluation of the diagnostic accuracy of two point-of-care tests for COVID-19 when used in symptomatic patients in community settings in the UK primary care COVID diagnostic accuracy platform trial (RAPTOR-C19). PLoS One 2023; 18:e0288612. [PMID: 37478103 PMCID: PMC10361479 DOI: 10.1371/journal.pone.0288612] [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] [Received: 02/02/2023] [Accepted: 07/02/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Point-of-care lateral flow device antigen testing has been used extensively to identify individuals with active SARS-CoV-2 infection in the community. This study aimed to evaluate the diagnostic accuracy of two point-of-care tests (POCTs) for SARS-CoV-2 in routine community care. METHODS Adults and children with symptoms consistent with suspected current COVID-19 infection were prospectively recruited from 19 UK general practices and two COVID-19 testing centres between October 2020 and October 2021. Participants were tested by trained healthcare workers using at least one of two index POCTs (Roche-branded SD Biosensor Standard™ Q SARS-CoV-2 Rapid Antigen Test and/or BD Veritor™ System for Rapid Detection of SARS-CoV-2). The reference standard was laboratory triplex reverse transcription quantitative PCR (RT-PCR) using a combined nasal/oropharyngeal swab. Diagnostic accuracy parameters were estimated, with 95% confidence intervals (CIs), overall, in relation to RT-PCR cycle threshold and in pre-specified subgroups. RESULTS Of 663 participants included in the primary analysis, 39.2% (260/663, 95% CI 35.5% to 43.0%) had a positive RT-PCR result. The SD Biosensor POCT had sensitivity 84.0% (178/212, 78.3% to 88.6%) and specificity 98.5% (328/333, 96.5% to 99.5%), and the BD Veritor POCT had sensitivity 76.5% (127/166, 69.3% to 82.7%) and specificity 98.8% (249/252, 96.6% to 99.8%) compared with RT-PCR. Sensitivity of both devices dropped substantially at cycle thresholds ≥30 and in participants more than 7 days after onset of symptoms. CONCLUSIONS Both POCTs assessed exceed the Medicines and Healthcare products Regulatory Agency target product profile's minimum acceptable specificity of 95%. Confidence intervals for both tests include the minimum acceptable sensitivity of 80%. In symptomatic patients, negative results on these two POCTs do not preclude the possibility of infection. Tests should not be expected to reliably detect disease more than a week after symptom onset, when viral load may be reduced. REGISTRATION ISRCTN142269.
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Affiliation(s)
- Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Philip J Turner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Alice J Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division and Public Health Programmes, UK Health Security Agency, London, United Kingdom
| | - Sharon Tonner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Maria Zambon
- Influenza and Respiratory Virology & Polio Reference Service, UK Health Security Agency, London, United Kingdom
- NIHR Health Protection Research Unit, Imperial College London, London, United Kingdom
| | - Richard Body
- Division of Cardiovascular Science, University of Manchester, Manchester, United Kingdom
- Emergency Department, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Manchester Academic Health Science Centre, & Healthcare Sciences Department, Manchester Metropolitan University, Manchester, United Kingdom
| | - Kerrie Davies
- Healthcare Associated Infections Research Group, Leeds Teaching Hospitals NHS trust and University of Leeds, Leeds, United Kingdom
- NIHR Leeds MedTech In vitro Diagnostic Co-operative, Leeds Teaching Hospitals NHS Trust and University of Leeds, Leeds, United Kingdom
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Gail N Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Fry NK, Pringle E, Newsholme W, Nicholls M, Stephenson J, Heathcock RT, Gower C, Lacy J, O'Boyle S, Litt DJ, Sheppard C, Groves N, D'Aeth J, Hopkins KL, Meunier D, De Zoysa A, Efstratiou A, Brown C, Chand M, Amirthalingam G. Household transmission of non-toxigenic diphtheria toxin gene-bearing Corynebacterium diphtheriae following a cluster of cutaneous cases in a specialist outpatient setting. J Med Microbiol 2023; 72. [PMID: 37384376 DOI: 10.1099/jmm.0.001722] [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: 06/30/2023] Open
Abstract
Introduction. Combination of PCR and Elek testing to identify toxigenic corynebacteria has revealed organisms described as non-toxigenic toxin-gene bearing (NTTB) Corynebacterium diphtheriae or C. ulcerans (i.e. PCR tox positive; Elek negative). These organisms carry part or all of tox, but are unable to express diphtheria toxin (DT) and present a challenge to clinical and public health case management.Gap analysis/Hypothesis. There are few data on the theoretical risk of NTTB reversion to toxigenicity. This unique cluster and subsequent epidemiologically linked isolates allowed the opportunity to determine any change in DT expression status.Aim. To characterize a cluster of infections due to NTTB in a skin clinic and subsequent cases in two household contacts.Methodology. Epidemiological and microbiological investigations were carried out according to existing national guidance at the time. Susceptibility testing used gradient strips. The tox operon analysis and multi-locus sequence typing (MLST) was derived from whole-genome sequencing. Alignment of the tox operon and phylogenetic analyses were performed using clustalW, mega, the public core-genome MLST (cgMLST) scheme and an in-house bioinformatic single nucleotide polymorphism (SNP) typing pipeline.Results. Isolates of NTTB C. diphtheriae were recovered from four cases (cases 1 to 4) with epidermolysis bullosa attending the clinic. Two further isolates were subsequently recovered from case 4, >18 months later, and from two household contacts (cases 5 and 6) after a further 18 months and 3.5 years, respectively. All eight strains were NTTB C. diphtheriae biovar mitis, belonged to the same sequence type (ST-336) with the same deletion in tox. Phylogenetic analysis showed relatively high diversity between the eight strains with 7-199 SNP and 3-109 cgMLST loci differences between them. The number of SNPs between the three isolates from case 4 and two household contacts (cases 5 and 6) was 44-70 with 28-38 cgMLST loci differences.Conclusions. We report a cluster of NTTB C. diphtheriae cases in a skin clinic and evidence of onward household transmission. We conclude the deletion in the tox was responsible for the non-expression of DT. There was no evidence of reversion to DT expression over the 6.5 year period studied. These data informed revision to guidance in the management of NTTB cases and their contacts in the UK.
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Affiliation(s)
- Norman K Fry
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, NW9 5EQ, UK
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, NW9 5EQ, UK
| | - Ellen Pringle
- North West London Health Protection Team, UK Health Security Agency, London, NW9 5EQ, UK
| | - William Newsholme
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust Infection Service, London, UK
| | - Margot Nicholls
- Surrey and Sussex Health Protection Team (South East), UK Health Security Agency, West Sussex, RH12 1XA, UK
| | - Jim Stephenson
- Epsom and St Helier University Hospital NHS Trust, St. Helier University Hospital, Surrey SM5 1AA, UK
| | | | - Charlotte Gower
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, NW9 5EQ, UK
| | - Joanne Lacy
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, NW9 5EQ, UK
- Present address: Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Shennae O'Boyle
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, NW9 5EQ, UK
| | - David J Litt
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, NW9 5EQ, UK
| | - Carmen Sheppard
- Present address: Genpax Ltd, 9 Pembridge Road, Notting Hill, London, W11 3JY, UK
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, NW9 5EQ, UK
| | - Natalie Groves
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, NW9 5EQ, UK
| | - Joshua D'Aeth
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, NW9 5EQ, UK
| | - Katie L Hopkins
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, UK Health Security Agency, London, NW9 5EQ, UK
- Healthcare Associated Infections, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis Division, UK Health Security Agency, London, NW9 5EQ, UK
| | - Danièle Meunier
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, UK Health Security Agency, London, NW9 5EQ, UK
- Healthcare Associated Infections, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis Division, UK Health Security Agency, London, NW9 5EQ, UK
| | - Aruni De Zoysa
- Respiratory and Vaccine Preventable Bacteria Reference Unit, UK Health Security Agency, London, NW9 5EQ, UK
| | - Androulla Efstratiou
- WHO Collaborating Centre for Diphtheria and Streptococcal Infections, UK Health Security Agency, London, NW9 5EQ, UK
| | - Colin Brown
- Clinical and Emerging Infections, UK Health Security Agency, London, NW9 5EQ, UK
- Healthcare Associated Infections, Fungal, Antimicrobial Resistance, Antimicrobial Usage and Sepsis Division, UK Health Security Agency, London, NW9 5EQ, UK
| | - Meera Chand
- Clinical and Emerging Infections, UK Health Security Agency, London, NW9 5EQ, UK
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, NW9 5EQ, UK
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15
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Esposito S, Amirthalingam G, Bassetti M, Blasi F, De Rosa FG, Halasa NB, Hung I, Osterhaus A, Tan T, Torres JP, Vena A, Principi N. Monoclonal antibodies for prophylaxis and therapy of respiratory syncytial virus, SARS-CoV-2, human immunodeficiency virus, rabies and bacterial infections: an update from the World Association of Infectious Diseases and Immunological Disorders and the Italian Society of Antinfective Therapy. Front Immunol 2023; 14:1162342. [PMID: 37256125 PMCID: PMC10226646 DOI: 10.3389/fimmu.2023.1162342] [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: 02/09/2023] [Accepted: 04/26/2023] [Indexed: 06/01/2023] Open
Abstract
Monoclonal antibodies (mABs) are safe and effective proteins produced in laboratory that may be used to target a single epitope of a highly conserved protein of a virus or a bacterial pathogen. For this purpose, the epitope is selected among those that play the major role as targets for prevention of infection or tissue damage. In this paper, characteristics of the most important mABs that have been licensed and used or are in advanced stages of development for use in prophylaxis and therapy of infectious diseases are discussed. We showed that a great number of mABs effective against virus or bacterial infections have been developed, although only in a small number of cases these are licensed for use in clinical practice and have reached the market. Although some examples of therapeutic efficacy have been shown, not unlike more traditional antiviral or antibacterial treatments, their efficacy is significantly greater in prophylaxis or early post-exposure treatment. Although in many cases the use of vaccines is more effective and cost-effective than that of mABs, for many infectious diseases no vaccines have yet been developed and licensed. Furthermore, in emergency situations, like in epidemics or pandemics, the availability of mABs can be an attractive adjunct to our armament to reduce the impact. Finally, the availability of mABs against bacteria can be an important alternative, when multidrug-resistant strains are involved.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Matteo Bassetti
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | | | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ivan Hung
- Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Department of Infectious Disease and Microbiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Albert Osterhaus
- Research Center for Emerging Infections and Zoonoses, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Tina Tan
- Division of Infectious Diseases, Feinberg School of Medicine of Northwestern University, Chicago, IL, United States
| | - Juan Pablo Torres
- Department of Pediatrics and Pediatric Surgery, Facultad de Medicina, University of Chile, Santiago, Chile
- Instituto Sistemas Complejos de Ingeniería (ISCI), Santiago, Chile
| | - Antonio Vena
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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16
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Calvert A, Amirthalingam G, Andrews N, Basude S, Coleman M, Cuthbertson H, England A, Greening V, Hallis B, Johnstone E, Jones CE, Karampatsas K, Khalil A, Le Doare K, Matheson M, Peregrine E, Snape MD, Vatish M, Heath PT. Optimising the timing of whooping cough immunisation in mums (OpTIMUM) through investigating pertussis vaccination in pregnancy: an open-label, equivalence, randomised controlled trial. Lancet Microbe 2023; 4:e300-e308. [PMID: 37080224 DOI: 10.1016/s2666-5247(22)00332-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 04/22/2023]
Abstract
BACKGROUND Pertussis vaccination in pregnancy is recommended in many countries to provide protection to young infants. The best timing for this vaccination is uncertain. In the UK, vaccination is recommended between 16 weeks and 32 weeks of gestation. In this trial we aimed to investigate the equivalence of three time periods for pertussis vaccination in pregnancy. METHODS In this open-label, equivalence, randomised controlled trial to investigate equivalence of different time windows for pertussis vaccination in pregnancy, participants were randomly assigned (1:1:1 ratio) to receive a pertussis-containing vaccine (Boostrix-inactivated poliovirus vaccine) in one of three gestational age groups, comprising group 1 (≤23 weeks + 6 days), group 2 (24-27 weeks + 6 days), and group 3 (28-31 weeks + 6 days) using a computer-generated randomisation list. The primary outcome was concentration of pertussis-specific antibodies in the infant born at term at birth. Maternal blood sampling was done before and 2 weeks after vaccination and at delivery, together with a cord sample, and an infant sample was collected at least 4 weeks after primary vaccination. Reactogenicity was assessed for 7 days after vaccination. This trial was registered with ClinicalTrials.gov (NCT03908164). FINDINGS Between May 7, 2019, and Feb 13, 2020, of 1010 women assessed for eligibility, 364 women were recruited and 351 received the intervention (120 in group 1, 119 in group 2, and 112 in group 3). Equivalence of time periods was demonstrated for anti-pertussis toxin and anti-pertactin IgG concentrations. The cord blood geometric mean concentrations of anti-filamentous haemagglutinin IgG were higher with increasing gestational age at vaccination, such that for infants in group 1 (≤23 weeks + 6 days), equivalence to group 3 (28-31 weeks + 6 days) was not shown. Reported rates of fever were similar between study groups. INTERPRETATION Pertussis vaccination at three different time intervals in pregnancy resulted in equivalent concentrations of IgG antibodies in infants against two of the three pertussis antigens assessed. Overall, these findings support recommendations to vaccinate any time between 16 weeks and 32 weeks of gestation. FUNDING The Thrasher Research Fund and the National Immunisation Schedule Evaluation Consortium through the National Institute for Health and Care Research policy research programme.
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Affiliation(s)
- Anna Calvert
- Centre for Neonatal and Paediatric Infection and Vaccine Institute St George's, University of London, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK.
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Nick Andrews
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Sneha Basude
- University Hospital Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Matthew Coleman
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Reproductive Health Research Team, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Anna England
- Research and Evaluation, UK Health Security Agency, Salisbury, UK
| | - Vanessa Greening
- Centre for Neonatal and Paediatric Infection and Vaccine Institute St George's, University of London, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK
| | - Bassam Hallis
- Research and Evaluation, UK Health Security Agency, Salisbury, UK
| | - Edward Johnstone
- Manchester Academic Health Science Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Maternal and Fetal Health Research Centre, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Christine E Jones
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Konstantinos Karampatsas
- Centre for Neonatal and Paediatric Infection and Vaccine Institute St George's, University of London, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK
| | - Asma Khalil
- Centre for Neonatal and Paediatric Infection and Vaccine Institute St George's, University of London, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection and Vaccine Institute St George's, University of London, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK; Research and Evaluation, UK Health Security Agency, Salisbury, UK; Medical Research Council and Ugandan Virus Research Institute and the London School of Hygiene and Tropical Medicine, Kampala, Uganda; Makerere University Johns Hopkins University, Kampala, Uganda
| | - Mary Matheson
- Research and Evaluation, UK Health Security Agency, Salisbury, UK
| | | | - Matthew D Snape
- Department of Paediatrics, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Manu Vatish
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; Clinical Research Network, Thames Valley and South Midlands
| | - Paul T Heath
- Centre for Neonatal and Paediatric Infection and Vaccine Institute St George's, University of London, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK
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Marlow R, Roderick M, Oliver J, Jordan Z, Amirthalingam G, Lopez-Bernal J, Finn A, Rodrigues F. Epidemiology of hospitalisations due to chickenpox and quality of life lost in community and hospital settings: protocol for a prospective cohort study across two countries. BMJ Open 2023; 13:e068611. [PMID: 36990479 PMCID: PMC10069595 DOI: 10.1136/bmjopen-2022-068611] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION While still a ubiquitous disease of childhood, chickenpox has been effectively controlled in many countries through the use of vaccination. Previous health economic assessment of the use of these vaccines in the UK were based on limited quality of life data and only routinely collected epidemiological outcomes. METHODS AND ANALYSIS This two armed study will carry prospective surveillance of hospital admissions and recruit from community settings to measure the acute quality of life loss caused by paediatric chickenpox both in the UK and in Portugal. The quality of life effects on children and their primary and secondary caregivers will be assessed using the EuroQol EQ-5D with the Child Health Utility instrument (CHU-9) in addition for children. Results will be used to derive quality-adjusted life year loss estimates for cases of simple varicella and the secondary complications. ETHICS AND DISSEMINATION We have received National Health Service ethical approval (REC ref: 18/ES/0040) for the inpatient arm, university ethical approval (University of Bristol ref: 60721) for the community arm and 10 sites currently are recruiting in the UK and 14 in Portugal. Informed consent is obtained from the parent(s). Results will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN15017985.
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Affiliation(s)
- Robin Marlow
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Vaccine Centre, Schools of Population Health Sciences and of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Marion Roderick
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jennifer Oliver
- Bristol Vaccine Centre, Schools of Population Health Sciences and of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Zoe Jordan
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Jamie Lopez-Bernal
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Adam Finn
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Vaccine Centre, Schools of Population Health Sciences and of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Fernanda Rodrigues
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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18
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Amirthalingam G, Campbell H, Ribeiro S, Stowe J, Tessier E, Litt D, Fry NK, Andrews N. Optimization of Timing of Maternal Pertussis Immunization From 6 Years of Postimplementation Surveillance Data in England. Clin Infect Dis 2023; 76:e1129-e1139. [PMID: 35959786 DOI: 10.1093/cid/ciac651] [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: 05/05/2022] [Revised: 07/31/2022] [Accepted: 08/09/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND England's third-trimester maternal pertussis vaccination, introduced in October 2012, was extended to the second trimester in 2016. Maternal vaccination provides high protection against infant disease, but routine second-trimester vaccination has not previously been assessed. METHODS National laboratory-confirmed pertussis case surveillance determined vaccination history, maternal vaccination history and hospitalization. Pertussis hospital admissions between 2012 and 2019 were extracted from the Hospital Episode Statistics data set. Vaccine effectiveness (VE) was calculated for pertussis case patients born between October 2012 and September 2018 using the screening method and matching with a nationally representative data set. RESULTS Higher coverage was observed after earlier maternal vaccination with approximately 40% of pregnant women vaccinated ≥13 weeks before delivery. Cases and hospitalizations stabilized at low levels in younger infants but remained elevated in older infants, children, and adults. No deaths occurred in infants with vaccinated mothers after 2016. Of 1162 laboratory-confirmed pertussis cases in the study, 599 (52%) were in infants aged <93 days: 463 (77%) with unvaccinated and 136 (23%) with vaccinated mothers. The VE was equivalent in infants with mothers vaccinated at different gestational periods except in those with mothers vaccinated between 7 days before and 41 days after delivery. Children whose mothers were unvaccinated but with vaccination in a previous pregnancy had a VE against disease of 44% (95% confidence interval, 19%-75%). There was no increased disease risk after primary vaccination in children with mothers vaccinated at least 7 days before delivery. CONCLUSIONS National policy recommending vaccination in the second trimester increased earlier maternal vaccine uptake with sustained high VE and impact against early infant disease.
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Affiliation(s)
- Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Helen Campbell
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Sonia Ribeiro
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Julia Stowe
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Elise Tessier
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - David Litt
- Vaccine Preventable Bacteria Section, Respiratory and Vaccine Preventable Bacteria Reference Unit, Specialised Microbiology and Laboratories Directorate, UK Health Security Agency, London, United Kingdom
| | - Norman K Fry
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom.,Vaccine Preventable Bacteria Section, Respiratory and Vaccine Preventable Bacteria Reference Unit, Specialised Microbiology and Laboratories Directorate, UK Health Security Agency, London, United Kingdom
| | - Nick Andrews
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
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19
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Auma E, Hall T, Chopra S, Bilton S, Ramkhelawon L, Amini F, Calvert A, Amirthalingam G, Jones CE, Andrews N, Heath PT, Le Doare K. Using Dried Blood Spots for a Sero-Surveillance Study of Maternally Derived Antibody against Group B Streptococcus. Vaccines (Basel) 2023; 11:vaccines11020357. [PMID: 36851236 PMCID: PMC9966576 DOI: 10.3390/vaccines11020357] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 02/08/2023] Open
Abstract
Vaccination during pregnancy could protect women and their infants from invasive Group B Streptococcus (GBS) disease. To understand if neonatal dried blood spots (DBS) can be used to determine the amount of maternally derived antibody that protects infants against invasive GBS disease, a retrospective case-control study was conducted in England between 1 April 2014 and 30 April 2015. The DBS of cases with invasive GBS disease (n = 61) were matched with healthy controls (n = 125). The haematocrit, DBS storage temperature, freeze-thaw cycle, and paired serum/DBS studies were set up to optimise the antibody assessment. The samples were analysed using a multiplex immunoassay, and the results were assessed using parametric and nonparametric tests. Antibody concentrations were stable at haematocrits of up to 50% but declined at 75%. DBS storage at room temperature was stable for three months compared with storage from collection at -20 °C and rapidly degraded thereafter. Total IgG levels measured in DBS and paired serum showed a good correlation (r2 = 0.99). However, due to suboptimal storage conditions, no difference was found in the GBS IgG levels between DBS samples from cases and controls. We have demonstrated a proof of concept that assays utilising DBS for assessing GBS serotype-specific antibodies in infants is viable. This method could be used to facilitate future large sero-correlate studies, but DBS samples must be stored at -20 °C for long term preservation of antibody.
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Affiliation(s)
- Erick Auma
- Department of Biology, Université Claude Bernard Lyon, ENS de Lyon, CNRS, UMR, 69100 Villeurbanne, France
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
| | - Tom Hall
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
- Correspondence:
| | - Simran Chopra
- Immunity and Infection, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
| | - Sam Bilton
- Neonatal Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Laxmee Ramkhelawon
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
| | - Fahimah Amini
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
| | - Anna Calvert
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London NW9 5EQ, UK
| | - Christine E. Jones
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, SO16 6YD, UK
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Nick Andrews
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London NW9 5EQ, UK
| | - Paul T. Heath
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London SW17 0RE, UK
- Makerere University—Johns Hopkins University Research Collaboration, Kampala P.O. Box 23491, Uganda
- Pathogen Immunology Group, UK Health Security Agency, Porton Down, Salisbury SP4 0JG, UK
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20
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Leston M, Elson WH, Watson C, Lakhani A, Aspden C, Bankhead CR, Borrow R, Button E, Byford R, Elliot AJ, Fan X, Hoang U, Linley E, Macartney J, Nicholson BD, Okusi C, Ramsay M, Smith G, Smith S, Thomas M, Todkill D, Tsang RS, Victor W, Williams AJ, Williams J, Zambon M, Howsam G, Amirthalingam G, Lopez-Bernal J, Hobbs FDR, de Lusignan S. Representativeness, Vaccination Uptake, and COVID-19 Clinical Outcomes 2020-2021 in the UK Oxford-Royal College of General Practitioners Research and Surveillance Network: Cohort Profile Summary. JMIR Public Health Surveill 2022; 8:e39141. [PMID: 36534462 PMCID: PMC9770023 DOI: 10.2196/39141] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) is one of Europe's oldest sentinel systems, working with the UK Health Security Agency (UKHSA) and its predecessor bodies for 55 years. Its surveillance report now runs twice weekly, supplemented by online observatories. In addition to conducting sentinel surveillance from a nationally representative group of practices, the RSC is now also providing data for syndromic surveillance. OBJECTIVE The aim of this study was to describe the cohort profile at the start of the 2021-2022 surveillance season and recent changes to our surveillance practice. METHODS The RSC's pseudonymized primary care data, linked to hospital and other data, are held in the Oxford-RCGP Clinical Informatics Digital Hub, a Trusted Research Environment. We describe the RSC's cohort profile as of September 2021, divided into a Primary Care Sentinel Cohort (PCSC)-collecting virological and serological specimens-and a larger group of syndromic surveillance general practices (SSGPs). We report changes to our sampling strategy that brings the RSC into alignment with European Centre for Disease Control guidance and then compare our cohort's sociodemographic characteristics with Office for National Statistics data. We further describe influenza and COVID-19 vaccine coverage for the 2020-2021 season (week 40 of 2020 to week 39 of 2021), with the latter differentiated by vaccine brand. Finally, we report COVID-19-related outcomes in terms of hospitalization, intensive care unit (ICU) admission, and death. RESULTS As a response to COVID-19, the RSC grew from just over 500 PCSC practices in 2019 to 1879 practices in 2021 (PCSC, n=938; SSGP, n=1203). This represents 28.6% of English general practices and 30.59% (17,299,780/56,550,136) of the population. In the reporting period, the PCSC collected >8000 virology and >23,000 serology samples. The RSC population was broadly representative of the national population in terms of age, gender, ethnicity, National Health Service Region, socioeconomic status, obesity, and smoking habit. The RSC captured vaccine coverage data for influenza (n=5.4 million) and COVID-19, reporting dose one (n=11.9 million), two (n=11 million), and three (n=0.4 million) for the latter as well as brand-specific uptake data (AstraZeneca vaccine, n=11.6 million; Pfizer, n=10.8 million; and Moderna, n=0.7 million). The median (IQR) number of COVID-19 hospitalizations and ICU admissions was 1181 (559-1559) and 115 (50-174) per week, respectively. CONCLUSIONS The RSC is broadly representative of the national population; its PCSC is geographically representative and its SSGPs are newly supporting UKHSA syndromic surveillance efforts. The network captures vaccine coverage and has expanded from reporting primary care attendances to providing data on onward hospital outcomes and deaths. The challenge remains to increase virological and serological sampling to monitor the effectiveness and waning of all vaccines available in a timely manner.
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Affiliation(s)
- Meredith Leston
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - William H Elson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Conall Watson
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, Colindale, London, United Kingdom
| | - Anissa Lakhani
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, Colindale, London, United Kingdom
| | - Carole Aspden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Clare R Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Elizabeth Button
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Alex J Elliot
- Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, Birmingham, United Kingdom
| | - Xuejuan Fan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Uy Hoang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ezra Linley
- Vaccine Evaluation Unit, UK Health Security Agency, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Jack Macartney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Cecilia Okusi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mary Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, Colindale, London, United Kingdom
| | - Gillian Smith
- Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, Birmingham, United Kingdom
| | - Sue Smith
- Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, Birmingham, United Kingdom
| | - Mark Thomas
- Royal College of General Practitioners, London, United Kingdom
| | - Dan Todkill
- Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, Birmingham, United Kingdom
| | - Ruby Sm Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - William Victor
- Royal College of General Practitioners, London, United Kingdom
| | - Alice J Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Maria Zambon
- Reference Microbiology, UK Health Security Agency, Colindale, London, United Kingdom
| | - Gary Howsam
- Royal College of General Practitioners, London, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, Colindale, London, United Kingdom
| | - Jamie Lopez-Bernal
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, Colindale, London, United Kingdom
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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21
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Blakeway H, Amin‐Chowdhury Z, Prasad S, Kalafat E, Ismail M, Abdallah FN, Rezvani A, Amirthalingam G, Brown K, Le Doare K, Heath PT, Ladhani SN, Khalil A. Evaluation of immunogenicity and reactogenicity of COVID-19 vaccines in pregnant women. Ultrasound Obstet Gynecol 2022; 60:673-680. [PMID: 36318630 PMCID: PMC9538835 DOI: 10.1002/uog.26050] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy is associated with increased risk of adverse maternal and perinatal outcomes. Vaccines are highly effective at preventing severe coronavirus disease 2019 (COVID-19), but there are limited data on COVID-19 vaccines in pregnancy. This study aimed to investigate the reactogenicity and immunogenicity of COVID-19 vaccines in pregnant women when administered according to the 12-week-interval dosing schedule recommended in the UK. METHODS This was a cohort study of pregnant women receiving COVID-19 vaccination between April and September 2021. The outcomes were immunogenicity and reactogenicity after COVID-19 vaccination. Pregnant women were recruited by phone, e-mail and/or text and were vaccinated according to vaccine availability at their local vaccination center. For immunogenicity assessment, blood samples were taken at specific timepoints after each dose to evaluate nucleocapsid protein (N) and spike protein (S) antibody titers. The comparator group comprised non-pregnant female healthcare workers in the same age group who were vaccinated as part of the national immunization program in a contemporaneous longitudinal cohort study. Longitudinal changes in serum antibody titers and association with pregnancy status were assessed using a two-step regression approach. Reactogenicity assessment in pregnant women was undertaken using an online questionnaire. The comparator group comprised non-pregnant women aged 18-49 years who had received two vaccine doses in primary care. The association of pregnancy status with reactogenicity was assessed using logistic regression analysis. RESULTS Overall, 67 pregnant women, of whom 66 had received a mRNA vaccine, and 79 non-pregnant women, of whom 50 had received a mRNA vaccine, were included in the immunogenicity study. Most (61.2%) pregnant women received their first vaccine dose in the third trimester, while 3.0% received it in the first trimester and 35.8% in the second trimester. SARS-CoV-2 S-antibody geometric mean concentrations after mRNA vaccination were not significantly different at 2-6 weeks after the first dose but were significantly lower at 2-6 weeks after the second dose in infection-naïve pregnant compared with non-pregnant women. In pregnant women, prior infection was associated with higher antibody levels at 2-6 weeks after the second vaccine dose. Reactogenicity analysis included 108 pregnant women and 116 non-pregnant women. After the first dose, tiredness and chills were reported less commonly in pregnant compared with non-pregnant women (P = 0.043 and P = 0.029, respectively). After the second dose, feeling generally unwell was reported less commonly (P = 0.046) in pregnant compared with non-pregnant women. CONCLUSIONS Using an extended 12-week interval between vaccine doses, antibody responses after two doses of mRNA COVID-19 vaccine were found to be lower in pregnant compared with non-pregnant women. Strong antibody responses were achieved after one dose in previously infected women, regardless of pregnancy status. Pregnant women reported fewer adverse events after both the first and second dose of vaccine. These findings should now be addressed in larger controlled studies. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- H. Blakeway
- Fetal Medicine Unit, St George's Hospital, St George's University of LondonLondonUK
| | - Z. Amin‐Chowdhury
- Immunisation and Vaccine Preventable Diseases DivisionUK Health Security Agency (previously known as Public Health England)LondonUK
| | - S. Prasad
- Fetal Medicine Unit, St George's Hospital, St George's University of LondonLondonUK
| | - E. Kalafat
- Koc University, School of Medicine, Department of Obstetrics and GynecologyIstanbulTurkey
- Department of Statistics, Faculty of Arts and SciencesMiddle East Technical UniversityAnkaraTurkey
| | - M. Ismail
- Fetal Medicine Unit, St George's Hospital, St George's University of LondonLondonUK
| | - F. N. Abdallah
- Fetal Medicine Unit, St George's Hospital, St George's University of LondonLondonUK
| | - A. Rezvani
- Fetal Medicine Unit, St George's Hospital, St George's University of LondonLondonUK
| | - G. Amirthalingam
- Immunisation and Vaccine Preventable Diseases DivisionUK Health Security Agency (previously known as Public Health England)LondonUK
| | - K. Brown
- Immunisation and Vaccine Preventable Diseases DivisionUK Health Security Agency (previously known as Public Health England)LondonUK
| | - K. Le Doare
- Centre for Neonatal and Paediatric Infection and Vaccine Institute, Institute of Infection and Immunity, St George's University of LondonLondonUK
| | - P. T. Heath
- Centre for Neonatal and Paediatric Infection and Vaccine Institute, Institute of Infection and Immunity, St George's University of LondonLondonUK
| | - S. N. Ladhani
- Immunisation and Vaccine Preventable Diseases DivisionUK Health Security Agency (previously known as Public Health England)LondonUK
- Centre for Neonatal and Paediatric Infection and Vaccine Institute, Institute of Infection and Immunity, St George's University of LondonLondonUK
| | - A. Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of LondonLondonUK
- Vascular Biology Research CentreMolecular and Clinical Sciences Research Institute, St George's University of LondonLondonUK
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22
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Fakhraei R, Fung SG, Petrcich W, Crowcroft N, Bolotin S, Gaudet L, Amirthalingam G, Biringer A, Wilson K, Dubey V, Halperin SA, Jamieson F, Kwong JC, Sadarangani M, Cook J, Hawken S, Walker MC, Fell DB. Trends and characteristics of Tdap vaccination during pregnancy in Ontario, Canada: a retrospective cohort study. CMAJ Open 2022; 10:E1017-E1026. [PMID: 36735222 PMCID: PMC9744266 DOI: 10.9778/cmajo.20220058] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In February 2018, Canada's National Advisory Committee on Immunization (NACI) recommended tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccination during pregnancy to protect newborns against pertussis infection. We sought to describe pre- and postrecommendation trends in Tdap vaccination coverage among pregnant Ontario residents. METHODS Using linked health administrative databases, we conducted a population-based retrospective cohort study of all pregnant individuals who gave birth in Ontario hospitals between April 2012 and March 2020. We described Tdap vaccination patterns in pregnancy for the entire study period and before and after the NACI recommendation. We used log-binomial regression to identify characteristics associated with Tdap vaccination during pregnancy. RESULTS Among the 991 850 deliveries included, 7.0% of pregnant individuals received the Tdap vaccination during pregnancy. Vaccine coverage increased from 0.4% in 2011/12 to 29.2% in 2019/20. Coverage was highest among individuals who were older, had no previous live births, had adequate prenatal care and received maternity care primarily from a family physician. After adjustment, characteristics associated with lower coverage included younger maternal age, having a multiple birth, residing in a rural location and higher area material deprivation. In 2019/20, 71.0% of vaccinated individuals received the Tdap vaccination during the recommended gestational window (27-32 wk). Stratified analyses of the pre- and postrecommendation cohorts yielded similar findings to the main analyses with a few gradient differences after adjustment. INTERPRETATION During pregnancy, Tdap vaccination coverage increased substantially in Ontario between 2011/12 and 2019/20, most notably after recommendations for universal Tdap vaccination during pregnancy began in Canada. To further improve vaccine coverage in the obstetric setting, public health strategies should consider tailoring their programs to reach subpopulations with lower vaccine coverage.
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Affiliation(s)
- Romina Fakhraei
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Stephen G Fung
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - William Petrcich
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Natasha Crowcroft
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Shelly Bolotin
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Laura Gaudet
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Gayatri Amirthalingam
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Anne Biringer
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Kumanan Wilson
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Vinita Dubey
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Scott A Halperin
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Frances Jamieson
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Jeffrey C Kwong
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Manish Sadarangani
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Jocelynn Cook
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Steven Hawken
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Mark C Walker
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont
| | - Deshayne B Fell
- Children's Hospital of Eastern Ontario (CHEO) Research Institute (Fakhraei, Fung, Fell); Ottawa Hospital Research Institute (Fakhraei, Wilson, Hawken, Walker); University of Ottawa (Fakhraei, Cook, Hawken, Walker, Fell); ICES uOttawa (Petrcich, Hawken, Fell), Ottawa, Ont.; ICES Central (Crowcroft, Kwong), University of Toronto (Crowcroft, Bolotin, Biringer, Dubey, Jamieson, Kwong); Public Health Ontario (Bolotin, Jamieson, Kwong), Toronto, Ont.; Kingston Health Sciences Centre (Gaudet); Queen's University (Gaudet), Kingston, Ont.; UK Health Security Agency (Amirthalingam), London, UK; Mount Sinai Hospital (Biringer), Toronto, Ont.; Bruyère Research Institute (Wilson), Ottawa, Ont.; Toronto Public Health (Dubey), Toronto, Ont.; Canadian Center for Vaccinology (Halperin); Dalhousie University (Halperin); Nova Scotia Health (Halperin); IWK Health (Halperin), Halifax, NS; Vaccine Evaluation Center (Sadarangani), BC Children's Hospital Research Institute; Department of Pediatrics (Sadarangani), University of British Columbia, Vancouver, BC; The Society of Obstetricians and Gynaecologists of Canada (Cook), Ottawa, Ont.
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23
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Ratcliffe H, Tiley KS, Andrews N, Amirthalingam G, Vichos I, Morey E, Douglas NL, Marinou S, Plested E, Aley P, Galiza EP, Faust SN, Hughes S, Murray CS, Roderick M, Shackley F, Oddie SJ, Lees T, Turner DPJ, Raman M, Owens S, Turner P, Cockerill H, Lopez Bernal J, Linley E, Borrow R, Brown K, Ramsay ME, Voysey M, Snape MD. Community seroprevalence of SARS-CoV-2 in children and adolescents in England, 2019-2021. Arch Dis Child 2022; 108:archdischild-2022-324375. [PMID: 35858775 PMCID: PMC9887370 DOI: 10.1136/archdischild-2022-324375] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/23/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To understand community seroprevalence of SARS-CoV-2 in children and adolescents. This is vital to understanding the susceptibility of this cohort to COVID-19 and to inform public health policy for disease control such as immunisation. DESIGN We conducted a community-based cross-sectional seroprevalence study in participants aged 0-18 years old recruiting from seven regions in England between October 2019 and June 2021 and collecting extensive demographic and symptom data. Serum samples were tested for antibodies against SARS-CoV-2 spike and nucleocapsid proteins using Roche assays processed at UK Health Security Agency laboratories. Prevalence estimates were calculated for six time periods and were standardised by age group, ethnicity and National Health Service region. RESULTS Post-first wave (June-August 2020), the (anti-spike IgG) adjusted seroprevalence was 5.2%, varying from 0.9% (participants 10-14 years old) to 9.5% (participants 5-9 years old). By April-June 2021, this had increased to 19.9%, varying from 13.9% (participants 0-4 years old) to 32.7% (participants 15-18 years old). Minority ethnic groups had higher risk of SARS-CoV-2 seropositivity than white participants (OR 1.4, 95% CI 1.0 to 2.0), after adjusting for sex, age, region, time period, deprivation and urban/rural geography. In children <10 years, there were no symptoms or symptom clusters that reliably predicted seropositivity. Overall, 48% of seropositive participants with complete questionnaire data recalled no symptoms between February 2020 and their study visit. CONCLUSIONS Approximately one-third of participants aged 15-18 years old had evidence of antibodies against SARS-CoV-2 prior to the introduction of widespread vaccination. These data demonstrate that ethnic background is independently associated with risk of SARS-CoV-2 infection in children. TRIAL REGISTRATION NUMBER NCT04061382.
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Affiliation(s)
| | - K S Tiley
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Department, Health Protection Agency, London, UK
| | - Gayatri Amirthalingam
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - I Vichos
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - E Morey
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - N L Douglas
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - S Marinou
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Emma Plested
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Parvinder Aley
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Eva P Galiza
- St George's Vaccine Institute, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Saul N Faust
- Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Wellcome Trust Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Hughes
- Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
| | - Clare S Murray
- Department of Paediatrics, Royal Manchester Children's Hospital, Manchester, UK
- Respiratory Group, University of Manchester, Manchester, UK
| | - Marion Roderick
- Paediatric Infectious Diseases and Immunology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Fiona Shackley
- Immunology, Allergy and Infectious Diseases, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Sam J Oddie
- Bradford Neonatology, Bradford Teaching Hospitals NHS Foundation Trust, West Yorkshire, UK
| | - Tim Lees
- Paediatric Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D P J Turner
- School of Life Sciences, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M Raman
- Department of Paediatrics, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Stephen Owens
- Paediatric Immunology and Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul Turner
- Section of Paediatrics, Imperial College London, London, UK
| | - H Cockerill
- Department of Paediatrics, West Suffolk NHS Foundation Trust, Bury Saint Edmunds, UK
| | - J Lopez Bernal
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - E Linley
- Vaccine Evaluation Unit, UK Health Security Agency, London, UK
| | - Ray Borrow
- Vaccine Evaluation Unit, UK Health Security Agency, London, UK
| | - Kevin Brown
- Virus Reference Department, Public Health England, Colindale, UK
| | - Mary Elizabeth Ramsay
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, UK
| | - M Voysey
- Department of Paediatrics, University of Oxford, Oxford, UK
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24
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Cuerden C, Gower C, Brown K, Heath PT, Andrews N, Amirthalingam G, Bate J. PEPtalk 3: oral aciclovir is equivalent to varicella zoster immunoglobulin as postexposure prophylaxis against chickenpox in children with cancer - results of a multicentre UK evaluation. Arch Dis Child 2022; 107:archdischild-2022-324396. [PMID: 35803693 DOI: 10.1136/archdischild-2022-324396] [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] [Received: 05/10/2022] [Accepted: 06/28/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the occurrence of chickenpox in children with cancer who received varicella immunoglobulin (VZIG) or aciclovir as postexposure prophylaxis (PEP). DESIGN Prospective multicentre service evaluation of children with cancer who received either VZIG or aciclovir as PEP following significant exposure to varicella zoster virus (VZV) over a 24-month period from May 2018. SETTING Data were collected from 9 UK Paediatric Oncology Primary Treatment Centres. PATIENTS Children under 16 years old with a diagnosis of cancer and/or previous haematopoietic stem cell transplant who were VZV seronegative at exposure and/or diagnosis and received PEP following significant VZV exposure. MAIN OUTCOME MEASURES The primary outcome was the incidence of breakthrough varicella within 6 weeks of VZV exposure and treatment with PEP. RESULTS A total of 105 eligible patients were registered with a median age of 4.9 years (range 1.1-10.5 years). Underlying diagnoses were acute leukaemia (64), solid tumours (22), Langerhans cell histiocytosis (9), central nervous system (CNS) tumours (8) and other (2). Aciclovir was received by 86 patients (81.9%), 18 received VZIG (17.1%) and 1 valaciclovir (0.9%). There were seven reported break-through VZV infections in 103 patients at follow-up (7/103, 6.8%). Clinical VZV developed in 5/84 of the aciclovir group (6.0%, 95% CI 2.0 to 13.3) and 2/18 of VZIG group (11.1%, 95% CI 1.4 to 34.7). All breakthrough infections were either mild (5/7) or moderate (2/7) in severity. CONCLUSION Aciclovir is a safe and effective alternative to VZIG as VZV PEP in children with cancer and should be considered as standard of care.
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Affiliation(s)
- Claire Cuerden
- Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
| | - Charlotte Gower
- Department of Immunisation and Counter Measures, Public Health England Colindale, London, UK
| | - Kevin Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Paul T Heath
- Vaccine Institute, St George's, University of London, London, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Unit, UK Health Security Agency, London, UK
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Jessica Bate
- Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
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25
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Dowell AC, Powell AA, Davis C, Scott S, Logan N, Willett BJ, Bruton R, Ayodele M, Jinks E, Gunn J, Spalkova E, Sylla P, Nicol SM, Zuo J, Ireland G, Okike I, Baawuah F, Beckmann J, Ahmad S, Garstang J, Brent AJ, Brent B, White M, Collins A, Davis F, Lim M, Cohen J, Kenny J, Linley E, Poh J, Amirthalingam G, Brown K, Ramsay ME, Azad R, Wright J, Waiblinger D, Moss P, Ladhani SN. mRNA or ChAd0x1 COVID-19 Vaccination of Adolescents Induces Robust Antibody and Cellular Responses With Continued Recognition of Omicron Following mRNA-1273. Front Immunol 2022; 13:882515. [PMID: 35720281 PMCID: PMC9201026 DOI: 10.3389/fimmu.2022.882515] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Children and adolescents generally experience mild COVID-19. However, those with underlying physical health conditions are at a significantly increased risk of severe disease. Here, we present a comprehensive analysis of antibody and cellular responses in adolescents with severe neuro-disabilities who received COVID-19 vaccination with either ChAdOx1 (n=6) or an mRNA vaccine (mRNA-1273, n=8, BNT162b2, n=1). Strong immune responses were observed after vaccination and antibody levels and neutralisation titres were both higher after two doses. Both measures were also higher after mRNA vaccination and were further enhanced by prior natural infection where one vaccine dose was sufficient to generate peak antibody response. Robust T-cell responses were generated after dual vaccination and were also higher following mRNA vaccination. Early T-cells were characterised by a dominant effector-memory CD4+ T-cell population with a type-1 cytokine signature with additional production of IL-10. Antibody levels were well-maintained for at least 3 months after vaccination and 3 of 4 donors showed measurable neutralisation titres against the Omicron variant. T-cell responses also remained robust, with generation of a central/stem cell memory pool and showed strong reactivity against Omicron spike. These data demonstrate that COVID-19 vaccines display strong immunogenicity in adolescents and that dual vaccination, or single vaccination following prior infection, generate higher immune responses than seen after natural infection and develop activity against Omicron. Initial evidence suggests that mRNA vaccination elicits stronger immune responses than adenoviral delivery, although the latter is also higher than seen in adult populations. COVID-19 vaccines are therefore highly immunogenic in high-risk adolescents and dual vaccination might be able to provide relative protection against the Omicron variant that is currently globally dominant.
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Affiliation(s)
- Alexander C. Dowell
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Annabel A. Powell
- Immunisation and Vaccine Preventable Diseases Division, United Kingdom (UK) Health Security Agency, London, United Kingdom
| | - Chris Davis
- Medical Research Council (MRC)-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Sam Scott
- Medical Research Council (MRC)-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Nicola Logan
- Medical Research Council (MRC)-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Brian J. Willett
- Medical Research Council (MRC)-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Rachel Bruton
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Morenike Ayodele
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Elizabeth Jinks
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Juliet Gunn
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Eliska Spalkova
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Panagiota Sylla
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Samantha M. Nicol
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jianmin Zuo
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Georgina Ireland
- Immunisation and Vaccine Preventable Diseases Division, United Kingdom (UK) Health Security Agency, London, United Kingdom
| | - Ifeanyichukwu Okike
- Immunisation and Vaccine Preventable Diseases Division, United Kingdom (UK) Health Security Agency, London, United Kingdom
- University Hospitals of Derby and Burton National Health Service (NHS) Foundation Trust, Derby, United Kingdom
| | - Frances Baawuah
- Immunisation and Vaccine Preventable Diseases Division, United Kingdom (UK) Health Security Agency, London, United Kingdom
| | - Joanne Beckmann
- East London National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Shazaad Ahmad
- Manchester University National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Joanna Garstang
- Birmingham Community Healthcare National Health Service (NHS) Trust, Aston, United Kingdom
| | - Andrew J. Brent
- Nuffield Department of Medicine, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
- University of Oxford, Oxford, United Kingdom
| | - Bernadette Brent
- Nuffield Department of Medicine, Oxford University Hospitals National Health Service (NHS) Foundation Trust, Oxford, United Kingdom
| | - Marie White
- Department of General Paediatrics, Evelina London Children’s Hospital, London, United Kingdom
| | - Aedin Collins
- The National Children’s Hospital, Tallaght University Hospital, Dublin, Ireland
| | - Francesca Davis
- Department of General Paediatrics, Evelina London Children’s Hospital, London, United Kingdom
| | - Ming Lim
- Children’s Neurosciences, Evelina London Children’s Hospital at Guy’s and St Thomas’ National Health Service (NHS) Foundation Trust, King’s Health Partners Academic Health Science Centre, London, United Kingdom
- Department Women and Children’s Health, School of Life Course Sciences (SoLCS), King’s College London, London, United Kingdom
| | - Jonathan Cohen
- Department of Paediatric Infectious Diseases and Immunology Evelina London Children’s Hospital, London, United Kingdom
| | - Julia Kenny
- Department Women and Children’s Health, School of Life Course Sciences (SoLCS), King’s College London, London, United Kingdom
- Department of Paediatric Infectious Diseases and Immunology Evelina London Children’s Hospital, London, United Kingdom
| | - Ezra Linley
- United Kingdom (UK) Health Security Agency, Manchester Royal Infirmary, Manchester, United Kingdom
| | - John Poh
- Immunisation and Vaccine Preventable Diseases Division, United Kingdom (UK) Health Security Agency, London, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, United Kingdom (UK) Health Security Agency, London, United Kingdom
| | - Kevin Brown
- Immunisation and Vaccine Preventable Diseases Division, United Kingdom (UK) Health Security Agency, London, United Kingdom
| | - Mary E. Ramsay
- Immunisation and Vaccine Preventable Diseases Division, United Kingdom (UK) Health Security Agency, London, United Kingdom
| | - Rafaq Azad
- Bradford Institute for Health Research, Bradford Teaching Hospitals National Health Service (NHS) Foundation Trust, Bradford, United Kingdom
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals National Health Service (NHS) Foundation Trust, Bradford, United Kingdom
| | - Dagmar Waiblinger
- Bradford Institute for Health Research, Bradford Teaching Hospitals National Health Service (NHS) Foundation Trust, Bradford, United Kingdom
| | - Paul Moss
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Shamez N. Ladhani
- Immunisation and Vaccine Preventable Diseases Division, United Kingdom (UK) Health Security Agency, London, United Kingdom
- Paediatric Infectious Diseases Research Group, St. George’s University of London, London, United Kingdom
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26
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Sile B, Brown KE, Gower C, Bosowski J, Dennis A, Falconer M, Stowe J, Andrews N, Amirthalingam G. Effectiveness of oral aciclovir in preventing maternal chickenpox: A comparison with VZIG. J Infect 2022; 85:147-151. [PMID: 35659543 DOI: 10.1016/j.jinf.2022.05.037] [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: 05/12/2022] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Although often presenting as a self-limiting childhood disease, chickenpox can have serious consequences if acquired in pregnancy. Until April 2022, the UK recommendations were that varicella immunoglobulin (VZIG) should be administered intramuscularly to susceptible pregnant women exposed to chickenpox prior to 20 weeks gestation. Oral aciclovir or VZIG was recommended if exposure occurred at 20+ weeks gestation. Our objective was to compare the effectiveness of oral aciclovir to VZIG in preventing maternal and neonatal chickenpox. METHODS We identified and followed up 186 pregnant women who were exposed to chickenpox and compared their outcomes. RESULTS 171/186 (91.9%) of these women received either VZIG or oral aciclovir. Of the 145 women who received VZIG, 53/145 (36.6%) went on to develop chickenpox compared to 8 of the 26 (30.8%) women who received oral aciclovir (p=0.32). No statistical difference was found between the oral aciclovir and VZIG groups even after controlling for maternal age, gestational stage, type of exposure and IgG titre (adjusted OR:0.83; 95%CI:0.26-2.65; p=0.75). CONCLUSIONS These findings support the use of oral aciclovir as first-line prophylaxis in pregnant women exposed to varicella as they suggest its effectiveness at preventing maternal chickenpox is either better or equal to VZIG.
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Affiliation(s)
- Bersabeh Sile
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom.
| | - Kevin E Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - Charlotte Gower
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - Johanna Bosowski
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - Amanda Dennis
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - Michelle Falconer
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - Julia Stowe
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - Nick Andrews
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, United Kingdom
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27
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Andrews N, Stowe J, Kirsebom F, Toffa S, Rickeard T, Gallagher E, Gower C, Kall M, Groves N, O'Connell AM, Simons D, Blomquist PB, Zaidi A, Nash S, Iwani Binti Abdul Aziz N, Thelwall S, Dabrera G, Myers R, Amirthalingam G, Gharbia S, Barrett JC, Elson R, Ladhani SN, Ferguson N, Zambon M, Campbell CNJ, Brown K, Hopkins S, Chand M, Ramsay M, Lopez Bernal J. Covid-19 Vaccine Effectiveness against the Omicron (B.1.1.529) Variant. N Engl J Med 2022; 386:1532-1546. [PMID: 35249272 DOI: 10.1101/2021.12.14.21267615] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND A rapid increase in coronavirus disease 2019 (Covid-19) cases due to the omicron (B.1.1.529) variant of severe acute respiratory syndrome coronavirus 2 in highly vaccinated populations has aroused concerns about the effectiveness of current vaccines. METHODS We used a test-negative case-control design to estimate vaccine effectiveness against symptomatic disease caused by the omicron and delta (B.1.617.2) variants in England. Vaccine effectiveness was calculated after primary immunization with two doses of BNT162b2 (Pfizer-BioNTech), ChAdOx1 nCoV-19 (AstraZeneca), or mRNA-1273 (Moderna) vaccine and after a booster dose of BNT162b2, ChAdOx1 nCoV-19, or mRNA-1273. RESULTS Between November 27, 2021, and January 12, 2022, a total of 886,774 eligible persons infected with the omicron variant, 204,154 eligible persons infected with the delta variant, and 1,572,621 eligible test-negative controls were identified. At all time points investigated and for all combinations of primary course and booster vaccines, vaccine effectiveness against symptomatic disease was higher for the delta variant than for the omicron variant. No effect against the omicron variant was noted from 20 weeks after two ChAdOx1 nCoV-19 doses, whereas vaccine effectiveness after two BNT162b2 doses was 65.5% (95% confidence interval [CI], 63.9 to 67.0) at 2 to 4 weeks, dropping to 8.8% (95% CI, 7.0 to 10.5) at 25 or more weeks. Among ChAdOx1 nCoV-19 primary course recipients, vaccine effectiveness increased to 62.4% (95% CI, 61.8 to 63.0) at 2 to 4 weeks after a BNT162b2 booster before decreasing to 39.6% (95% CI, 38.0 to 41.1) at 10 or more weeks. Among BNT162b2 primary course recipients, vaccine effectiveness increased to 67.2% (95% CI, 66.5 to 67.8) at 2 to 4 weeks after a BNT162b2 booster before declining to 45.7% (95% CI, 44.7 to 46.7) at 10 or more weeks. Vaccine effectiveness after a ChAdOx1 nCoV-19 primary course increased to 70.1% (95% CI, 69.5 to 70.7) at 2 to 4 weeks after an mRNA-1273 booster and decreased to 60.9% (95% CI, 59.7 to 62.1) at 5 to 9 weeks. After a BNT162b2 primary course, the mRNA-1273 booster increased vaccine effectiveness to 73.9% (95% CI, 73.1 to 74.6) at 2 to 4 weeks; vaccine effectiveness fell to 64.4% (95% CI, 62.6 to 66.1) at 5 to 9 weeks. CONCLUSIONS Primary immunization with two doses of ChAdOx1 nCoV-19 or BNT162b2 vaccine provided limited protection against symptomatic disease caused by the omicron variant. A BNT162b2 or mRNA-1273 booster after either the ChAdOx1 nCoV-19 or BNT162b2 primary course substantially increased protection, but that protection waned over time. (Funded by the U.K. Health Security Agency.).
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Affiliation(s)
- Nick Andrews
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Julia Stowe
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Freja Kirsebom
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Samuel Toffa
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Tim Rickeard
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Eileen Gallagher
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Charlotte Gower
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Meaghan Kall
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Natalie Groves
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Anne-Marie O'Connell
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - David Simons
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Paula B Blomquist
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Asad Zaidi
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Sophie Nash
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Nurin Iwani Binti Abdul Aziz
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Simon Thelwall
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Gavin Dabrera
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Richard Myers
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Gayatri Amirthalingam
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Saheer Gharbia
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Jeffrey C Barrett
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Richard Elson
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Shamez N Ladhani
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Neil Ferguson
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Maria Zambon
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Colin N J Campbell
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Kevin Brown
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Susan Hopkins
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Meera Chand
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Mary Ramsay
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Jamie Lopez Bernal
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
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Andrews N, Stowe J, Kirsebom F, Toffa S, Rickeard T, Gallagher E, Gower C, Kall M, Groves N, O'Connell AM, Simons D, Blomquist PB, Zaidi A, Nash S, Iwani Binti Abdul Aziz N, Thelwall S, Dabrera G, Myers R, Amirthalingam G, Gharbia S, Barrett JC, Elson R, Ladhani SN, Ferguson N, Zambon M, Campbell CNJ, Brown K, Hopkins S, Chand M, Ramsay M, Lopez Bernal J. Covid-19 Vaccine Effectiveness against the Omicron (B.1.1.529) Variant. N Engl J Med 2022; 386:1532-1546. [PMID: 35249272 PMCID: PMC8908811 DOI: 10.1056/nejmoa2119451] [Citation(s) in RCA: 1339] [Impact Index Per Article: 669.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND A rapid increase in coronavirus disease 2019 (Covid-19) cases due to the omicron (B.1.1.529) variant of severe acute respiratory syndrome coronavirus 2 in highly vaccinated populations has aroused concerns about the effectiveness of current vaccines. METHODS We used a test-negative case-control design to estimate vaccine effectiveness against symptomatic disease caused by the omicron and delta (B.1.617.2) variants in England. Vaccine effectiveness was calculated after primary immunization with two doses of BNT162b2 (Pfizer-BioNTech), ChAdOx1 nCoV-19 (AstraZeneca), or mRNA-1273 (Moderna) vaccine and after a booster dose of BNT162b2, ChAdOx1 nCoV-19, or mRNA-1273. RESULTS Between November 27, 2021, and January 12, 2022, a total of 886,774 eligible persons infected with the omicron variant, 204,154 eligible persons infected with the delta variant, and 1,572,621 eligible test-negative controls were identified. At all time points investigated and for all combinations of primary course and booster vaccines, vaccine effectiveness against symptomatic disease was higher for the delta variant than for the omicron variant. No effect against the omicron variant was noted from 20 weeks after two ChAdOx1 nCoV-19 doses, whereas vaccine effectiveness after two BNT162b2 doses was 65.5% (95% confidence interval [CI], 63.9 to 67.0) at 2 to 4 weeks, dropping to 8.8% (95% CI, 7.0 to 10.5) at 25 or more weeks. Among ChAdOx1 nCoV-19 primary course recipients, vaccine effectiveness increased to 62.4% (95% CI, 61.8 to 63.0) at 2 to 4 weeks after a BNT162b2 booster before decreasing to 39.6% (95% CI, 38.0 to 41.1) at 10 or more weeks. Among BNT162b2 primary course recipients, vaccine effectiveness increased to 67.2% (95% CI, 66.5 to 67.8) at 2 to 4 weeks after a BNT162b2 booster before declining to 45.7% (95% CI, 44.7 to 46.7) at 10 or more weeks. Vaccine effectiveness after a ChAdOx1 nCoV-19 primary course increased to 70.1% (95% CI, 69.5 to 70.7) at 2 to 4 weeks after an mRNA-1273 booster and decreased to 60.9% (95% CI, 59.7 to 62.1) at 5 to 9 weeks. After a BNT162b2 primary course, the mRNA-1273 booster increased vaccine effectiveness to 73.9% (95% CI, 73.1 to 74.6) at 2 to 4 weeks; vaccine effectiveness fell to 64.4% (95% CI, 62.6 to 66.1) at 5 to 9 weeks. CONCLUSIONS Primary immunization with two doses of ChAdOx1 nCoV-19 or BNT162b2 vaccine provided limited protection against symptomatic disease caused by the omicron variant. A BNT162b2 or mRNA-1273 booster after either the ChAdOx1 nCoV-19 or BNT162b2 primary course substantially increased protection, but that protection waned over time. (Funded by the U.K. Health Security Agency.).
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Affiliation(s)
- Nick Andrews
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Julia Stowe
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Freja Kirsebom
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Samuel Toffa
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Tim Rickeard
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Eileen Gallagher
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Charlotte Gower
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Meaghan Kall
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Natalie Groves
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Anne-Marie O'Connell
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - David Simons
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Paula B Blomquist
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Asad Zaidi
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Sophie Nash
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Nurin Iwani Binti Abdul Aziz
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Simon Thelwall
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Gavin Dabrera
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Richard Myers
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Gayatri Amirthalingam
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Saheer Gharbia
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Jeffrey C Barrett
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Richard Elson
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Shamez N Ladhani
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Neil Ferguson
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Maria Zambon
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Colin N J Campbell
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Kevin Brown
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Susan Hopkins
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Meera Chand
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Mary Ramsay
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Jamie Lopez Bernal
- From the U.K. Health Security Agency (N.A., J.S., F.K., S. Toffa, T.R., E.G., C.G., M.K., N.G., A.-M.O., D.S., P.B.B., A.Z., S.N., N.I.B.A.A., S. Thelwall, G.D., R.M., G.A., S.G., R.E., S.N.L., M.Z., C.N.J.C., K.B., S.H., M.C., M.R., J.L.B.), the National Institute for Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., G.A., C.N.J.C., K.B., M.R., J.L.B.), the Paediatric Infectious Diseases Research Group, St. George's University of London (R.M., S.N.L.), the Medical Research Council Centre for Global Infectious Disease Analysis (N.F.) and the NIHR Health Protection Research Unit in Respiratory Infections (N.F., M.Z., J.L.B.), Imperial College London, and Guy's and St. Thomas's Hospital NHS Trust (M.C.), London, Wellcome Sanger Institute, Hinxton (J.C.B.), and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
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Higgins H, Andrews N, Stowe J, Amirthalingam G, Ramsay M, Bahra G, Hackett A, Breen KA, Desborough M, Khan D, Leary H, Sweeney C, Hutchinson E, Shapiro SE, Lees C, Dhanapal J, MacCallum PK, Burke S, McDonald V, Entwistle NMA, Booth S, Atchison CJ, Hunt BJ. Risk of thrombosis with thrombocytopenia syndrome after COVID‐19 vaccination prior to the recognition of vaccine‐induced thrombocytopenia and thrombosis: A self‐controlled case series study in England. Res Pract Thromb Haemost 2022; 6:e12698. [PMID: 35475292 PMCID: PMC9020167 DOI: 10.1002/rth2.12698] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 11/08/2022] Open
Abstract
Background Objectives Methods Results Conclusions
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Affiliation(s)
- Hannah Higgins
- Health Protection Division UK Health Security Agency London UK
| | - Nick Andrews
- Immunisation and Vaccine Preventable Diseases Division UK Health Security Agency London UK
| | - Julia Stowe
- Immunisation and Vaccine Preventable Diseases Division UK Health Security Agency London UK
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division UK Health Security Agency London UK
| | - Mary Ramsay
- Immunisation and Vaccine Preventable Diseases Division UK Health Security Agency London UK
| | - Gurpreet Bahra
- Centre for Thrombosis and Haemostasis St Thomas' Hospital Guy’s and Saint Thomas’ NHS Foundation Trust London UK
| | - Anthony Hackett
- Centre for Thrombosis and Haemostasis St Thomas' Hospital Guy’s and Saint Thomas’ NHS Foundation Trust London UK
| | - Karen A. Breen
- Centre for Thrombosis and Haemostasis St Thomas' Hospital Guy’s and Saint Thomas’ NHS Foundation Trust London UK
| | - Michael Desborough
- Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK
- Radcliffe Department of Medicine University of Oxford Oxford UK
| | - Dalia Khan
- Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK
- Radcliffe Department of Medicine University of Oxford Oxford UK
| | - Heather Leary
- Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK
- Radcliffe Department of Medicine University of Oxford Oxford UK
| | - Connor Sweeney
- Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK
- Radcliffe Department of Medicine University of Oxford Oxford UK
| | - Elizabeth Hutchinson
- Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK
- Radcliffe Department of Medicine University of Oxford Oxford UK
| | - Susan E. Shapiro
- Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK
- Radcliffe Department of Medicine University of Oxford Oxford UK
| | - Charlotte Lees
- Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK
- Radcliffe Department of Medicine University of Oxford Oxford UK
| | - Jay Dhanapal
- Oxford University Hospitals NHS Foundation Trust Oxford NIHR Biomedical Research Centre Oxford UK
| | - Peter K. MacCallum
- Wolfson Institute of Population Health Queen Mary University of London London UK
- Barts Health NHS Trust London UK
| | | | | | | | - Stephen Booth
- Department of Haematology Royal Berkshire Hospital NHS Foundation Trust London UK
| | - Christina J. Atchison
- Patient Experience Research Centre School of Public Health Imperial College London London UK
| | - Beverley J. Hunt
- Centre for Thrombosis and Haemostasis St Thomas' Hospital Guy’s and Saint Thomas’ NHS Foundation Trust London UK
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30
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Sandmann FG, Tessier E, Lacy J, Kall M, Van Leeuwen E, Charlett A, Eggo RM, Dabrera G, Edmunds WJ, Ramsay M, Campbell H, Amirthalingam G, Jit M. Long-Term Health-Related Quality of Life in Non-Hospitalized Coronavirus Disease 2019 (COVID-19) Cases With Confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in England: Longitudinal Analysis and Cross-Sectional Comparison With Controls. Clin Infect Dis 2022; 75:e962-e973. [PMID: 35245941 PMCID: PMC8903473 DOI: 10.1093/cid/ciac151] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We aimed to quantify the unknown losses in health-related quality of life of coronavirus disease 2019 (COVID-19) cases using quality-adjusted lifedays (QALDs) and the recommended EQ-5D instrument in England. METHODS Prospective cohort study of nonhospitalized, polymerase chain reaction (PCR)-confirmed severe acute respiratory syndrome coronavirus 2-positive (SARS-CoV-2-positive) cases aged 12-85 years and followed up for 6 months from 1 December 2020, with cross-sectional comparison to SARS-CoV-2-negative controls. Main outcomes were QALD losses; physical symptoms; and COVID-19-related private expenditures. We analyzed results using multivariable regressions with post hoc weighting by age and sex, and conditional logistic regressions for the association of each symptom and EQ-5D limitation on cases and controls. RESULTS Of 548 cases (mean age 41.1 years; 61.5% female), 16.8% reported physical symptoms at month 6 (most frequently extreme tiredness, headache, loss of taste and/or smell, and shortness of breath). Cases reported more limitations with doing usual activities than controls. Almost half of cases spent a mean of £18.1 on nonprescription drugs (median: £10.0), and 52.7% missed work or school for a mean of 12 days (median: 10). On average, all cases lost 13.7 (95% confidence interval [CI]: 9.7, 17.7) QALDs, whereas those reporting symptoms at month 6 lost 32.9 (95% CI: 24.5, 37.6) QALDs. Losses also increased with older age. Cumulatively, the health loss from morbidity contributes at least 18% of the total COVID-19-related disease burden in the England. CONCLUSIONS One in 6 cases report ongoing symptoms at 6 months, and 10% report prolonged loss of function compared to pre-COVID-19 baselines. A marked health burden was observed among older COVID-19 cases and those with persistent physical symptoms.
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Affiliation(s)
- Frank G Sandmann
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,Corresponding author: Frank G. Sandmann Infectious Disease Modeller / Health Economist
| | - Elise Tessier
- Immunisation Division, UK Health Security Agency, London, UK,COVID-19 National Epidemiology Cell, UK Health Security Agency, Wellington House, London, UK
| | - Joanne Lacy
- Immunisation Division, UK Health Security Agency, London, UK
| | - Meaghan Kall
- COVID-19 National Epidemiology Cell, UK Health Security Agency, Wellington House, London, UK
| | - Edwin Van Leeuwen
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Andre Charlett
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, UK
| | - Rosalind M Eggo
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Gavin Dabrera
- COVID-19 National Epidemiology Cell, UK Health Security Agency, Wellington House, London, UK
| | - W John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Mary Ramsay
- Immunisation Division, UK Health Security Agency, London, UK
| | - Helen Campbell
- Immunisation Division, UK Health Security Agency, London, UK
| | | | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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31
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Ladhani SN, Ireland G, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Aiano F, Amin-Chowdhury Z, Kall M, Borrow R, Linley E, Zambon M, Poh J, Warrener L, Lackenby A, Ellis J, Amirthalingam G, Brown KE, Ramsay ME. Emergence of the delta variant and risk of SARS-CoV-2 infection in secondary school students and staff: Prospective surveillance in 18 schools, England. EClinicalMedicine 2022; 45:101319. [PMID: 35233517 PMCID: PMC8882000 DOI: 10.1016/j.eclinm.2022.101319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The role of educational settings in SARS-CoV-2 infection and transmission remains controversial. We investigated SARS-CoV-2 infection, seroprevalence, and seroconversion rates in secondary schools during the 2020/21 academic year, which included the emergence of the more transmissible alpha and delta variants, in England. METHODS The UK Health Security Agency (UKHSA) initiated prospective surveillance in 18 urban English secondary schools. Participants had nasal swabs for SARS-CoV-2 RT-PCR and blood sampling for SARS-CoV-2 nucleoprotein and spike protein antibodies at the start (Round 1: September-October 2020) and end (Round 2: December 2020) of the autumn term, when schools reopened after national lockdown was imposed in January 2021 (Round 3: March-April 2021), and end of the academic year (Round 4: May-July 2021). FINDINGS We enrolled 2314 participants (1277 students, 1037 staff; one participant had missing data for PCR testing). In-school testing identified 31 PCR-positive participants (20 students, 11 staff). Another 247 confirmed cases (112 students, 135 staff) were identified after linkage with national surveillance data, giving an overall positivity rate of 12.0% (278/2313; staff: 14.1%, 146/1037 vs students: 10.3%, 132/1276; p = 0.006). Trends were similar to national infection data. Nucleoprotein-antibody seroprevalence increased for students and staff between Rounds 1 and 3 but were similar between Rounds 3 and 4, when the delta variant was the dominant circulating strain. Overall, Nucleoprotein-antibody seroconversion was 18.4% (137/744) in staff and 18.8% (146/778) in students, while Spike-antibody seroconversion was higher in staff (72.8%, 525/721) than students (21.3%, 163/764) because of vaccination. INTERPRETATION SARS-CoV-2 infection rates in secondary schools remained low when community infection rates were low, even as the delta variant was emerging in England. FUNDING This study was funded by the UK Department of Health and Social Care.
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Affiliation(s)
- Shamez N. Ladhani
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
- Paediatric Infectious Diseases Research Group, St. George's University of London, London SW17 0RE, UK
| | - Georgina Ireland
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
- Corresponding author.
| | - Frances Baawuah
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Joanne Beckmann
- East London NHS Foundation Trust, 9 Alie Street, London E1 8DE, UK
| | - Ifeanyichukwu O. Okike
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, 201 London Road, Derby DE1 2TZ, UK
| | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Holt Street, Aston B7 4BN, UK
| | - Andrew J. Brent
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, UK
- University of Oxford, Wellington Square, Oxford OX1 2JD, UK
| | | | - Felicity Aiano
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Zahin Amin-Chowdhury
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Meaghan Kall
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Ray Borrow
- UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Ezra Linley
- UK Health Security Agency, Manchester Royal Infirmary, Manchester, UK
| | - Maria Zambon
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - John Poh
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Lenesha Warrener
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Angie Lackenby
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Joanna Ellis
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Kevin E. Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mary E. Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
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32
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Tessier E, Campbell H, Ribeiro S, Rai Y, Burton S, Roy P, Fry NK, Litt D, Amirthalingam G. Impact of the COVID-19 pandemic on Bordetella pertussis infections in England. BMC Public Health 2022; 22:405. [PMID: 35220973 PMCID: PMC8882439 DOI: 10.1186/s12889-022-12830-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In March 2020, England went into its first lockdown in response to the COVID-19 pandemic. Restrictions eased temporarily, followed by second and third waves in October 2020 and January 2021. Recent data showed that the COVID-19 pandemic resulted in reduced transmission of some invasive diseases. We assess the impact of the COVID-19 pandemic on pertussis incidence and on the immunisation programme in England.
Methods
We assessed trends in pertussis cases from 2012 to 2020 by age group and month. Incidence from the time that England eased its initial lockdown measures in July 2020 through to summer 2021 was calculated and the incidence rate ratios of pertussis cases from five years prior to the pandemic (July 2014 – June 2019) compared to the same time period during the pandemic (July 2020 – June 2021). Vaccine coverage estimates for pertussis containing vaccines were reviewed for the maternal and childhood programmes.
Results
A substantial decline in pertussis cases was observed from April 2020 onwards, marking the lowest number of cases in the last decade. Pertussis incidence dropped in all age groups, particularly among infants less than one year old (0.50 / 100,000 during July 2020 to June 2021 compared to 24.49/ 100,000 from July 2014 to June 2019). The incidence rate ratio was 0.02 (95% CI 0.01 to 0.02) for July 2014 to June 2019 (pre-pandemic) compared to the pandemic period of July 2020 to June 2021. None of the cases had a co-infection with SARS-CoV-2. Vaccine coverage for infants born between January to March 2020 with three doses of pertussis vaccine by 12 months of age decreased by 1.1% points compared to infants born between January to March 2019 (91.6% and 92.7%, respectively). Prenatal pertussis coverage for the 2020 to 2021 financial year was 2.7% points lower than the year prior to the pandemic (70.5% and 76.8%, respectively).
Conclusions
Lockdown measures due to the COVID-19 pandemic have had a significant impact on pertussis transmission. With the easing of restrictions it is important to continue monitoring pertussis cases in England alongside coverage of the maternal and childhood immunisation programmes.
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Richardson JL, Stephens S, Chappell LC, Campbell H, Amirthalingam G, O’Boyle S, Bukasa A, Knight M, Hodson KK. Monitoring the safety of COVID-19 vaccination in pregnancy in the UK: A national study using the UK Obstetric Surveillance System (UKOSS), UK Teratology Information Service (UKTIS) and Vaccination in Pregnancy (VIP) safety monitoring systems. Obstet Med 2022; 16:40-47. [PMID: 37124763 PMCID: PMC10126751 DOI: 10.1177/1753495x221076713] [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] [Received: 07/30/2021] [Accepted: 01/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background COVID-19 vaccines are protective against disease. Pregnant women benefit from vaccination as they are at higher risk of poor maternal and neonatal outcomes following infection. Methods Following regulatory approval of two COVID-19 vaccines in the United Kingdom, a rapid national study of vaccination in pregnancy was instituted using three existing safety surveillance platforms: UKOSS, UKTIS and VIP. This preliminary report describes the data collected up to the 15th June 2021. Results There were 971 reports of COVID-19 vaccination in the UKOSS/UKTIS ( n = 493) and VIP ( n = 478) monitoring systems describing 908 individual pregnancies. Pfizer-BioNTech mRNA vaccination was most common ( n = 501, 55.2%), most women were vaccinated in their second or third trimester ( n = 566, 62.3%), and were mainly vaccinated due to occupational infection risk ( n = 577, 63.5%). Conclusion Obstetric outcome data will be obtained by December 2021. However, women should not delay vaccination whilst awaiting further safety data to emerge.
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Affiliation(s)
- Jonathan L Richardson
- UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sally Stephens
- UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lucy C Chappell
- School of Life Course Sciences, King’s College London, London, UK
| | - Helen Campbell
- Immunisation Department, Immunisation and Countermeasures National Infection Service, UK Health Security Agency, London, UK
| | - Gayatri Amirthalingam
- Immunisation Department, Immunisation and Countermeasures National Infection Service, UK Health Security Agency, London, UK
| | - Shennae O’Boyle
- Immunisation Department, Immunisation and Countermeasures National Infection Service, UK Health Security Agency, London, UK
| | - Antoaneta Bukasa
- Immunisation Department, Immunisation and Countermeasures National Infection Service, UK Health Security Agency, London, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Kenneth K Hodson
- UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Amirthalingam G, Bernal JL, Andrews NJ, Whitaker H, Gower C, Stowe J, Tessier E, Subbarao S, Ireland G, Baawuah F, Linley E, Warrener L, O'Brien M, Whillock C, Moss P, Ladhani SN, Brown KE, Ramsay ME. Author Correction: Serological responses and vaccine effectiveness for extended COVID-19 vaccine schedules in England. Nat Commun 2022; 13:733. [PMID: 35110555 PMCID: PMC8808467 DOI: 10.1038/s41467-022-28393-7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom.
| | - Jamie Lopez Bernal
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Nick J Andrews
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Heather Whitaker
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, United Kingdom
| | - Charlotte Gower
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Julia Stowe
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Elise Tessier
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Sathyavani Subbarao
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Georgina Ireland
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Frances Baawuah
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom.,Brondesbury Medical Centre, Kilburn, London, United Kingdom
| | - Ezra Linley
- Sero-Epidemiolgy Unit, UK Health Security Agency, Manchester, United Kingdom
| | - Lenesha Warrener
- Virus Reference Department, UK Health Security Agency, London, United Kingdom
| | | | - Corinne Whillock
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, United Kingdom
| | - Shamez N Ladhani
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom.,Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom
| | - Kevin E Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Mary E Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
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35
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Andrews N, Tessier E, Stowe J, Gower C, Kirsebom F, Simmons R, Gallagher E, Thelwall S, Groves N, Dabrera G, Myers R, Campbell CNJ, Amirthalingam G, Edmunds M, Zambon M, Brown K, Hopkins S, Chand M, Ladhani SN, Ramsay M, Lopez Bernal J. Duration of Protection against Mild and Severe Disease by Covid-19 Vaccines. N Engl J Med 2022; 386:340-350. [PMID: 35021002 PMCID: PMC8781262 DOI: 10.1056/nejmoa2115481] [Citation(s) in RCA: 385] [Impact Index Per Article: 192.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), have been used since December 2020 in the United Kingdom. Real-world data have shown the vaccines to be highly effective against Covid-19 and related severe disease and death. Vaccine effectiveness may wane over time since the receipt of the second dose of the ChAdOx1-S (ChAdOx1 nCoV-19) and BNT162b2 vaccines. METHODS We used a test-negative case-control design to estimate vaccine effectiveness against symptomatic Covid-19 and related hospitalization and death in England. Effectiveness of the ChAdOx1-S and BNT162b2 vaccines was assessed according to participant age and status with regard to coexisting conditions and over time since receipt of the second vaccine dose to investigate waning of effectiveness separately for the B.1.1.7 (alpha) and B.1.617.2 (delta) variants. RESULTS Vaccine effectiveness against symptomatic Covid-19 with the delta variant peaked in the early weeks after receipt of the second dose and then decreased by 20 weeks to 44.3% (95% confidence interval [CI], 43.2 to 45.4) with the ChAdOx1-S vaccine and to 66.3% (95% CI, 65.7 to 66.9) with the BNT162b2 vaccine. Waning of vaccine effectiveness was greater in persons 65 years of age or older than in those 40 to 64 years of age. At 20 weeks or more after vaccination, vaccine effectiveness decreased less against both hospitalization, to 80.0% (95% CI, 76.8 to 82.7) with the ChAdOx1-S vaccine and 91.7% (95% CI, 90.2 to 93.0) with the BNT162b2 vaccine, and death, to 84.8% (95% CI, 76.2 to 90.3) and 91.9% (95% CI, 88.5 to 94.3), respectively. Greater waning in vaccine effectiveness against hospitalization was observed in persons 65 years of age or older in a clinically extremely vulnerable group and in persons 40 to 64 years of age with underlying medical conditions than in healthy adults. CONCLUSIONS We observed limited waning in vaccine effectiveness against Covid-19-related hospitalization and death at 20 weeks or more after vaccination with two doses of the ChAdOx1-S or BNT162b2 vaccine. Waning was greater in older adults and in those in a clinical risk group.
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Affiliation(s)
- Nick Andrews
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Elise Tessier
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Julia Stowe
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Charlotte Gower
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Freja Kirsebom
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Ruth Simmons
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Eileen Gallagher
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Simon Thelwall
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Natalie Groves
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Gavin Dabrera
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Richard Myers
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Colin N J Campbell
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Gayatri Amirthalingam
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Matt Edmunds
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Maria Zambon
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Kevin Brown
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Susan Hopkins
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Meera Chand
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Shamez N Ladhani
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Mary Ramsay
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Jamie Lopez Bernal
- From the United Kingdom Health Security Agency (N.A., E.T., J.S., C.G., F.K., R.S., E.G., S.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.B., S.H., M.C., S.N.L., M.R., J.L.B.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (N.A., C.N.J.C., G.A., K.B., M.R., J.L.B.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (M.Z., J.L.B.), Guy's and St. Thomas' Hospital NHS Trust (M.C.), and the Paediatric Infectious Diseases Research Group, St. George's University of London (S.N.L.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
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Whitaker HJ, Tsang RS, Byford R, Andrews NJ, Sherlock J, Pillai PS, Williams J, Button E, Campbell H, Sinnathamby M, Victor W, Anand S, Linley E, Hewson J, DArchangelo S, Otter AD, Ellis J, Hobbs RF, Howsam G, Zambon M, Ramsay M, Brown KE, de Lusignan S, Amirthalingam G, Bernal JL. Pfizer-BioNTech and Oxford AstraZeneca COVID-19 vaccine effectiveness and immune response among individuals in clinical risk groups. J Infect 2022; 84:675-683. [PMID: 34990709 PMCID: PMC8720678 DOI: 10.1016/j.jinf.2021.12.044] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [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: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 01/30/2023]
Abstract
Background COVID-19 vaccines approved in the UK are highly effective in general population cohorts, however, data on effectiveness amongst individuals with clinical conditions that place them at increased risk of severe disease are limited. Methods We used GP electronic health record data, sentinel virology swabbing and antibody testing within a cohort of 712 general practices across England to estimate vaccine antibody response and vaccine effectiveness against medically attended COVID-19 amongst individuals in clinical risk groups using cohort and test-negative case control designs. Findings There was no reduction in S-antibody positivity in most clinical risk groups, however reduced S-antibody positivity and response was significant in the immunosuppressed group. Reduced vaccine effectiveness against clinical disease was also noted in the immunosuppressed group; after a second dose, effectiveness was moderate (Pfizer: 59.6%, 95%CI 18.0–80.1%; AstraZeneca 60.0%, 95%CI -63.6–90.2%). Interpretation In most clinical risk groups, immune response to primary vaccination was maintained and high levels of vaccine effectiveness were seen. Reduced antibody response and vaccine effectiveness were seen after 1 dose of vaccine amongst a broad immunosuppressed group, and second dose vaccine effectiveness was moderate. These findings support maximising coverage in immunosuppressed individuals and the policy of prioritisation of this group for third doses.
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Affiliation(s)
- Heather J Whitaker
- Statistics, Modelling and Economics Department, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Ruby Sm Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Rachel Byford
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Nick J Andrews
- Statistics, Modelling and Economics Department, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK; Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Praveen Sebastian Pillai
- Virus Reference Laboratory, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - John Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Elizabeth Button
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Helen Campbell
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mary Sinnathamby
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - William Victor
- Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London, NW1 2FB
| | - Sneha Anand
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Ezra Linley
- Vaccine Evaluation Unit, UK Health Security Agency (formerly Public Health England)), Manchester M13 9WL, UK
| | - Jacqueline Hewson
- Diagnostics and Genomics, UK Health Security Agency (formerly Public Health England), Porton Down, Salisbury SP4 0JG, UK
| | - Silvia DArchangelo
- Diagnostics and Genomics, UK Health Security Agency (formerly Public Health England), Porton Down, Salisbury SP4 0JG, UK
| | - Ashley D Otter
- Diagnostics and Genomics, UK Health Security Agency (formerly Public Health England), Porton Down, Salisbury SP4 0JG, UK
| | - Joanna Ellis
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK; Virus Reference Laboratory, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Richard Fd Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
| | - Gary Howsam
- Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London, NW1 2FB
| | - Maria Zambon
- Virus Reference Laboratory, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mary Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Kevin E Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG; Royal College of General Practitioners Research and Surveillance Centre, Euston Square, London, NW1 2FB
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK
| | - Jamie Lopez Bernal
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency (formerly Public Health England), 61 Colindale Avenue, London NW9 5EQ, UK.
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Ireland G, Whitaker H, Ladhani SN, Baawuah F, Subbarao S, Linley E, Warrener L, O'Brien M, Whillock C, Martin O, Moss P, Ramsay ME, Amirthalingam G, Brown KE. Serological responses to COVID-19 Comirnaty booster vaccine, London, United Kingdom, September to December 2021. Euro Surveill 2022; 27:2101114. [PMID: 34991777 PMCID: PMC8739342 DOI: 10.2807/1560-7917.es.2022.27.1.2101114] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Serum samples were collected pre- and post-booster vaccination with Comirnaty in 626 participants (aged ≥ 50 years) who had received two Comirnaty doses < 30 days apart, two Comirnaty doses ≥ 30 days apart or two Vaxzevria doses ≥ 30 days apart. Irrespective of primary vaccine type or schedule, spike antibody GMTs peaked 2-4 weeks after second dose, fell significantly ≤ 38 weeks later and rose above primary immunisation GMTs 2-4 weeks post-booster. Higher post-booster responses were observed with a longer interval between primary immunisation and boosting.
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Affiliation(s)
- Georgina Ireland
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Heather Whitaker
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, United Kingdom
| | - Shamez N Ladhani
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
- Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom
| | - Frances Baawuah
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
- Brondesbury Medical Centre, Kilburn, London, United Kingdom
| | - Sathyvani Subbarao
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Ezra Linley
- Sero-Epidemiology Unit, UK Health Security Agency, Manchester, United Kingdom
| | - Lenesha Warrener
- Virus Reference Department, UK Health Security Agency, London, United Kingdom
| | | | - Corinne Whillock
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Oliver Martin
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, United Kingdom
| | - Mary E Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Kevin E Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
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38
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Dowell AC, Butler MS, Jinks E, Tut G, Lancaster T, Sylla P, Begum J, Bruton R, Pearce H, Verma K, Logan N, Tyson G, Spalkova E, Margielewska-Davies S, Taylor GS, Syrimi E, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Ireland G, Aiano F, Amin-Chowdhury Z, Jones S, Borrow R, Linley E, Wright J, Azad R, Waiblinger D, Davis C, Thomson EC, Palmarini M, Willett BJ, Barclay WS, Poh J, Amirthalingam G, Brown KE, Ramsay ME, Zuo J, Moss P, Ladhani S. Children develop robust and sustained cross-reactive spike-specific immune responses to SARS-CoV-2 infection. Nat Immunol 2022; 23:40-49. [PMID: 34937928 PMCID: PMC8709786 DOI: 10.1038/s41590-021-01089-8] [Citation(s) in RCA: 115] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
SARS-CoV-2 infection is generally mild or asymptomatic in children but a biological basis for this outcome is unclear. Here we compare antibody and cellular immunity in children (aged 3-11 years) and adults. Antibody responses against spike protein were high in children and seroconversion boosted responses against seasonal Beta-coronaviruses through cross-recognition of the S2 domain. Neutralization of viral variants was comparable between children and adults. Spike-specific T cell responses were more than twice as high in children and were also detected in many seronegative children, indicating pre-existing cross-reactive responses to seasonal coronaviruses. Importantly, children retained antibody and cellular responses 6 months after infection, whereas relative waning occurred in adults. Spike-specific responses were also broadly stable beyond 12 months. Therefore, children generate robust, cross-reactive and sustained immune responses to SARS-CoV-2 with focused specificity for the spike protein. These findings provide insight into the relative clinical protection that occurs in most children and might help to guide the design of pediatric vaccination regimens.
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Affiliation(s)
- Alexander C Dowell
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Megan S Butler
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Elizabeth Jinks
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gokhan Tut
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Tara Lancaster
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Panagiota Sylla
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jusnara Begum
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Rachel Bruton
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Hayden Pearce
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Kriti Verma
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nicola Logan
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Grace Tyson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Eliska Spalkova
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sandra Margielewska-Davies
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Graham S Taylor
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Eleni Syrimi
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Ifeanyichukwu O Okike
- Public Health England, 61 Colindale Avenue, London, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Aston, UK
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Andrew J Brent
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- University of Oxford, Wellington Square, Oxford, UK
| | | | | | | | | | - Samuel Jones
- Public Health England, 61 Colindale Avenue, London, UK
| | - Ray Borrow
- Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - Ezra Linley
- Public Health England, Manchester Royal Infirmary, Manchester, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rafaq Azad
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Dagmar Waiblinger
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Chris Davis
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Emma C Thomson
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | | | - Brian J Willett
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Wendy S Barclay
- Department of Infectious Disease, Imperial College, London, UK
| | - John Poh
- Public Health England, 61 Colindale Avenue, London, UK
| | | | - Kevin E Brown
- Public Health England, 61 Colindale Avenue, London, UK
| | - Mary E Ramsay
- Public Health England, 61 Colindale Avenue, London, UK
| | - Jianmin Zuo
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Paul Moss
- Institute of Immunology & Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | - Shamez Ladhani
- Public Health England, 61 Colindale Avenue, London, UK
- Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
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Abu-Raya B, Madhi SA, Omer SB, Amirthalingam G, Giles ML, Flanagan KL, Zimmermann P, O’Ryan M, Safadi MA, Papaevangelou V, Maertens K, Wanlapakorn N, Diaz-Brito V, Tommelein E, Esposito S. Global Perspectives on Immunization Against SARS-CoV-2 During Pregnancy and Priorities for Future Research: An International Consensus Paper From the World Association of Infectious Diseases and Immunological Disorders. Front Immunol 2021; 12:808064. [PMID: 35003137 PMCID: PMC8733958 DOI: 10.3389/fimmu.2021.808064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/03/2021] [Indexed: 12/18/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy is associated with a higher risk for severe morbidity and mortality when compared with infection in non-pregnant women of childbearing age. An increasing number of countries recommend immunization against SARS-CoV-2 in pregnant women. Recent studies provide preliminary and supportive evidence on safety, immunogenicity and effectiveness of coronavirus disease 2019 (COVID-19) vaccines in pregnant women; however, important knowledge gaps remain which warrant further studies. This collaborative consensus paper provides a review of the current literature on COVID-19 vaccines in pregnant women, identifies knowledge gaps and outlines priorities for future research to optimize protection against SARS-CoV-2 in the pregnant women and their infants.
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Affiliation(s)
- Bahaa Abu-Raya
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Shabir A. Madhi
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- African Leadership in Vaccinology Expertise, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Saad B. Omer
- Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, United States
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| | - Michelle L. Giles
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Katie L. Flanagan
- School of Medicine, Faculty of Health Sciences, University of Tasmania, Launceston, TAS, Australia
- School of Health and Biomedical Science, Royal Melbourne Institute of Technology (RMIT) University, Melbourne, VIC, Australia
- Department of Immunology and Pathology, Monash University, Melbourne, VIC, Australia
- Tasmanian Vaccine Trial Centre, Clifford Craig Foundation, Launceston General Hospital, Launceston, TAS, Australia
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - Miguel O’Ryan
- Microbiology and Mycology Program, Institute of Biomedical Sciences and Millennium Institute of Immunology and Immunotherapy, Faculty of Medicine, University of Chile, Santiago de Chile, Chile
| | - Marco A. Safadi
- Department of Pediatrics, Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, Brazil
| | - Vassiliki Papaevangelou
- National and Kapodistrian University of Athens, Third Department of Pediatrics, University Hospital Attikon, Athens, Greece
| | - Kirsten Maertens
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Diseases Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vicens Diaz-Brito
- Department of Infectious Diseases, Parc Sanitari Sant Joan de Déu,, Barcelona, Spain
| | - Eline Tommelein
- Department of Pharmacy, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
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40
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Amirthalingam G, Bernal JL, Andrews NJ, Whitaker H, Gower C, Stowe J, Tessier E, Subbarao S, Ireland G, Baawuah F, Linley E, Warrener L, O'Brien M, Whillock C, Moss P, Ladhani SN, Brown KE, Ramsay ME. Serological responses and vaccine effectiveness for extended COVID-19 vaccine schedules in England. Nat Commun 2021; 12:7217. [PMID: 34893611 PMCID: PMC8664823 DOI: 10.1038/s41467-021-27410-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/09/2021] [Indexed: 11/09/2022] Open
Abstract
The UK prioritised delivery of the first dose of BNT162b2 (Pfizer/BioNTech) and AZD1222 (AstraZeneca) vaccines by extending the interval between doses up to 12 weeks. In 750 participants aged 50-89 years, we here compare serological responses after BNT162b2 and AZD1222 vaccination with varying dose intervals, and evaluate these against real-world national vaccine effectiveness (VE) estimates against COVID-19 in England. We show that antibody levels 14-35 days after dose two are higher in BNT162b2 recipients with an extended vaccine interval (65-84 days) compared with those vaccinated with a standard (19-29 days) interval. Following the extended schedule, antibody levels were 6-fold higher at 14-35 days post dose 2 for BNT162b2 than AZD1222. For both vaccines, VE was higher across all age-groups from 14 days after dose two compared to one dose, but the magnitude varied with dose interval. Higher dose two VE was observed with >6 week interval between BNT162b2 doses compared to the standard schedule. Our findings suggest higher effectiveness against infection using an extended vaccine schedule. Given global vaccine constraints these results are relevant to policymakers.
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Affiliation(s)
- Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom.
| | - Jamie Lopez Bernal
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Nick J Andrews
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Heather Whitaker
- Statistics, Modelling and Economics Department, UK Health Security Agency, London, United Kingdom
| | - Charlotte Gower
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Julia Stowe
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Elise Tessier
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Sathyavani Subbarao
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Georgina Ireland
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Frances Baawuah
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
- Brondesbury Medical Centre, Kilburn, London, United Kingdom
| | - Ezra Linley
- Sero-Epidemiolgy Unit, UK Health Security Agency, Manchester, United Kingdom
| | - Lenesha Warrener
- Virus Reference Department, UK Health Security Agency, London, United Kingdom
| | | | - Corinne Whillock
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, United Kingdom
| | - Shamez N Ladhani
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
- Paediatric Infectious Diseases Research Group, St. George's University of London, London, United Kingdom
| | - Kevin E Brown
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Mary E Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
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41
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Oeser C, Whitaker H, Linley E, Borrow R, Tonge S, Brown CS, Gower C, Warrener L, Brown KE, Ramsay M, Amirthalingam G. Large increases in SARS-CoV-2 seropositivity in children in England: Effects of the delta wave and vaccination. J Infect 2021; 84:418-467. [PMID: 34861351 PMCID: PMC8631044 DOI: 10.1016/j.jinf.2021.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Clarissa Oeser
- Immunisation and Vaccine Preventable Diseases Division, UKHSA: UK Health Security Agency, 61 Colindale Avenue, London, United Kingdom.
| | - Heather Whitaker
- Statistics, Modelling and Economics Department, UKHSA, 61 Colindale Avenue, London, United Kingdom
| | - Ezra Linley
- Public Health Laboratory Manchester, Manchester Royal Infirmary, Sero-epidemiology Unit, UKHSA, Oxford Road, Manchester, United Kingdom
| | - Ray Borrow
- Public Health Laboratory Manchester, Manchester Royal Infirmary, Sero-epidemiology Unit, UKHSA, Oxford Road, Manchester, United Kingdom
| | - Simon Tonge
- Public Health Laboratory Manchester, Manchester Royal Infirmary, Sero-epidemiology Unit, UKHSA, Oxford Road, Manchester, United Kingdom
| | - Colin S Brown
- HCAI, Fungal, AMR, AMU and Sepsis Division, UKHSA, 61 Colindale Avenue, London, United Kingdom
| | - Charlotte Gower
- Immunisation and Vaccine Preventable Diseases Division, UKHSA: UK Health Security Agency, 61 Colindale Avenue, London, United Kingdom
| | - Lenesha Warrener
- Reference Laboratories, UKHSA, 61 Colindale Avenue, London, United Kingdom
| | - Kevin E Brown
- Immunisation and Vaccine Preventable Diseases Division, UKHSA: UK Health Security Agency, 61 Colindale Avenue, London, United Kingdom
| | - Mary Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UKHSA: UK Health Security Agency, 61 Colindale Avenue, London, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Vaccine Preventable Diseases Division, UKHSA: UK Health Security Agency, 61 Colindale Avenue, London, United Kingdom
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42
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Ireland G, Jeffery-Smith A, Zambon M, Hoschler K, Harris R, Poh J, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Aiano F, Amin-Chowdhury Z, Letley L, Jones SEI, Kall M, Patel M, Gopal R, Borrow R, Linley E, Amirthalingam G, Brown KE, Ramsay ME, Ladhani SN. Antibody persistence and neutralising activity in primary school students and staff: Prospective active surveillance, June to December 2020, England. EClinicalMedicine 2021; 41:101150. [PMID: 34608455 PMCID: PMC8481203 DOI: 10.1016/j.eclinm.2021.101150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prospective, longitudinal SARS-CoV-2 sero-surveillance in schools across England was initiated after the first national lockdown, allowing comparison of child and adult antibody responses over time. METHODS Prospective active serological surveillance in 46 primary schools in England tested for SARS-CoV-2 antibodies during June, July and December 2020. Samples were tested for nucleocapsid (N) and receptor binding domain (RBD) antibodies, to estimate antibody persistence at least 6 months after infection, and for the correlation of N, RBD and live virus neutralising activity. FINDINGS In June 2020, 1,344 staff and 835 students were tested. Overall, 11.5% (95%CI: 9.4-13.9) and 11.3% (95%CI: 9.2-13.6; p = 0.88) of students had nucleoprotein and RBD antibodies, compared to 15.6% (95%CI: 13.7-17.6) and 15.3% (95%CI: 13.4-17.3; p = 0.83) of staff. Live virus neutralising activity was detected in 79.8% (n = 71/89) of nucleocapsid and 85.5% (71/83) of RBD antibody positive children. RBD antibodies correlated more strongly with neutralising antibodies (rs=0.7527; p<0.0001) than nucleocapsid antibodies (rs=0.3698; p<0.0001). A median of 24.4 weeks later, 58.2% (107/184) participants had nucleocapsid antibody seroreversion, compared to 20.9% (33/158) for RBD (p<0.001). Similar seroreversion rates were observed between staff and students for nucleocapsid (p = 0.26) and RBD-antibodies (p = 0.43). Nucleocapsid and RBD antibody quantitative results were significantly lower in staff compared to students (p = 0.028 and <0.0001 respectively) at baseline, but not at 24 weeks (p = 0.16 and p = 0.37, respectively). INTERPRETATION The immune response in children following SARS-CoV-2 infection was robust and sustained (>6 months) but further work is required to understand the extent to which this protects against reinfection.
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Affiliation(s)
- Georgina Ireland
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Anna Jeffery-Smith
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Maria Zambon
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Katja Hoschler
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Ross Harris
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - John Poh
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Frances Baawuah
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Joanne Beckmann
- East London NHS Foundation Trust, 9 Allie Street, London E1 8DE, United Kingdom
| | - Ifeanyichukwu O Okike
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
- University Hospitals of Derby and Burton NHS Foundation Trust, 201 London Road, Derby DE1 2TZ, United Kingdom
| | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Holt Street, Aston, B7 4BN, United Kingdom
| | - Andrew J Brent
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, United Kingdom
- Wellington Square, University of Oxford, Oxford OX1 2JD, United Kingdom
| | - Bernadette Brent
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, United Kingdom
| | - Felicity Aiano
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Zahin Amin-Chowdhury
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Louise Letley
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Samuel E I Jones
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Meaghan Kall
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Monika Patel
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Robin Gopal
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Ray Borrow
- Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Ezra Linley
- Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Kevin E Brown
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
- Paediatric Infectious Diseases Research Group, St. George's University of London, London SW17 0RE, United Kingdom
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43
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Fry NK, Campbell H, Amirthalingam G. JMM Profile: Bordetella pertussis and whooping cough (pertussis): still a significant cause of infant morbidity and mortality, but vaccine-preventable. J Med Microbiol 2021; 70. [PMID: 34668853 PMCID: PMC8604168 DOI: 10.1099/jmm.0.001442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Whooping cough (pertussis) is a highly contagious respiratory bacterial infection caused by Bordetella pertussis and is an important cause of morbidity and mortality worldwide, particularly in infants. Bordetella parapertussis can cause a similar, but usually less severe pertussis-like disease. Bordetella pertussis has a number of virulence factors including adhesins and toxins which allow the organism to bind to ciliated epithelial cells in the upper respiratory tract and interfere with host clearance mechanisms. Typical symptoms of pertussis include paroxysmal cough with characteristic whoop and vomiting. Severe complications and deaths occur mostly in infants. Laboratory confirmation can be performed by isolation, detection of genomic DNA or specific antibodies. Childhood vaccination is safe, effective and remains the best control method available. Many countries have replaced whole-cell pertussis vaccines (wP) with acellular pertussis vaccines (aP). Waning protection following immunisation with aP is considered to be more rapid than that from wP. Deployed by resource-rich countries to date, maternal immunisation programmes have also demonstrated high efficacy in preventing hospitalisation and death in infants by passive immunisation through transplacental transfer of maternal antibodies.
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Affiliation(s)
- Norman K Fry
- Immunisation and Countermeasures Division, Public Health England - National Infection Service, London, UK.,Vaccine Preventable Bacteria Section, Public Health England - National Infection Service, London, UK
| | - Helen Campbell
- Immunisation and Countermeasures Division, Public Health England - National Infection Service, London, UK
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, Public Health England - National Infection Service, London, UK
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Parry H, Tut G, Bruton R, Faustini S, Stephens C, Saunders P, Bentley C, Hilyard K, Brown K, Amirthalingam G, Charlton S, Leung S, Chiplin E, Coombes NS, Bewley KR, Penn EJ, Rowe C, Otter A, Watts R, D'Arcangelo S, Hallis B, Makin A, Richter A, Zuo J, Moss P. mRNA vaccination in people over 80 years of age induces strong humoral immune responses against SARS-CoV-2 with cross neutralization of P.1 Brazilian variant. eLife 2021; 10:e69375. [PMID: 34586068 PMCID: PMC8500710 DOI: 10.7554/elife.69375] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/24/2021] [Indexed: 12/19/2022] Open
Abstract
Age is the major risk factor for mortality after SARS-CoV-2 infection and older people have received priority consideration for COVID-19 vaccination. However, vaccine responses are often suboptimal in this age group and few people over the age of 80 years were included in vaccine registration trials. We determined the serological and cellular response to spike protein in 100 people aged 80-96 years at 2 weeks after the second vaccination with the Pfizer BNT162b2 mRNA vaccine. Antibody responses were seen in every donor with high titers in 98%. Spike-specific cellular immune responses were detectable in only 63% and correlated with humoral response. Previous SARS-CoV-2 infection substantially increased antibody responses after one vaccine and antibody and cellular responses remained 28-fold and 3-fold higher, respectively, after dual vaccination. Post-vaccine sera mediated strong neutralization of live Victoria infection and although neutralization titers were reduced 14-fold against the P.1 variant first discovered in Brazil they remained largely effective. These data demonstrate that the mRNA vaccine platform delivers strong humoral immunity in people up to 96 years of age and retains broad efficacy against the P.1 variant of concern.
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Affiliation(s)
- Helen Parry
- Institute of Immunology and Immunotherapy, University of BirminghamBirminghamUnited Kingdom
| | - Gokhan Tut
- Institute of Immunology and Immunotherapy, University of BirminghamBirminghamUnited Kingdom
| | - Rachel Bruton
- Institute of Immunology and Immunotherapy, University of BirminghamBirminghamUnited Kingdom
| | - Sian Faustini
- Institute of Immunology and Immunotherapy, University of BirminghamBirminghamUnited Kingdom
| | - Christine Stephens
- Institute of Immunology and Immunotherapy, University of BirminghamBirminghamUnited Kingdom
| | - Philip Saunders
- Clinical Lead, Quinton and Harborne PCN, Ridgacre House SurgeryQuintonUnited Kingdom
| | - Christopher Bentley
- Institute of Immunology and Immunotherapy, University of BirminghamBirminghamUnited Kingdom
| | - Katherine Hilyard
- Vaccine Taskforce, Department for Business, Energy and Industrial StrategyLondonUnited Kingdom
| | - Kevin Brown
- National infection Service, Public Health EnglandLondonUnited Kingdom
| | | | - Sue Charlton
- National infection Service, Public Health England, Porton DownSalisburyUnited Kingdom
| | - Stephanie Leung
- National infection Service, Public Health England, Porton DownSalisburyUnited Kingdom
| | - Emily Chiplin
- National infection Service, Public Health England, Porton DownSalisburyUnited Kingdom
| | - Naomi S Coombes
- National infection Service, Public Health England, Porton DownSalisburyUnited Kingdom
| | - Kevin R Bewley
- National infection Service, Public Health England, Porton DownSalisburyUnited Kingdom
| | - Elizabeth J Penn
- National infection Service, Public Health England, Porton DownSalisburyUnited Kingdom
| | - Cathy Rowe
- National infection Service, Public Health England, Porton DownSalisburyUnited Kingdom
| | - Ashley Otter
- National infection Service, Public Health England, Porton DownSalisburyUnited Kingdom
| | - Rosie Watts
- National infection Service, Public Health England, Porton DownSalisburyUnited Kingdom
| | - Silvia D'Arcangelo
- National infection Service, Public Health England, Porton DownSalisburyUnited Kingdom
| | - Bassam Hallis
- National infection Service, Public Health England, Porton DownSalisburyUnited Kingdom
| | | | - Alex Richter
- Institute of Immunology and Immunotherapy, University of BirminghamBirminghamUnited Kingdom
| | - Jianmin Zuo
- Institute of Immunology and Immunotherapy, University of BirminghamBirminghamUnited Kingdom
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of BirminghamBirminghamUnited Kingdom
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de Lusignan S, Tsang RSM, Amirthalingam G, Akinyemi O, Sherlock J, Tripathy M, Deeks A, Ferreira F, Howsam G, Hobbs FDR, Joy M. Adverse events of interest following influenza vaccination, a comparison of cell culture-based with egg-based alternatives: English sentinel network annual report paper 2019/20. Lancet Reg Health Eur 2021; 2:100029. [PMID: 34557791 PMCID: PMC8454842 DOI: 10.1016/j.lanepe.2021.100029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background The cell-based quadrivalent influenza vaccine (QIVc) is now offered as an alternative to egg-based quadrivalent (QIVe) and adjuvanted trivalent (aTIV) influenza vaccines in the UK. While post-licensure studies show non-inferiority of cell-based vaccines, it is not known how its safety profile compares to other types of vaccines in real-world use. Methods We conducted a retrospective cohort study using computerised medical records from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network database. We used a self-controlled case series design and calculated the relative incidence (RI) of adverse events of interest (AEIs) over different risk periods. We then compared the RIs of AEIs within seven days of vaccination overall and between QIVc and QIVe in the 18–64 years age group, and between QIVc and aTIV in the ≥65 years age group. Findings The majority of AEIs occurred within seven days of vaccination, and a seasonal effect was observed. Using QIVc as the reference group, QIVe showed similar incidence of AEIs whereas live attenuated influenza vaccine (LAIV) and aTIV had lower incidence of AEIs. In the stratified analyses, QIVe and aTIV were associated with a 16% lower incidence of AEIs in the seven days post-vaccination in both the 18–64 years and ≥65 years age groups. Interpretation Routine sentinel network data allow comparisons of safety profiles of equally suitable seasonal influenza vaccines. The higher incidence of AEIs associated with QIVc suggest monitoring of several seasons would allow robust comparisons to be made. Funding Public Health England.
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Affiliation(s)
- Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, United Kingdom.,Royal College of General Practitioners Research and Surveillance Centre, 30 Euston Square, London NW1 2FB, United Kingdom
| | - Ruby S M Tsang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, United Kingdom
| | | | - Oluwafunmi Akinyemi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, United Kingdom
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, United Kingdom
| | - Manasa Tripathy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, United Kingdom
| | - Alexandra Deeks
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, United Kingdom
| | - Filipa Ferreira
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, United Kingdom
| | - Gary Howsam
- Royal College of General Practitioners Research and Surveillance Centre, 30 Euston Square, London NW1 2FB, United Kingdom
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, United Kingdom
| | - Mark Joy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, United Kingdom
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Parry H, Bruton R, Tut G, Ali M, Stephens C, Greenwood D, Faustini S, Hughes S, Huissoon A, Meade R, Brown K, Amirthalingam G, Otter A, Hallis B, Richter A, Zuo J, Moss P. Immunogenicity of single vaccination with BNT162b2 or ChAdOx1 nCoV-19 at 5-6 weeks post vaccine in participants aged 80 years or older: an exploratory analysis. Lancet Healthy Longev 2021; 2:e554-e560. [PMID: 34401865 PMCID: PMC8357462 DOI: 10.1016/s2666-7568(21)00169-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In several countries, extended interval COVID-19 vaccination regimens are now used to accelerate population coverage, but the relative immunogenicity of different vaccines in older people remains uncertain. In this study we aimed to assess the antibody and cellular responses of older people after a single dose of either the BNT162b2 vaccine (tozinameran; Pfizer-BioNTech) or ChAdOx1 nCoV-19 vaccine (Oxford University-AstraZeneca). METHODS Participants aged 80 years or older, who did not live in a residential or care home or require assisted living, and had received a single dose of either the BNT162b2 vaccine or ChAdOx1 nCoV-19 vaccine were eligible to participate. Participants were recruited through local primary care networks in the West Midlands, UK. Blood samples and dried blood spots were taken 5-6 weeks after vaccination to assess adaptive immune responses using Elecsys electrochemiluminescence immunoassay and cellular responses by ELISpot. Primary endpoints were percentage response and quantification of adaptive immunity. FINDINGS Between Dec 29, 2020, and Feb 28, 2021, 165 participants were recruited and included in the analysis. 76 participants had received BNT162b2 (median age 84 years, IQR 82-89; range 80-98) and 89 had received ChAdOx1 nCoV-19 (median age 84 years, 81-87; 80-99). Antibody responses against the spike protein were detectable in 69 (93%) of 74 BNT162b2 vaccine recipients and 77 (87%) of 89 ChAdOx1 nCoV-19 vaccine recipients. Median antibody titres were of 19·3 U/mL (7·4-79·4) in the BNT162b2 vaccine recipients and 19·6 U/mL (6·1-60·0) in the ChAdOx1 nCoV-19 vaccine recipients (p=0·41). Spike protein-specific T-cell responses were observed in nine (12%) of 73 BNT162b2 vaccine recipients and 27 (31%) of 88 ChAdOx1 nCoV-19 vaccine recipients, and median responses were three-times higher in ChAdOx1 nCoV-19 vaccine recipients (24 spots per 1 × 106 peripheral blood mononuclear cells) than BNT162b2 vaccine recipients (eight spots per 1 × 106 peripheral blood mononuclear cells; p<0·0001). Humoral and cellular immune responses against spike protein were correlated in both cohorts. Evidence of previous SARS-CoV-2 infection was seen in eight participants (n=5 BNT162b2 recipients and n=3 ChAdOx1 nCoV-19 recipients), and was associated with 691-times and four-times increase in humoral and cellular immune responses across the whole cohort. INTERPRETATION Single doses of either BNT162b2 or ChAdOx1 nCoV-19 in older people induces humoral immunity in most participants, and is markedly enhanced by previous infection. Cellular responses were weaker, but showed enhancement after the ChAdOx1 nCoV-19 vaccine at the 5-6 week timepoint. FUNDING Medical Research Council, National Institute for Health Research, and National Core Studies.
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Affiliation(s)
- Helen Parry
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Rachel Bruton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gokhan Tut
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Myah Ali
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Christine Stephens
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - David Greenwood
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Sian Faustini
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Sam Hughes
- Department of Immunology, Birmingham Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Aarnoud Huissoon
- Department of Immunology, Birmingham Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Rory Meade
- Harborne Medical Practice, Harborne, Birmingham, UK
| | - Kevin Brown
- National Infection Service, Public Health England, Colindale, London, UK
| | | | - Ashley Otter
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Bassam Hallis
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Alex Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Jianmin Zuo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Parry H, Bruton R, Stephens C, Brown K, Amirthalingam G, Otter A, Hallis B, Zuo J, Moss P. Differential immunogenicity of BNT162b2 or ChAdOx1 vaccines after extended-interval homologous dual vaccination in older people. Immun Ageing 2021; 18:34. [PMID: 34416887 PMCID: PMC8377354 DOI: 10.1186/s12979-021-00246-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [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: 07/17/2021] [Accepted: 08/04/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Several SARS-CoV-2 vaccines have shown clinical efficacy against Covid-19 infection but there remains uncertainty about the immune responses elicited by different regimens. This is a particularly important question for older people who are at increased clinical risk following infection and in whom immune senescence may limit vaccine responses. The BNT162b2 mRNA and ChAdOx1 adenovirus vaccines were the first two vaccines deployed in the UK programme using an 8-12 week 'extended interval'. OBJECTIVES We undertook analysis of the spike-specific antibody and cellular immune response in 131 participants aged 80+ years after the second dose of 'extended interval' dual vaccination with either BNT162b2 mRNA (n = 54) or ChAdOx1 (n = 77) adenovirus vaccine. Blood samples were taken 2-3 weeks after second vaccine and were paired with samples taken at 5-weeks after first vaccine which have been reported previously. Antibody responses were measured using the Elecsys® electrochemiluminescence immunoassay assay and cellular responses were assessed by IFN-γ ELISpot. RESULTS Antibody responses against spike protein became detectable in all donors following dual vaccination with either vaccine. 4 donors had evidence of previous natural infection which is known to boost vaccine responses. Within the 53 infection-naïve donors the median antibody titre was 4030 U/ml (IQR 1892-8530) following BNT162b2 dual vaccination and 1405 (IQR 469.5-2543) in the 74 patients after the ChAdOx1 vaccine (p = < 0.0001). Spike-specific T cell responses were observed in 30% and 49% of mRNA and ChAdOx1 recipients respectively and median responses were 1.4-times higher in ChAdOx1 vaccinees at 14 vs 20 spots/million respectively (p = 0.022). CONCLUSION Dual vaccination with BNT162b2 or ChAdOx1 induces strong humoral immunity in older people following an extended interval protocol. Antibody responses are 2.9-times higher following the mRNA regimen whilst cellular responses are 1.4-times higher with the adenovirus-based vaccine. Differential patterns of immunogenicity are therefore elicited from the two vaccine platforms. It will be of interest to assess the relative stability of immune responses after these homologous vaccine regimens in order to assess the potential need for vaccine boosting. Furthermore, these findings indicate that heterologous vaccine platforms may offer the opportunity to further optimize vaccine responses.
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Affiliation(s)
- Helen Parry
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15, UK
| | - Rachel Bruton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15, UK
| | - Christine Stephens
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15, UK
| | - Kevin Brown
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | | | - Ashley Otter
- National Infection Service, Public Health England, Porton Down, Salisbury, SP4 OJG, UK
| | - Bassam Hallis
- National Infection Service, Public Health England, Porton Down, Salisbury, SP4 OJG, UK
| | - Jianmin Zuo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15, UK.
- University Hospitals, Birmingham, UK.
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Ladhani SN, Ireland G, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Aiano F, Amin-Chowdhury Z, Kall M, Borrow R, Linley E, Zambon M, Poh J, Warrener L, Lackenby A, Ellis J, Amirthalingam G, Brown KE, Ramsay ME. Emergence of SARS-CoV-2 Alpha (B.1.1.7) variant, infection rates, antibody seroconversion and seroprevalence rates in secondary school students and staff: Active prospective surveillance, December 2020 to March 2021, England. J Infect 2021; 83:573-580. [PMID: 34400220 PMCID: PMC8361003 DOI: 10.1016/j.jinf.2021.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022]
Abstract
Objectives We assessed SARS-CoV-2 infection, seroprevalence and seroconversion in students and staff when secondary schools reopened in March 2021. Methods We initiated SARS-CoV-2 surveillance in 18 secondary schools across six regions in September 2020. Participants provided nasal swabs for RT-PCR and blood samples for SARS-CoV-2 antibodies at the beginning (September 2020) and end (December 2020) of the autumn term and at the start of the spring term (March 2021). Findings In March 2021, 1895 participants (1100 students:795 staff) were tested; 5.6% (61/1094) students and 4.4% (35/792) staff had laboratory-confirmed SARS-CoV-2 infection from December 2020-March 2021. Nucleoprotein-antibody seroprevalence was 36.3% (370/1018) in students and 31.9% (245/769) in staff, while spike-antibody prevalence was 39.5% (402/1018) and 59.8% (459/769), respectively, similar to regional community seroprevalence. Between December 2020 and March 2021, 14.8% (97/656; 95%CI: 12.2–17.7) students and 10.0% (59/590; 95%CI: 7.7–12.7) staff seroconverted. Weekly seroconversion rates were similar from September to December 2020 (8.0/1000) and from December 2020 to March 2021 (7.9/1000; students: 9.3/1,000; staff: 6.3/1,000). Interpretation By March 2021, a third of secondary school students and staff had evidence of prior infection based on N-antibody seropositivity, and an additional third of staff had evidence of vaccine-induced immunity based on S-antibody seropositivity.
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Affiliation(s)
- Shamez N Ladhani
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; Paediatric Infectious Diseases Research Group, St. George's University of London, London SW17 0RE, United Kingdom
| | - Georgina Ireland
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Frances Baawuah
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Joanne Beckmann
- East London NHS Foundation Trust, 9 Alie Street, London E1 8DE, United Kingdom
| | - Ifeanyichukwu O Okike
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom; University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK, 201 London Road, Derby DE1 2TZ, United Kingdom
| | - Shazaad Ahmad
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, United Kingdom
| | - Joanna Garstang
- Birmingham Community Healthcare NHS Trust, Holt Street, Aston B7 4BN, United Kingdom
| | - Andrew J Brent
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, United Kingdom; University of Oxford, Wellington Square, Oxford OX1 2JD, United Kingdom
| | - Bernadette Brent
- Nuffield Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Old Road, Oxford OX3 7HE, United Kingdom
| | - Felicity Aiano
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Zahin Amin-Chowdhury
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Meaghan Kall
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Ray Borrow
- Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Ezra Linley
- Public Health England, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Maria Zambon
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - John Poh
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Lenesha Warrener
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Angie Lackenby
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Joanna Ellis
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Kevin E Brown
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom
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Lopez Bernal J, Andrews N, Gower C, Gallagher E, Simmons R, Thelwall S, Stowe J, Tessier E, Groves N, Dabrera G, Myers R, Campbell CNJ, Amirthalingam G, Edmunds M, Zambon M, Brown KE, Hopkins S, Chand M, Ramsay M. Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant. N Engl J Med 2021; 385:585-594. [PMID: 34289274 DOI: 10.1101/2021.05.22.21257658] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND The B.1.617.2 (delta) variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), has contributed to a surge in cases in India and has now been detected across the globe, including a notable increase in cases in the United Kingdom. The effectiveness of the BNT162b2 and ChAdOx1 nCoV-19 vaccines against this variant has been unclear. METHODS We used a test-negative case-control design to estimate the effectiveness of vaccination against symptomatic disease caused by the delta variant or the predominant strain (B.1.1.7, or alpha variant) over the period that the delta variant began circulating. Variants were identified with the use of sequencing and on the basis of the spike (S) gene status. Data on all symptomatic sequenced cases of Covid-19 in England were used to estimate the proportion of cases with either variant according to the patients' vaccination status. RESULTS Effectiveness after one dose of vaccine (BNT162b2 or ChAdOx1 nCoV-19) was notably lower among persons with the delta variant (30.7%; 95% confidence interval [CI], 25.2 to 35.7) than among those with the alpha variant (48.7%; 95% CI, 45.5 to 51.7); the results were similar for both vaccines. With the BNT162b2 vaccine, the effectiveness of two doses was 93.7% (95% CI, 91.6 to 95.3) among persons with the alpha variant and 88.0% (95% CI, 85.3 to 90.1) among those with the delta variant. With the ChAdOx1 nCoV-19 vaccine, the effectiveness of two doses was 74.5% (95% CI, 68.4 to 79.4) among persons with the alpha variant and 67.0% (95% CI, 61.3 to 71.8) among those with the delta variant. CONCLUSIONS Only modest differences in vaccine effectiveness were noted with the delta variant as compared with the alpha variant after the receipt of two vaccine doses. Absolute differences in vaccine effectiveness were more marked after the receipt of the first dose. This finding would support efforts to maximize vaccine uptake with two doses among vulnerable populations. (Funded by Public Health England.).
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Affiliation(s)
- Jamie Lopez Bernal
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Nick Andrews
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Charlotte Gower
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Eileen Gallagher
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Ruth Simmons
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Simon Thelwall
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Julia Stowe
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Elise Tessier
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Natalie Groves
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Gavin Dabrera
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Richard Myers
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Colin N J Campbell
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Gayatri Amirthalingam
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Matt Edmunds
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Maria Zambon
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Kevin E Brown
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Susan Hopkins
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Meera Chand
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Mary Ramsay
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
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Lopez Bernal J, Andrews N, Gower C, Gallagher E, Simmons R, Thelwall S, Stowe J, Tessier E, Groves N, Dabrera G, Myers R, Campbell CNJ, Amirthalingam G, Edmunds M, Zambon M, Brown KE, Hopkins S, Chand M, Ramsay M. Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant. N Engl J Med 2021. [PMID: 34289274 DOI: 10.1056/nejmdo006116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND The B.1.617.2 (delta) variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (Covid-19), has contributed to a surge in cases in India and has now been detected across the globe, including a notable increase in cases in the United Kingdom. The effectiveness of the BNT162b2 and ChAdOx1 nCoV-19 vaccines against this variant has been unclear. METHODS We used a test-negative case-control design to estimate the effectiveness of vaccination against symptomatic disease caused by the delta variant or the predominant strain (B.1.1.7, or alpha variant) over the period that the delta variant began circulating. Variants were identified with the use of sequencing and on the basis of the spike (S) gene status. Data on all symptomatic sequenced cases of Covid-19 in England were used to estimate the proportion of cases with either variant according to the patients' vaccination status. RESULTS Effectiveness after one dose of vaccine (BNT162b2 or ChAdOx1 nCoV-19) was notably lower among persons with the delta variant (30.7%; 95% confidence interval [CI], 25.2 to 35.7) than among those with the alpha variant (48.7%; 95% CI, 45.5 to 51.7); the results were similar for both vaccines. With the BNT162b2 vaccine, the effectiveness of two doses was 93.7% (95% CI, 91.6 to 95.3) among persons with the alpha variant and 88.0% (95% CI, 85.3 to 90.1) among those with the delta variant. With the ChAdOx1 nCoV-19 vaccine, the effectiveness of two doses was 74.5% (95% CI, 68.4 to 79.4) among persons with the alpha variant and 67.0% (95% CI, 61.3 to 71.8) among those with the delta variant. CONCLUSIONS Only modest differences in vaccine effectiveness were noted with the delta variant as compared with the alpha variant after the receipt of two vaccine doses. Absolute differences in vaccine effectiveness were more marked after the receipt of the first dose. This finding would support efforts to maximize vaccine uptake with two doses among vulnerable populations. (Funded by Public Health England.).
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Affiliation(s)
- Jamie Lopez Bernal
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Nick Andrews
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Charlotte Gower
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Eileen Gallagher
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Ruth Simmons
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Simon Thelwall
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Julia Stowe
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Elise Tessier
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Natalie Groves
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Gavin Dabrera
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Richard Myers
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Colin N J Campbell
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Gayatri Amirthalingam
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Matt Edmunds
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Maria Zambon
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Kevin E Brown
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Susan Hopkins
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Meera Chand
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
| | - Mary Ramsay
- From Public Health England (J.L.B., N.A., C.G., E.G., R.S., S.T., J.S., E.T., N.G., G.D., R.M., C.N.J.C., G.A., M.E., M.Z., K.E.B., S.H., M.C., M.R.), the National Institute of Health Research (NIHR) Health Protection Research Unit in Vaccines and Immunisation, London School of Hygiene and Tropical Medicine (J.L.B., N.A., C.N.J.C., G.A., K.E.B., M.R.), the NIHR Health Protection Research Unit in Respiratory Infections, Imperial College London (J.L.B., M.Z.), and Guy's and St. Thomas' Hospital NHS Trust (M.C.), London, and Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford (S.H.) - all in the United Kingdom
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