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Tadmor T, Melamed G, Alapi H, Gazit S, Patalon T, Rokach L. Supplement of Vitamin D for early-stage Chronic Lymphocytic Leukemia Patients is Associated with a Longer Time to first Treatment. Blood Adv 2024:bloodadvances.2023011458. [PMID: 38701347 DOI: 10.1182/bloodadvances.2023011458] [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: 08/15/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/05/2024] Open
Abstract
Low levels of vitamin D are associated with a shorter time to first treatment (TTFT) and inferior overall survival in patients with Chronic Lymphocytic leukemia. But whether vitamin D supplement affects the clinical course of CLL patients, remains an open question. In the current study, we aimed to retrospectively explore the clinical benefit of Vitamin D supplement, or one of its analogues, on TTFT and treatment-free survival (TFS) in a large cohort of patients with asymptomatic CLL, who were under watch and wait approach. Among the 3,474 patients included in the study, 931 patients (26.8%) received either vitamin D supplement or its analogue, for a minimum of 6 months. We found that vitamin D supplement was statistically significant for longer TTFT in the young cohort (age<=65) and was associated with a longer TFS for all ages (p-value=0.004). Among non-vitamin D users, the median TFS was found to be 84 months, while among vitamin D supplement users the median TFS extended to 169 months. In conclusion, our long-term retrospective study demonstrates that the administration of vitamin D to patients with CLL in a watch and wait active surveillance is significantly associated with a longer treatment free survival (in any age) and a longer time to first treatment among young patients (age<=65). A prospective clinical trial is needed to validate results.
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Affiliation(s)
- Tamar Tadmor
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Guy Melamed
- Maccabi Healthcare Services, Tel Aviv, Israel
| | - Hillel Alapi
- Maccabi Institute for research and innovation, Tel-Aviv, Alabama, Israel
| | - Sivan Gazit
- Maccabi Healthcare Services, Tel Aviv, Israel
| | - Tal Patalon
- Maccabi Healthcare Services, Tel Aviv, Israel
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Nakhleh A, Abdul-Ghani M, Gazit S, Gross A, Livnat I, Greenbloom M, Yarden A, Khazim K, Shehadeh N, Melzer Cohen C. Real-world effectiveness of sodium-glucose cotransporter-2 inhibitors on the progression of chronic kidney disease in patients without diabetes, with and without albuminuria. Diabetes Obes Metab 2024. [PMID: 38680053 DOI: 10.1111/dom.15623] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Abstract
AIM To examine the renal effects of sodium-glucose cotransporter-2 (SGLT2) inhibition among non-diabetic individuals with chronic kidney disease (CKD) in a real-world setting. METHODS We collected de-identified data on adults without diabetes and with an estimated glomerular filtration rate (eGFR) of 25-60 mL/min/1.73 m2, who initiated the SGLT2 inhibitors dapagliflozin or empagliflozin between September 2020 and November 2022 at Maccabi Healthcare Services, an Israeli health maintenance organization. We assessed the effects of SGLT2 inhibitors on renal function (changes in eGFR slope/time). Index date was defined as the date of the first dispensing of SGLT2 inhibitors. Annual baseline slope was calculated using all eGFR measurements during the 2 years prior to index date (median = 7 measurements), while annual follow-up slope was calculated from all evaluations during 90-900 days post index date, along with baseline measurement at index date (median = 6 measurements). Paired t tests were used to compare differences between baseline and follow-up annual slopes. RESULTS Of a total of 354 participants with CKD, without diabetes, who received SGLT2 inhibitors and were followed for a median of 527 days, the mean age was 72.8 ± 11.8 years, 26% were female, and 91% used renin-angiotensin system blockade. The mean eGFR was 45.4 ± 9.5 mL/min/1.73 m2. The mean body mass index was 29.1 ± 5.4 kg/m2. During the year before index date, 146 participants (41%) had a urinary albumin to creatinine ratio (UACR) <30 mg/g, 81 (23%) had a UACR of 30-300 mg/g, 74 (21%) had a UACR >300 mg/g, and 53 (15%) had no UACR evaluation. The mean eGFR slope over time was -5.6 ± 7.7 mL/min/1.73 m2 per year at baseline, which improved to -1.7 ± 6.8 mL/min/1.73 m2 per year after SGLT2 inhibitor administration (p <0.001). This effect was independent of UACR. CONCLUSION In a real-world study of primarily older non-diabetic adults with CKD, SGLT2 inhibition was associated with a slower rate of kidney function decline, regardless of baseline UACR level.
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Affiliation(s)
- Afif Nakhleh
- Diabetes and Endocrinology Clinic, Maccabi Healthcare Services, Haifa, Israel
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Muhammad Abdul-Ghani
- Diabetes and Endocrinology Clinic, Maccabi Healthcare Services, Haifa, Israel
- Division of Diabetes, University of Texas Health Science Centre, San Antonio, Texas, USA
| | - Sivan Gazit
- Maccabi Institute for Research and Innovation, Tel-Aviv, Israel
| | - Adi Gross
- Medical Affairs, AstraZeneca, Kfar Saba, Israel
| | - Idit Livnat
- Medical Affairs, AstraZeneca, Kfar Saba, Israel
| | | | - Adva Yarden
- Medical Affairs, AstraZeneca, Kfar Saba, Israel
| | - Khaled Khazim
- Diabetes and Endocrinology Clinic, Maccabi Healthcare Services, Haifa, Israel
| | - Naim Shehadeh
- Diabetes and Endocrinology Clinic, Maccabi Healthcare Services, Haifa, Israel
- Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, Haifa, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Patalon T, Saciuk Y, Trotzky D, Pachys G, Ben-Tov A, Segal Y, Gazit S. An Outbreak of Parvovirus B19 in Israel. Viruses 2023; 15:2261. [PMID: 38005937 PMCID: PMC10674631 DOI: 10.3390/v15112261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Human parvovirus B19 (B19V) has a wide clinical spectrum, ranging from an asymptomatic infection to a life threatening one. During pregnancy, it can lead to fetal loss and hydrops fetalis. This retrospective study examined the incidence rates of B19V in Israel, analyzing anonymized electronic medical records of 2.7 million individuals between January 2015 and September 2023. A generalized linear model with a Poisson distribution was fit to the data, adjusting for potential confounders. A marked increase in B19V was observed in 2023, with an adjusted incidence rate ratio (IRR) of 6.6 (95% CI 6.33-6.89) when comparing 2023 to previous years. When specifically comparing 2023 to COVID-19 years (2020-2022), adjusted IRR climbs to 9.21 (8.66-9.80). Moreover, in 2023, previously existing seasonality has largely disappeared. High SES characterized most infected individuals with a marked discrepancy in social sectors; the Arab population was significantly less likely to be found B19V positive, even when adjusting for SES. Most infections occurred in school-aged children (6-11 years old). Pregnant women experienced the most significant rise in B19V, with an adjusted IRR of 11.47 (9.44-13.97) in 2023 compared to previous years; most cases were diagnosed in the first trimester. This study demonstrates that Israel is currently experiencing the largest and longest reported outbreak of B19V to date. Policymakers should consider setting screening policies in place, at least for populations at risk, while specifically studying and potentially targeting low socioeconomic populations and specific social sectors to avoid health inequalities.
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Affiliation(s)
- Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 68125, Israel
| | - Yaki Saciuk
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
| | - Daniel Trotzky
- Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin 70300, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Gal Pachys
- Shamir Medical Center (Assaf Harofeh Medical Center), Zerifin 70300, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Amir Ben-Tov
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yaakov Segal
- Maccabi Healthcare Services, Tel Aviv 68125, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 68125, Israel
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Ben-Tov A, Lebwohl B, Banon T, Chodick G, Kariv R, Assa A, Gazit S, Patalon T. BNT162b2 mRNA COVID-19 Vaccine Effectiveness in Patients with Coeliac Disease Autoimmunity: Real-World Data from Mass Vaccination Campaign. Viruses 2023; 15:1968. [PMID: 37766374 PMCID: PMC10534420 DOI: 10.3390/v15091968] [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: 08/16/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Data on COVID-19 vaccine effectiveness among patients with coeliac disease are currently lacking because patients with immune conditions were excluded from clinical trials. We used our coeliac disease autoimmunity (CDA) cohort to explore the effectiveness of the BNT162b2 mRNA COVID-19 vaccine in preventing SARS-CoV-2 infection among patients with CDA. METHODS This retrospective cohort study included patients with positive autoantibodies against tissue transglutaminase (tTG-IgA). In the primary analysis, the cohort included CDA patients who received two vaccine doses against COVID-19 and matched patients in a 1:3 ratio. Patients were divided into subgroups based on their positive tTG-IgA level at diagnosis and their current serology status. RESULTS The cohort included 5381 vaccinated patients with CDA and 14,939 matched vaccinated patients. The risk for breakthrough SARS-CoV-2 infection evaluated with Kaplan-Meier survival analysis via log-rank tests was similar between groups (p = 0.71). In a Cox regression survival analysis, the hazard ratio for breakthrough infection among patients with CDA compared to matched patients was 0.91 (95% confidence interval = 0.77-1.09). CONCLUSIONS COVID-19 vaccination is effective in patients with coeliac disease autoimmunity. Vaccine effectiveness was comparable to the reference population.
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Affiliation(s)
- Amir Ben-Tov
- Kahn Sagol Maccabi (KSM) Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 68125, Israel
| | - Benjamin Lebwohl
- Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Tamar Banon
- Kahn Sagol Maccabi (KSM) Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
| | - Gabriel Chodick
- Kahn Sagol Maccabi (KSM) Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 68125, Israel
| | - Revital Kariv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 68125, Israel
- Department of Gastroenterology, Tel Aviv Sourasky Medical Center, Tel Aviv 68125, Israel
| | - Amit Assa
- The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University, Jerusalem 91905, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
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Levy Yurkovski I, Rokach L, Melamed G, Alapi H, Gazit S, Patalon T, Tadmor T. Clinical Outcomes of COVID-19 in Mycosis Fungoides and Sezary Syndrome. Acta Haematol 2023; 146:496-503. [PMID: 37517402 DOI: 10.1159/000531831] [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: 04/22/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Haemato-oncologic patients are more susceptible to severe infections with SARS-CoV-2. We aimed to assess the clinical outcomes of SARS-CoV-2 infection among patients with Mycosis Fungoides and Sezary Syndrome (MF/SS). METHODS The data were retrieved from anonymized electronic medical records of Maccabi Healthcare Services (MHS), the second-largest healthcare organization in Israel. Patients diagnosed with MF/SS were included in the study. COVID-19 PCR test results together with sociodemographic and clinical data were extracted and analyzed to evaluate the association of COVID-19 with clinical outcomes. RESULTS In the period of 2020-2022, 1,472 MF/SS patients were included in the study. Among them, 768 (52%) had SARS-CoV-2 infection. The hospitalization rate was 2.9% and infection by the Delta variant was associated with the highest hospitalization rate (7.7%). The hospitalization rate was lower among fully vaccinated patients (p = 0.032) but higher for patients older than 65 (p < 0.001) and patients with SS (vs. MF) (p < 0.001) or COPD (p = 0.024) diagnosis. There was a tendency for decreased hospitalization among patients treated with nirmatrelvir + ritonavir within 5 days of infection, with a 79% risk reduction, although it was not statistically significant (p = 0.164). CONCLUSION Patients with MF/SS do not necessarily have worse COVID-19 outcomes compared to the general population.
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Affiliation(s)
- Ilana Levy Yurkovski
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel
- Technion Israel Institute of Technology, Haifa, Israel
| | - Lior Rokach
- Department of Information Systems Engineering, Faculty of Engineering Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Guy Melamed
- Kahn Sagol Maccabi (KSM) Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Hillel Alapi
- Kahn Sagol Maccabi (KSM) Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel
- Technion Israel Institute of Technology, Haifa, Israel
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Gazit S, Saciuk Y, Perez G, Peretz A, Ben-Tov A, Stuart EA, Patalon T. Hybrid immunity against reinfection with SARS-CoV-2 following a previous SARS-CoV-2 infection and single dose of the BNT162b2 vaccine in children and adolescents: a target trial emulation. Lancet Microbe 2023; 4:e495-e505. [PMID: 37062294 PMCID: PMC10101759 DOI: 10.1016/s2666-5247(23)00103-9] [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] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/05/2023] [Accepted: 03/07/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Although most children and adolescents have had a previous SARS-CoV-2 infection and many continue to receive COVID-19 vaccinations, studies of the effectiveness of hybrid immunity against reinfection with the omicron (B.1.1.529) variant are scarce. We aimed to examine the effectiveness of vaccination in convalescent children and adolescents against reinfection with the delta (B.1.617.2) variant and the BA.1 and BA.2 and BA.4 and BA.5 omicron subvariants. METHODS This retrospective cohort study was devised to emulate a target randomised control trial using a retrospective dataset of anonymised health records of children (5-11 years old) and adolescents (12-16 years old) who were members of the Maccabi Healthcare Services, Israel. The design emulated 91 randomised trials by devising a series of multiple nested trials, compiling the results into a single dataset, and fitting Cox proportional hazards models to estimate adjusted hazard ratios (HRs) with 95% CIs of each measured outcome. The primary aim was to assess the protection from reinfection with the delta variant and the BA.1 and BA.2 and BA.4 and BA.5 omicron subvariants associated with hybrid immunity as a result of a previous SARS-CoV-2 infection followed by vaccination with the BNT162b2 (Pfizer-BioNTech) vaccine. FINDINGS Data from between from March 1, 2020, to July 31, 2022, for 163 812 individuals (120 721 children [59 404 girls and 61 317 boys], median age 8·0 years [IQR 6·7 to 10·2]; and 43 091 adolescents [21 239 girls and 21 852 boys], median age 13·5 years [12·6 to 14·8]) were included in at least one trial. A single dose of the BNT162b2 vaccine in convalescent children and adolescents confers statistically significant protection against the delta variant (78% [95% CI 72 to 83] in adolescents and 64% [3 to 87] in children) and the omicron BA.1 and BA.2 subvariants (54% [50 to 57] in adolescents and 71% [67 to 73] in children) compared with children who had a previous infection but were unvaccinated. However, the vaccine was not found to confer statistically significant protection against the BA.4 and BA.5 omicron subvariants in adolescents (8% [-18 to 29]) and children (12% [-6 to 27]). INTERPRETATION Decision makers in BA.4 and BA.5 dominant regions should re-examine whether convalescent individuals aged 5-16 years should receive the BNT162b2 vaccine to prevent future reinfection, especially in light of reports that show that most children and adolescents have already been infected with SARS-CoV-2. FUNDING None.
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Affiliation(s)
- Sivan Gazit
- Kahn Sagol Maccabi Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel; Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel; Ben-Gurion University, Beersheba, Israel.
| | - Yaki Saciuk
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Galit Perez
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel; Ben-Gurion University, Beersheba, Israel
| | - Asaf Peretz
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Amir Ben-Tov
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tal Patalon
- Kahn Sagol Maccabi Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel; Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
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Tadmor T, Melamed G, Alapi H, Gazit S, Patalon T, Rokach L. Pregnancy Course of 10 Women Diagnosed with Chronic Lymphocytic Leukemia. Acta Haematol 2023; 146:379-383. [PMID: 37276848 PMCID: PMC10614226 DOI: 10.1159/000531400] [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: 02/09/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023]
Abstract
Pregnancies following diagnosis of chronic lymphocytic leukemia (CLL) are rare events, mainly because the disease is typically diagnosed in the elderly. Literature on the topic is based only on case reports, and limited data are available on the influence of pregnancy on CLL course. In this retrospective study, we aimed to summarize the clinical and laboratory course of 10 women with CLL who became pregnant. None of the patients had significant changes in blood count during or after pregnancy or had complications such as infection, autoimmune phenomenon, or preeclampsia. Four out of 10 pregnancies were terminated with an early miscarriage. Following labor, 1 patient started anti-CLL treatment due to preexisting anemia, but none of the women required therapy during CLL progression during the first 2 years of follow-up. We conclude that based on our serial, pregnancy does not negatively impact on CLL course.
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Affiliation(s)
- Tamar Tadmor
- Hematology Unit, Bnai Zion Medical Center, and the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Guy Melamed
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Hillel Alapi
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Lior Rokach
- Department of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Patalon T, Saciuk Y, Perez G, Peretz A, Ben-Tov A, Gazit S. Dynamics of Naturally Acquired Immunity Against Severe Acute Respiratory Syndrome Coronavirus 2 in Children and Adolescents. J Pediatr 2023; 257:113371. [PMID: 36870558 PMCID: PMC9981270 DOI: 10.1016/j.jpeds.2023.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 02/03/2023] [Accepted: 02/12/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE To evaluate the duration of protection against reinfection conferred by a previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents. STUDY DESIGN We applied 2 complementary approaches: a matched test-negative, case-control design and a retrospective cohort design. A total of 458 959 unvaccinated individuals aged 5-18 years were included. The analyses focused on the period July 1, 2021, to December 13, 2021, a period of Delta variant dominance in Israel. We evaluated 3 SARS-CoV-2-related outcomes: documented polymerase chain reaction-confirmed infection or reinfection, symptomatic infection or reinfection, and SARS-CoV-2-related hospitalization or death. RESULTS Overall, children and adolescents who were previously infected acquired durable protection against reinfection with SARS-CoV-2 for at least 18 months. Importantly, no SARS-CoV-2-related deaths were recorded in either the SARS-CoV-2-naïve group or the previously infected group. The effectiveness of naturally acquired immunity against a recurrent infection reached 89.2% (95% CI, 84.7%-92.4%) at 3-6 months after the first infection and declined slightly to 82.5% (95% CI, 79.1%-85.3%) by 9-12 months after infection, with a slight nonsignificant waning trend seen up to 18 months after infection. Additionally, children aged 5-11 years exhibited no significant waning of naturally acquired protection throughout the outcome period, whereas waning protection in those aged 12-18 years was more prominent but still mild. CONCLUSIONS Children and adolescents who were previously infected with SARS-CoV-2 remain protected to a high degree for 18 months. Further research is needed to examine naturally acquired immunity against Omicron and newer emerging variants.
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Affiliation(s)
- Tal Patalon
- Kahn Sagol Maccabi Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel; Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.
| | - Yaki Saciuk
- Kahn Sagol Maccabi Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Galit Perez
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel; Department of Health Policy and Management, School of Public Health, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Asaf Peretz
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Amir Ben-Tov
- Kahn Sagol Maccabi Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel; Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
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Patalon T, Perez G, Saciuk Y, Refaeli Z, Gazit S. Mpox Patient Journey in Israel. Microorganisms 2023; 11:microorganisms11041042. [PMID: 37110465 PMCID: PMC10145053 DOI: 10.3390/microorganisms11041042] [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: 03/18/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Reports on Mpox have, thus far, characterized the disease, but mostly through a single timepoint view. The aim of this study was to characterize Mpox in the Israeli setting, in general, alongside compiling a detailed patient journey from multiple in-depth interviews with infected individuals. This descriptive study followed two complimentary paths: retrospective and prospective. The first consisted of interviews with Mpox patients, while the retrospective part included the retrieval of anonymized electronic medical records of patients diagnosed with Mpox between May and November 2022. Patient characteristics in Israel were, overall, comparable to global reports. We found that the median time from symptoms to first suspicion of Mpox was 3.5 days, while the median time from the first symptom to a confirmatory test was 6.5 days, which could explain the surge in Israel. The duration of lesions did not alter in terms of their anatomical location, while lower Ct values correlated both with a longer symptom duration and more symptoms. Most patients reported anxiety to a high degree. Clinical trials that consist of a long-term relationship with the medical researchers contribute greatly to a deeper understanding of the patient journey, especially for unfamiliar or stigmatized diseases. Emerging infections, such as Mpox, should be further investigated to assess asymptomatic carriers, especially when rapidly spreading.
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Affiliation(s)
- Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 68125, Israel
| | - Galit Perez
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- Department of Health Policy and Management, School of Public Health, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Yaki Saciuk
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
| | - Ziva Refaeli
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 68125, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 68125, Israel
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Shapira G, Patalon T, Gazit S, Shomron N. Immunosuppression as a Hub for SARS-CoV-2 Mutational Drift. Viruses 2023; 15:v15040855. [PMID: 37112835 PMCID: PMC10145566 DOI: 10.3390/v15040855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
The clinical course of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is largely determined by host factors, with a wide range of outcomes. Despite an extensive vaccination campaign and high rates of infection worldwide, the pandemic persists, adapting to overcome antiviral immunity acquired through prior exposure. The source of many such major adaptations is variants of concern (VOCs), novel SARS-CoV-2 variants produced by extraordinary evolutionary leaps whose origins remain mostly unknown. In this study, we tested the influence of factors on the evolutionary course of SARS-CoV-2. Electronic health records of individuals infected with SARS-CoV-2 were paired to viral whole-genome sequences to assess the effects of host clinical parameters and immunity on the intra-host evolution of SARS-CoV-2. We found slight, albeit significant, differences in SARS-CoV-2 intra-host diversity, which depended on host parameters such as vaccination status and smoking. Only one viral genome had significant alterations as a result of host parameters; it was found in an immunocompromised, chronically infected woman in her 70s. We highlight the unusual viral genome obtained from this woman, which had an accelerated mutational rate and an excess of rare mutations, including near-complete truncating of the accessory protein ORF3a. Our findings suggest that the evolutionary capacity of SARS-CoV-2 during acute infection is limited and mostly unaffected by host characteristics. Significant viral evolution is seemingly exclusive to a small subset of COVID-19 cases, which typically prolong infections in immunocompromised patients. In these rare cases, SARS-CoV-2 genomes accumulate many impactful and potentially adaptive mutations; however, the transmissibility of such viruses remains unclear.
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Davidovitch M, Gazit S, Patalon T, Leitner Y, Rotem RS. Late diagnosis of autism spectrum disorder-Journey, parents' concerns, and sex influences. Autism Res 2023; 16:294-301. [PMID: 36495248 DOI: 10.1002/aur.2869] [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: 09/05/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022]
Abstract
Despite increasing awareness for diagnosing autism spectrum disorder (ASD) and initiating treatments early in life, many children and adolescents continue to be diagnosed at a relatively older age. Focusing on children who first received an ASD diagnosis at age six or older, this study aimed to describe the symptoms that parents reported when ASD was diagnosed, follow the patients' clinical trajectory prior to receiving the diagnosis, and describe differences in symptoms and prior diagnoses between males and females cases. We included 258 children (205 males and 53 females) who were first diagnosed with autism at age 6-18 in 2017-2018. We retrieved demographic information, neurologic and developmental symptoms, diagnoses, and medications dispensing history from the children's electronic medical charts. The data indicated that prior diagnoses of language delays and attention deficit hyperactivity disorder were common among children with a late ASD diagnosis. Two thirds of the children were prescribed one or more medications to treat psychosocial and behavioral conditions before receiving a late ASD diagnosis. Difficulties in social relationships with peers were the leading reported symptoms by parents at the time of ASD diagnosis. Across these different domains, some differences were found between males and females, including a somewhat higher cognitive level in males, who were also more likely to present aggressive behavior.
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Affiliation(s)
- Michael Davidovitch
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Yael Leitner
- Child Development Center & Pediatric ADHD Clinic, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Ran S Rotem
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
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12
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Yechezkel M, Mofaz M, Painsky A, Patalon T, Gazit S, Shmueli E, Yamin D. Safety of the fourth COVID-19 BNT162b2 mRNA (second booster) vaccine: a prospective and retrospective cohort study. Lancet Respir Med 2023; 11:139-150. [PMID: 36410364 PMCID: PMC9889528 DOI: 10.1016/s2213-2600(22)00407-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/06/2022] [Accepted: 10/08/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The effectiveness of the second BNT162b2 (Pfizer-BioNTech) mRNA COVID-19 booster vaccine dose (ie, fourth inoculation) is well established, but its safety has yet to be fully understood. The absence of sufficient vaccine safety information is one of the key contributors to vaccine hesitancy. In this study, we aimed to evaluate the safety profile of the second BNT162b2 mRNA COVID-19 booster vaccine using data from a retrospective cohort and a prospective cohort. METHODS To evaluate the safety profile of the second booster vaccine, we analysed its short-term effects and compared them to those of the first booster by using data from, first, a retrospective cohort of 250 000 random members of the second-largest health-care organisation in Israel (Maccabi Healthcare Services) and, second, a prospective cohort (the PerMed study) of 4698 participants from all across Israel. Individuals who were aged 18 years or older who received the second BNT162b2 mRNA COVID-19 vaccine booster during the vaccination campaign, from Dec 30, 2021, to July 22, 2022, were eligible for inclusion in the retrospective cohort analysis. To be included in the PerMed study, participants needed to be 18 years or older, members of Maccabi Healthcare Services at the time of enrolment, using their own smartphone, and be able to give informed consent by themselves. Participants from the prospective cohort received smartwatches, downloaded a dedicated mobile application, and granted access to their medical records. The smartwatches continuously monitored several physiological measures, including heart rate. For analysis of the prospective cohort data, we used the Kruskal-Wallis test to compare heart rate levels observed before and after vaccination. The mobile application collected daily self-reported questionnaires on local and systemic reactions. Medical records of the retrospective cohort were accessed to examine the occurrence of 25 potential adverse events, and we evaluated the risk differences between 42 days in the periods before and after vaccination in a pairwise method using non-parametric percentile bootstrap. FINDINGS The retrospective cohort included 94 169 participants who received the first booster and 17 814 who received the second booster. Comparing the 42 days before and after vaccination, the second booster was not associated with any of the 25 adverse events investigated, including myocardial infarction (risk difference, 2·25 events per 10 000 individuals [95% CI -3·93 to 8·98]) and Bell's Palsy (-1·68 events [-5·61 to 2·25]). None of the individuals was diagnosed with myocarditis or pericarditis following vaccination with the second booster. The prospective cohort included 1785 participants who received the first booster and 699 who received the second booster. We found no significant differences after inoculation with the first booster compared with the second booster (heart rate: day 2 [p=0·3], day 6 [p=0·89]; extent of self-reported reactions [p=0·06]). We found a significant increase in mean heart rate relative to that observed during the week before vaccination (baseline) levels during the first 3 days following the second booster (p<0·0001), peaking on day 2 (mean difference of 1·61 bpm [1·07 to 2·16] compared with baseline). Mean heart rate values returned to baseline levels by day 6 (-0·055 bpm [-0·56 to 0·45] compared with baseline). INTERPRETATION Both our retrospective and prospective analyses support the safety of the second booster, with our findings reflecting physicians' diagnoses, patients' objective physiological measures, and patients' subjective reactions. We believe this study provides safety assurances to the global population who are eligible to receive an additional COVID-19 booster inoculation. These assurances can help increase the number of high-risk individuals who opt to receive this booster vaccine and thereby prevent severe outcomes associated with COVID-19. FUNDING European Research Council (ERC).
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Affiliation(s)
- Matan Yechezkel
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Merav Mofaz
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Amichai Painsky
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Erez Shmueli
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv, Israel,Media Lab, MIT, Cambridge, MA, USA
| | - Dan Yamin
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv, Israel; Center for Combatting Pandemics, Tel Aviv University, Tel Aviv, Israel.
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13
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Prunas O, Weinberger DM, Pitzer VE, Gazit S, Patalon T. Waning Effectiveness of the BNT162b2 Vaccine Against Infection in Adolescents in Israel. Clin Infect Dis 2023; 76:113-118. [PMID: 36484301 DOI: 10.1093/cid/ciac315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The short-term effectiveness of a 2-dose regimen of the BioNTech/Pfizer BNT162b2 vaccine for adolescents has been demonstrated. However, little is known about the long-term effectiveness in this age group. It is known, however, that waning of vaccine-induced immunity against infection in adult populations is evident within a few months. METHODS Leveraging the database of Maccabi Healthcare Services (MHS), we conducted a matched case-control design for evaluating the association between time since vaccination and the incidence of infections, where 2 outcomes were evaluated: documented SARS-CoV-2 infection (regardless of symptoms) and symptomatic infection (COVID-19). Cases were defined as individuals aged 12-16 with a positive polymerase chain reaction (PCR) test occurring between 15 June and 8 December 2021, when the Delta variant was dominant in Israel. Controls were adolescents who had not tested positive previously. RESULTS We estimated a peak vaccine effectiveness between 2 weeks and 3 months following receipt of the second dose, with 85% (95% confidence interval [CI]: 84-86%) and 90% (95% CI: 89-91%) effectiveness against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19), respectively. However, in line with findings for adults, waning effectiveness was evident. Long-term protection was reduced to 73% (95% CI: 68-77%) against infection and 79% (95% CI: 73-83%) against COVID-19 3-5 months after the second dose and waned to 53% (95% CI: 46-60%) against infection and 66% (95% CI: 59-72%) against COVID-19 after 5 months. CONCLUSIONS Although vaccine-induced protection against both infection and COVID-19 continues over time in adolescents, the protection wanes with time since vaccination, starting 3 months after inoculation and continuing for more than 5 months.
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Affiliation(s)
- Ottavia Prunas
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel.,Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel.,Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
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14
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Patalon T, Perez G, Melamed G, Wolf T, Gazit S. Mpox Infection in a Developed Country: A Case Report. Trop Med Infect Dis 2022; 8:tropicalmed8010015. [PMID: 36668922 PMCID: PMC9862481 DOI: 10.3390/tropicalmed8010015] [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: 12/17/2022] [Revised: 12/24/2022] [Accepted: 12/26/2022] [Indexed: 12/28/2022] Open
Abstract
This is the first Israeli case report of mpox (monkeypox) disease, as it is manifested in the current outbreak. This manuscript depicts two detailed patient journeys of Israeli men in their 30s who were diagnosed in recent months, depicting their symptoms, presumed exposure, and outcomes. The two cases were atypical compared to the clinical presentation prior to the current outbreak but were similar to other recent reported cases; they differed in their prodromal presentation. Importantly, both patients described that significant anxiety around the diagnosis dominated their journey while sharing that a concern is rising in the GBMSM community, a concern that should be addressed by healthcare providers.
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Affiliation(s)
- Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 68125, Israel
| | - Galit Perez
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- Department of Health Policy and Management, School of Public Health, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Guy Melamed
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
| | - Tamar Wolf
- Central Laboratory, Maccabi Healthcare Services, Rehovot 76703, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 68125, Israel
- Correspondence:
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15
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Hen Gabzi R, Patalon T, Shomron N, Gazit S. A Data-Driven Strategy for Identifying Individuals Resistant to SARS-CoV-2 Virus under In-Household Exposure. J Pers Med 2022; 12:jpm12121975. [PMID: 36556196 PMCID: PMC9784910 DOI: 10.3390/jpm12121975] [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: 10/29/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
This report describes the development of a data-driven approach for identifying individuals who tested negative to a SARS-CoV-2 infection, despite their residence with individuals who had confirmed infections. Household studies have demonstrated efficiency in evaluating exposure to SARS-CoV-2. Leveraging earlier studies based on the household unit, our analysis utilized close contacts in order to trace chains of infection and to subsequently categorize TEFLONs, an acronym for Timely Exposed to Family members Leaving One Not infected. We used over one million anonymized electronic medical records, retrieved from Maccabi Healthcare Services' centralized computerized database from March 2020 to March 2022. The analysis yielded 252 TEFLONs, who were probably at very high risk of infection and yet, demonstrated clinical resistance. The exposure extent in each household positively correlated with household size, reflecting the in-house rolling transmission event. Our approach can be easily implemented in other clinical fields and should spur further research of clinical resistance to various infections.
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Affiliation(s)
- Roni Hen Gabzi
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Edmond J Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv 69978, Israel
- Tel Aviv University Innovation Laboratory (TILabs), Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence: (R.H.G.); (S.G.)
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 69978, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 69978, Israel
| | - Noam Shomron
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Edmond J Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv 69978, Israel
- Tel Aviv University Innovation Laboratory (TILabs), Tel Aviv University, Tel Aviv 69978, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 69978, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv 69978, Israel
- Correspondence: (R.H.G.); (S.G.)
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Patalon T, Ben Moshe S, Peretz A, Neuberger A, Schreiber L, Lazar R, Supino-Rosin L, Perez G, Mizrahi-Reuveni M, Gazit S. SARS-CoV-2 spike IgG titres up to 137 days following Comirnaty mRNA COVID-19 vaccination, Israel, February to May 2021. Euro Surveill 2022; 27. [PMID: 36205168 PMCID: PMC9540524 DOI: 10.2807/1560-7917.es.2022.27.40.2100703] [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: 12/02/2022]
Abstract
Background Data regarding the long-term protection afforded by vaccination for the SARS-CoV-2 infection are essential for allocation of scarce vaccination resources worldwide. Methods We conducted a retrospective cohort study aimed at studying the kinetics of IgG antibodies against SARS-CoV-2 in COVID-19-naïve patients fully vaccinated with two doses of Comirnaty mRNA COVID-19 vaccine. Geometric mean concentrations (GMCs) of antibody levels were reported. Linear models were used to assess antibody levels after full vaccination and their decline over time. Results The study included 4,740 patients and 5,719 serological tests. Unadjusted GMCs peaked 28–41 days after the first dose at 10,174 AU/mL (95% CI: 9,211–11,237) and gradually decreased but remained well above the positivity cut-off. After adjusting for baseline characteristics and repeated measurements, the antibodies half-life time was 34.1 days (95% CI: 33.1–35.2), and females aged 16–39 years with no comorbidities had antibody levels of 20,613 AU/mL (95% CI: 18,526–22,934) on day 28 post-first-dose. Antibody levels were lower among males (0.736 of the level measured in females; 95% CI: 0.672–0.806), people aged 40–59 (0.729; 95% CI: 0.649–0.818) and ≥ 60 years (0.452; 95% CI: 0.398–0.513), and patients having haematological (0.241; 95% CI: 0.190–0.306) or solid malignancies (0.757; 95% CI: 0.650–0.881), chronic kidney disease with glomerular filtration rate (GFR) ≥ 30 (0.434; 95% CI: 0.354–0.532) or with GFR < 30 mL/min (0.176; 95% CI: 0.109–0.287), and immunosuppression (0.273; 95% CI: 0.235–0.317). Body mass index, cardiovascular disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes and inflammatory bowel diseases were not associated with antibody levels. Conclusions Vaccination with two doses resulted in persistently high levels of antibodies (≥ cut-off of 50 AU/mL) up to 137 days post-first-dose. Risk factors for lower antibody levels were identified.
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Affiliation(s)
- Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Shay Ben Moshe
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Computer Science, Ben-Gurion University, Beer Sheva, Israel
| | - Asaf Peretz
- Internal Medicine COVID-19 Ward, Samson Assuta Ashdod University Hospital, Ashdod Israel
| | - Ami Neuberger
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.,Infectious Diseases Institute, Rambam Healthcare Campus, Haifa, Israel
| | - Licita Schreiber
- Central Laboratory, Maccabi Healthcare Services, Rehovot, Israel
| | - Rachel Lazar
- Central Laboratory, Maccabi Healthcare Services, Rehovot, Israel
| | - Lia Supino-Rosin
- Central Laboratory, Maccabi Healthcare Services, Rehovot, Israel
| | - Galit Perez
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
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Adler L, Gazit S, Pinto Y, Perez G, Mizrahi Reuveni M, Yehoshua I, Hoffman R, Azuri J, Patalon T. Long-COVID in patients with a history of mild or asymptomatic SARS-CoV-2 infection: a Nationwide Cohort Study. Scand J Prim Health Care 2022; 40:342-349. [PMID: 36314555 PMCID: PMC9848375 DOI: 10.1080/02813432.2022.2139480] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Evaluating the prevalence of long-COVID symptoms in patients with a history of mild or asymptomatic infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the factors associated with developing long-COVID. DESIGN A nationwide cohort study. Using a centralized database, we have identified patients with and without a history of SARS-CoV-2 infection 1-6 months before data collection. Patients were asked to fill out an online questionnaire through text messages. SETTING Israeli general practice. SUBJECTS 2755 persons participated in the study in September 2021 (a response rate of 7.5%): 819 with and, 936 without a history of SARS-CoV-2 infection. MAIN OUTCOME MEASURES We asked patients to provide details about their demographic status, medical history, COVID-related variables and the presence of long-COVID symptoms. RESULTS Most prevalent long-COVID symptoms were decreased smell sensation (35.1% vs. 4.3%, p < 0.001), decreased taste sensation (25.2% vs. 3.2%, p < 0.001), memory disturbances (36.9% vs. 14.4%, p < 0.001), dyspnea (24.2% vs. 10.7%, p < 0.001) and arthralgia (33% vs. 16.3%, p < 0.001). Risk factors associated with long-COVID included female gender, symptomatic COVID-19, overweight or obesity and the presence of dyslipidemia. About 34.6% of participants reported not returning to their baseline health condition after the acute illness. CONCLUSION Long-COVID is frequently seen following a mild symptomatic COVID-19 infection and, to a lesser extent, following an asymptomatic SARS-CoV-2 infection. Primary care physicians should be aware of these symptoms and consider this option in their differential diagnosis. Health policymakers should expect a significant impact of this syndrome on public health.Key PointsLong-COVID has emerged as a significant health problem with a serious impact on normal daily function• Long-COVID symptoms were evident in patients with mild symptomatic disease and in asymptomatic patients to a lesser extent.• Risk factors for having Long-COVID symptoms include female gender, symptomatic disease, increased BMI, and the presence of dyslipidemia.• Fatigue, dyspnea, weakness, decreased libido, weight changes, memory, and sleep disturbances were associated with not returning to the baseline health state.
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Affiliation(s)
- Limor Adler
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- CONTACT Limor Adler Health Division, Maccabi Healthcare Services, Hamered 27 st, Tel Aviv, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Yuval Pinto
- Family Medicine Residency Program, Meritus Medical Center, Hagerstwon, MD, USA
| | - Galit Perez
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Ilan Yehoshua
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Family Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Robert Hoffman
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Azuri
- Health Division, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
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Gazit S, Mizrahi B, Kalkstein N, Neuberger A, Peretz A, Mizrahi-Reuveni M, Ben-Tov A, Patalon T. BNT162b2 mRNA Vaccine Effectiveness Given Confirmed Exposure: Analysis of Household Members of Coronavirus Disease 2019 Patients. Clin Infect Dis 2022; 75:e734-e740. [PMID: 34849630 PMCID: PMC8767821 DOI: 10.1093/cid/ciab973] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although BNT162b2 vaccine-efficacy analyses have been published, the effectiveness of the vaccine in preventing coronavirus disease 2019 given confirmed exposure has not been previously demonstrated, even though it has policy implications, such as the need for self-quarantine when exposure has occurred. METHODS In a retrospective cohort study, we used data collected between 20 December 2020 and 17 March 2021 from the second largest healthcare provider in Israel to analyze the probability of an additional household infection occurring within 10 days after an index infection. In model 1, vaccine effectiveness was described for Fully Vaccinated individuals (7 or more days from second dose) vs either Unvaccinated individuals or those Recently Vaccinated Once (0-7 days from the first dose, presumably still unprotected). Secondary analyses included correction for differing testing rates. In model 2, we conducted a separate analysis of households comprised of only adults with the same vaccination status. RESULTS A total of 173 569 households were included, of which 6351 had an index infection (mean [standard deviation] age, 58.9 [13.5] years); 50% were women. Adjusted vaccine effectiveness of Fully Vaccinated compared with Unvaccinated participants was 80.3% (95% confidence interval [CI], 73.5-85.4) and 82.0% (95% CI, 75.6-86.8) compared with those Recently Vaccinated Once. CONCLUSIONS The BNT162b2 vaccine is effective in high-risk real-life exposure scenarios, but the protection afforded in these settings is lower than that previously described. Individuals with a confirmed significant exposure to severe acute respiratory syndrome are still at risk of being infected even if fully vaccinated.
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Affiliation(s)
- Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel
| | | | | | - Ami Neuberger
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Asaf Peretz
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel
- Internal Medicine COVID-19 Ward, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | | | - Amir Ben-Tov
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel
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19
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Fallach N, Segal Y, Agassy J, Perez G, Peretz A, Chodick G, Gazit S, Patalon T, Ben Tov A, Goldshtein I. Pregnancy outcomes after SARS-CoV-2 infection by trimester: A large, population-based cohort study. PLoS One 2022; 17:e0270893. [PMID: 35857758 PMCID: PMC9299339 DOI: 10.1371/journal.pone.0270893] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/18/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Data regarding women infected with SARS-CoV-2 during early trimesters are scarce. We aimed to assess preterm birth (PTB) and small-for-gestational-age (SGA) rates in a large and unselected cohort by trimester at infection and overall. Design A retrospective cohort study including all women with a positive SARS-CoV-2 RT-PCR test during a non-ectopic singleton pregnancy between February 21st 2020 and July 2nd 2021 (N = 2753). Each infected woman was matched to a non-infected pregnant woman by age, last menstruation date, sector, and socioeconomic status. Methods Logistic regression was conducted to assess the risks of PTB and SGA including an interaction between group and trimester of infection. Multivariable models included underlying diseases, previous abortions and null parity. Subgroup analyses were conducted on symptomatic infected women and matched non-infected women. Results A total of 2753 /2789 (98.7%) eligible women that were infected during pregnancy could be matched, among them, 17.4% and 48.4% were infected during the first and third trimesters, respectively. While first and second trimester infections were not associated with PTB (p>0.8), third trimester infections and in particular after 34 weeks of gestation had a greater risk of PTB with adjusted ORs of 2.76 (95% CI 1.63–4.67) and 7.10 (95% CI 2.44–20.61), respectively. PTB risk was further heightened in symptomatic third trimester infections (OR = 4.28, 95% CI 1.94–9.25). SGA risk was comparable between study groups across all trimesters of infection. Pregnancy loss incidence was similar in both groups (adjusted OR = 1.16; 95% CI 0.90–1.50). Conclusion SARS-CoV-2 infection was associated with increased risk of PTB only among women infected during late pregnancy, particularly among symptomatic women.
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Affiliation(s)
- Noga Fallach
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
- * E-mail:
| | - Yaakov Segal
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Jeny Agassy
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Galit Perez
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Asaf Peretz
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
- Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Gabriel Chodick
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sivan Gazit
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Tal Patalon
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Amir Ben Tov
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Inbal Goldshtein
- Kahn-Sagol-Maccabi Research and Innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Mofaz M, Yechezkel M, Guan G, Brandeau ML, Patalon T, Gazit S, Yamin D, Shmueli E. Self-Reported and Physiologic Reactions to Third BNT162b2 mRNA COVID-19 (Booster) Vaccine Dose. Emerg Infect Dis 2022; 28:1375-1383. [PMID: 35654410 PMCID: PMC9239876 DOI: 10.3201/eid2807.212330] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Despite extensive technological advances in recent years, objective and continuous assessment of physiologic measures after vaccination is rarely performed. We conducted a prospective observational study to evaluate short-term self-reported and physiologic reactions to the booster BNT162b2 mRNA (Pfizer-BioNTech, https://www.pfizer.com) vaccine dose. A total of 1,609 participants were equipped with smartwatches and completed daily questionnaires through a dedicated mobile application. The extent of systemic reactions reported after the booster dose was similar to that of the second dose and considerably greater than that of the first dose. Analyses of objective heart rate and heart rate variability measures recorded by smartwatches further supported this finding. Subjective and objective reactions after the booster dose were more apparent in younger participants and in participants who did not have underlying medical conditions. Our findings further support the safety of the booster dose from subjective and objective perspectives and underscore the need for integrating wearables in clinical trials.
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21
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Levi Y, Yamin D, Brandes T, Shmueli E, Patalon T, Peretz A, Gazit S, Nahir B. Early Oxygen Treatment Measurements Can Predict COVID-19 Mortality: A Preliminary Study. Healthcare (Basel) 2022; 10:healthcare10061146. [PMID: 35742198 PMCID: PMC9222284 DOI: 10.3390/healthcare10061146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 01/08/2023] Open
Abstract
Halting the rapid clinical deterioration, marked by arterial hypoxemia, is among the greatest challenges clinicians face when treating COVID-19 patients in hospitals. While it is clear that oxygen measures and treatment procedures describe a patient’s clinical condition at a given time point, the potential predictive strength of the duration and extent of oxygen supplementation methods over the entire course of hospitalization for a patient death from COVID-19 has yet to be assessed. In this study, we aim to develop a prediction model for COVID-19 mortality in hospitals by utilizing data on oxygen supplementation modalities of patients. We analyzed the data of 545 patients hospitalized with COVID-19 complications admitted to Assuta Ashdod Medical Center, Israel, between 7 March 2020, and 16 March 2021. By solely analyzing the daily data on oxygen supplementation modalities in 182 random patients, we could identify that 75% (9 out of 12) of individuals supported by reservoir oxygen masks during the first two days died 3–30 days following hospital admission. By contrast, the mortality rate was 4% (4 out of 98) among those who did not require any oxygenation supplementation. Then, we combined this data with daily blood test results and clinical information of 545 patients to predict COVID-19 mortality. Our Random Forest model yielded an area under the receiver operating characteristic curve (AUC) score on the test set of 82.5%, 81.3%, and 83.0% at admission, two days post-admission, and seven days post-admission, respectively. Overall, our results could essentially assist clinical decision-making and optimized treatment and management for COVID-19 hospitalized patients with an elevated risk of mortality.
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Affiliation(s)
- Yosi Levi
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel; (Y.L.); (T.B.); (E.S.)
| | - Dan Yamin
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel; (Y.L.); (T.B.); (E.S.)
- Center for Combatting Pandemics, Tel Aviv University, Tel Aviv 69978, Israel
- Correspondence:
| | - Tomer Brandes
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel; (Y.L.); (T.B.); (E.S.)
| | - Erez Shmueli
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel; (Y.L.); (T.B.); (E.S.)
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel; (T.P.); (S.G.); (B.N.)
| | - Asaf Peretz
- Internal Medicine COVID-19 Ward, Samson Assuta Ashdod University Hospital, Ashdod 7747629, Israel;
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel; (T.P.); (S.G.); (B.N.)
| | - Barak Nahir
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv 68125, Israel; (T.P.); (S.G.); (B.N.)
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22
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Patalon T, Saciuk Y, Peretz A, Perez G, Lurie Y, Maor Y, Gazit S. Waning effectiveness of the third dose of the BNT162b2 mRNA COVID-19 vaccine. Nat Commun 2022; 13:3203. [PMID: 35680872 PMCID: PMC9184525 DOI: 10.1038/s41467-022-30884-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [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: 02/14/2022] [Accepted: 05/24/2022] [Indexed: 12/19/2022] Open
Abstract
The duration of protection of the third (booster) dose of the BioNTech/Pfizer BNT162b2 mRNA Coronavirus Disease 2019 vaccine has been the subject of recent investigations, as global discussions around the necessity and effectiveness of a fourth dose are already underway. By conducting a retrospective study implementing a test-negative case-control design, analyzing 546,924 PCR tests performed throughout January 2022 by 389,265 persons who received at least two doses, we find that the effectiveness in each month-since-vaccination decreases significantly. Compared to those vaccinated five months prior to the outcome period, on August 2021, relative protection against infection waned from 53.4% a month after vaccination to 16.5% three months after vaccination. These results suggest that there is a significant waning of vaccine effectiveness against the Omicron variant of the third dose of the BNT162b2 vaccine within a few months after administration. Additional information could assist to comprehensively estimate the effectiveness of the three-dose-strategy. In this retrospective study, authors show that relative protection against SARS-CoV-2 infection wanes from 53.4% one month after vaccination to 16.5% three months after vaccination, suggesting that there is a significant waning of mRNA vaccine effectiveness against infection with the Omicron variant.
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Affiliation(s)
- Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel. .,Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.
| | - Yaki Saciuk
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel
| | - Asaf Peretz
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.,Internal Medicine COVID-19 Ward, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Galit Perez
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Yoav Lurie
- Liver unit, Shaare Zedek City Center Campus, Jerusalem, Israel
| | - Yasmin Maor
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Disease Unit, Edith Wolfson Medical Centre, Holon, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel.,Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
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23
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Gazit S, Saciuk Y, Perez G, Peretz A, Pitzer VE, Patalon T. Short term, relative effectiveness of four doses versus three doses of BNT162b2 vaccine in people aged 60 years and older in Israel: retrospective, test negative, case-control study. BMJ 2022; 377:e071113. [PMID: 35609888 PMCID: PMC9127435 DOI: 10.1136/bmj-2022-071113] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the relative effectiveness of a fourth dose of the Pfizer-BioNTech mRNA (BNT162b2) vaccine compared with three vaccine doses over the span of 10 weeks. DESIGN Retrospective, test negative, case-control study, with a matched analysis and an unmatched multiple tests analysis. SETTING Nationally centralised database of Maccabi Healthcare Services, an Israeli national health fund for 2.5 million people; from 10 January 2022 (seven days after the fourth dose was first given to eligible individuals) to 13 March 2022, an omicron dominant period in Israel. PARTICIPANTS 97 499 Maccabi Healthcare Services members aged 60 years and older, who were eligible to receive a fourth vaccine dose and obtained at least one polymerase chain reaction (PCR) test during the study. MAIN OUTCOME MEASURES Breakthrough SARS-CoV-2 infection, defined as a positive PCR test performed seven or more days after inoculation with the BNT162b2 vaccine; and breakthrough SARS-CoV-2 infection resulting in severe covid-19 disease, defined as hospital admission or death related to covid-19. RESULTS 27 876 participants received the fourth BNT162b2 vaccine dose and 69 623 received three doses only. Of 106 participants who died during the follow-up period, 77 had had their third doses only and 23 had had their fourth doses during the first three weeks after inoculation. In the first three weeks, a fourth dose provided additional protection against both SARS-CoV-2 infection and severe disease relative to three doses of the vaccine. However, relative vaccine effectiveness against infection quickly decreased over time, peaking during the third week at 65.1% (95% confidence interval 63.0% to 67.1%) and falling to 22.0% (4.9% to 36.1%) by the end of the 10 week follow-up period. Unlike relative effectiveness against SARS-CoV-2 infection, the relative effectiveness of a fourth dose against severe covid-19 was maintained at a high level (>72%) throughout follow-up. However, severe disease was a relatively rare event, occurring in <1% of study participants who received four doses or three doses only. CONCLUSIONS A fourth dose of the BNT162b2 vaccine appears to have provided additional protection against both SARS-CoV-2 infection and severe covid-19 disease relative to three vaccine doses. However, relative effectiveness of the fourth dose against infection appears to wane sooner than that of the third dose.
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Affiliation(s)
- Sivan Gazit
- Kahn Sagol Maccabi Research and Innovation Centre, Maccabi Healthcare Services, Tel Aviv, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Yaki Saciuk
- Kahn Sagol Maccabi Research and Innovation Centre, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Galit Perez
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Asaf Peretz
- Kahn Sagol Maccabi Research and Innovation Centre, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Tal Patalon
- Kahn Sagol Maccabi Research and Innovation Centre, Maccabi Healthcare Services, Tel Aviv, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
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24
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Gazit S, Shlezinger R, Perez G, Lotan R, Peretz A, Ben-Tov A, Herzel E, Alapi H, Cohen D, Muhsen K, Chodick G, Patalon T. The Incidence of SARS-CoV-2 Reinfection in Persons With Naturally Acquired Immunity With and Without Subsequent Receipt of a Single Dose of BNT162b2 Vaccine : A Retrospective Cohort Study. Ann Intern Med 2022; 175:674-681. [PMID: 35157493 PMCID: PMC8855786 DOI: 10.7326/m21-4130] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [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: 11/30/2022] Open
Abstract
BACKGROUND There is insufficient evidence regarding the magnitude and durability of protection conferred by a combined effect of naturally acquired immunity after SARS-CoV-2 infection and vaccine-induced immunity. OBJECTIVE To compare the incidence rate of SARS-CoV-2 reinfection in previously infected persons to that of previously infected persons who subsequently received a single dose of BNT162b2 messenger RNA vaccine. DESIGN A retrospective cohort study emulating a randomized controlled target trial through a series of nested trials. SETTING Nationally centralized database of Maccabi Healthcare Services, Israel. PARTICIPANTS Persons with documented SARS-CoV-2 infection who did not receive subsequent SARS-CoV-2 vaccination were compared with persons with documented SARS-CoV-2 infection who received a single dose of the BNT162b2 vaccine at least 3 months after infection. INTERVENTION Forty-one randomized controlled trials were emulated, in which 107 413 Maccabi Healthcare Services' members aged 16 years and older were eligible for at least 1 trial. MEASUREMENTS SARS-CoV-2-related outcomes of infection, symptomatic disease, hospitalization, and death, between 2 March and 13 December 2021. RESULTS A statistically significant decreased risk (hazard ratio, 0.18 [95% CI, 0.15 to 0.20]) for reinfection was found among persons who were previously infected and then vaccinated versus those who were previously infected but remained unvaccinated. In addition, there was a decreased risk for symptomatic disease (hazard ratio, 0.24 [CI, 0.20 to 0.29]) among previously infected and vaccinated persons compared with those who were not vaccinated after infection. No COVID-19-related mortality cases were found. LIMITATION Hybrid protection against non-Delta variants could not be inferred. CONCLUSION Persons previously infected with SARS-CoV-2 gained additional protection against reinfection and COVID-19 from a subsequent single dose of the BNT162b2 vaccine. Nonetheless, even without a subsequent vaccination, reinfection appeared relatively rare. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center and Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel (S.G., T.P.)
| | - Roei Shlezinger
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel (R.S.)
| | - Galit Perez
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel (G.P., R.L., E.H., H.A.)
| | - Roni Lotan
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel (G.P., R.L., E.H., H.A.)
| | - Asaf Peretz
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, and Internal Medicine COVID-19 Ward, Samson Assuta Ashdod University Hospital, Ashdod, Israel (A.P.)
| | - Amir Ben-Tov
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, and Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel (A.B.)
| | - Esma Herzel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel (G.P., R.L., E.H., H.A.)
| | - Hillel Alapi
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel (G.P., R.L., E.H., H.A.)
| | - Dani Cohen
- Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel (D.C., K.M.)
| | - Khitam Muhsen
- Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel (D.C., K.M.)
| | - Gabriel Chodick
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, and Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel (G.C.)
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center and Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel (S.G., T.P.)
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25
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Gazit S, Shlezinger R, Perez G, Lotan R, Peretz A, Ben-Tov A, Herzel E, Alapi H, Cohen D, Muhsen K, Chodick G, Patalon T. SARS-CoV-2 Naturally Acquired Immunity vs. Vaccine-induced Immunity, Reinfections versus Breakthrough Infections: a Retrospective Cohort Study. Clin Infect Dis 2022; 75:e545-e551. [PMID: 35380632 PMCID: PMC9047157 DOI: 10.1093/cid/ciac262] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Indexed: 01/01/2023] Open
Abstract
Background Waning of protection against infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) conferred by 2 doses of the BNT162b2 vaccine begins shortly after inoculation and becomes substantial within 4 months. With that, the impact of prior infection on incident SARS-CoV-2 reinfection is unclear. Therefore, we examined the long-term protection of naturally acquired immunity (protection conferred by previous infection) compared to vaccine-induced immunity. Methods A retrospective observational study of 124 500 persons, compared 2 groups: (1) SARS-CoV-2-naive individuals who received a 2-dose regimen of the BioNTech/Pfizer mRNA BNT162b2 vaccine, and (2) previously infected individuals who have not been vaccinated. Two multivariate logistic regression models were applied, evaluating four SARS-CoV-2-related outcomes—infection, symptomatic disease (coronavirus disease 2019 [COVID-19]), hospitalization, and death—between 1 June and 14 August 2021, when the Delta variant was dominant in Israel. Results SARS-CoV-2-naive vaccinees had a 13.06-fold (95% confidence interval [CI], 8.08–21.11) increased risk for breakthrough infection with the Delta variant compared to unvaccinated-previously-infected individuals, when the first event (infection or vaccination) occurred during January and February of 2021. The increased risk was significant for symptomatic disease as well. When allowing the infection to occur at any time between March 2020 and February 2021, evidence of waning naturally acquired immunity was demonstrated, although SARS-CoV-2 naive vaccinees still had a 5.96-fold (95% CI: 4.85–7.33) increased risk for breakthrough infection and a 7.13-fold (95% CI: 5.51–9.21) increased risk for symptomatic disease. Conclusions Naturally acquired immunity confers stronger protection against infection and symptomatic disease caused by the Delta variant of SARS-CoV-2, compared to the BNT162b2 2-dose vaccine-indued immunity.
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Affiliation(s)
- Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel.,Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Israel
| | - Roei Shlezinger
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel
| | - Galit Perez
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Israel
| | - Roni Lotan
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Israel
| | - Asaf Peretz
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel.,Internal Medicine COVID-19 Ward, Samson Assuta Ashdod University Hospital, Ashdod Israel
| | - Amir Ben-Tov
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel.,Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Esma Herzel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Israel
| | - Hillel Alapi
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Israel
| | - Dani Cohen
- Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Khitam Muhsen
- Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Chodick
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Israel.,Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel.,Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Israel
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26
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Prunas O, Warren JL, Crawford FW, Gazit S, Patalon T, Weinberger DM, Pitzer VE. Vaccination with BNT162b2 reduces transmission of SARS-CoV-2 to household contacts in Israel. Science 2022; 375:1151-1154. [PMID: 35084937 PMCID: PMC9261115 DOI: 10.1126/science.abl4292] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/21/2022] [Indexed: 12/17/2022]
Abstract
The effectiveness of vaccines against COVID-19 on the individual level is well established. However, few studies have examined vaccine effectiveness against transmission. We used a chain binomial model to estimate the effectiveness of vaccination with BNT162b2 [Pfizer-BioNTech messenger RNA (mRNA)-based vaccine] against household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Israel before and after emergence of the B.1.617.2 (Delta) variant. Vaccination reduced susceptibility to infection by 89.4% [95% confidence interval (CI): 88.7 to 90.0%], whereas vaccine effectiveness against infectiousness given infection was 23.0% (95% CI: -11.3 to 46.7%) during days 10 to 90 after the second dose, before 1 June 2021. Total vaccine effectiveness was 91.8% (95% CI: 88.1 to 94.3%). However, vaccine effectiveness is reduced over time as a result of the combined effect of waning of immunity and emergence of the Delta variant.
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Affiliation(s)
- Ottavia Prunas
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Joshua L. Warren
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Forrest W. Crawford
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
- Department of Statistics and Data Science, Yale School of Public Health, Yale University, New Haven, CT, USA
- Department of Ecology and Evolutionary Biology, Yale School of Public Health, Yale University, New Haven, CT, USA
- Yale School of Management, Yale University, New Haven, CT, USA
| | - Sivan Gazit
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Tal Patalon
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Virginia E. Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, CT, USA
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27
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Levine-Tiefenbrun M, Yelin I, Uriel H, Kuint J, Schreiber L, Herzel E, Katz R, Ben-Tov A, Gazit S, Patalon T, Chodick G, Kishony R. SARS-CoV-2 RT-qPCR Test Detection Rates Are Associated with Patient Age, Sex, and Time since Diagnosis. J Mol Diagn 2022; 24:112-119. [PMID: 34826637 PMCID: PMC8608683 DOI: 10.1016/j.jmoldx.2021.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/16/2021] [Accepted: 10/04/2021] [Indexed: 02/02/2023] Open
Abstract
Quantifying the detection rate of the widely used quantitative RT-PCR (RT-qPCR) test for severe acute respiratory syndrome coronavirus 2 and its dependence on patient demographic characteristics and disease progression is key in designing epidemiologic strategies. Analyzing 843,917 test results of 521,696 patients, a "positive period" was defined for each patient between diagnosis of coronavirus disease 2019 and the last positive test result. The fraction of positive test results within this period was then used to estimate detection rate. Regression analyses were used to determine associations of detection with time of sampling after diagnosis, patient demographic characteristics, and viral RNA copy number based on RT-qPCR cycle threshold values of the next positive test result. The overall detection rate in tests performed within 14 days after diagnosis was 83.1%. This rate was higher at days 0 to 5 after diagnosis (89.3%). Furthermore, detection rate was strongly associated with age and sex. Finally, the detection rate with the Allplex 2019-nCoV RT-qPCR kit was associated, at the single-patient level, with viral RNA copy number (P < 10-9). These results show that the reliability of the test result is reduced in later days as well as for women and younger patients, in whom the viral loads are typically lower.
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Affiliation(s)
| | - Idan Yelin
- Biology Faculty, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Hedva Uriel
- Faculty of Computer Science, Technion-Israel Institute of Technology, Haifa, Israel
| | - Jacob Kuint
- Maccabitech, Maccabi Health Services, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Esma Herzel
- Maccabitech, Maccabi Health Services, Tel Aviv, Israel
| | - Rachel Katz
- Maccabitech, Maccabi Health Services, Tel Aviv, Israel
| | - Amir Ben-Tov
- Maccabitech, Maccabi Health Services, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sivan Gazit
- Maccabitech, Maccabi Health Services, Tel Aviv, Israel
| | - Tal Patalon
- Maccabitech, Maccabi Health Services, Tel Aviv, Israel
| | - Gabriel Chodick
- Maccabitech, Maccabi Health Services, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Kishony
- Biology Faculty, Technion-Israel Institute of Technology, Haifa, Israel; Faculty of Computer Science, Technion-Israel Institute of Technology, Haifa, Israel
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Patalon T, Gazit S, Pitzer VE, Prunas O, Warren JL, Weinberger DM. Odds of Testing Positive for SARS-CoV-2 Following Receipt of 3 vs 2 Doses of the BNT162b2 mRNA Vaccine. JAMA Intern Med 2022; 182:179-184. [PMID: 34846533 PMCID: PMC8634151 DOI: 10.1001/jamainternmed.2021.7382] [Citation(s) in RCA: 105] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE With the evidence of waning immunity of the mRNA vaccine BNT162b2 (Pfizer-BioNTech), a nationwide third-dose (booster) vaccination campaign was initiated in Israel during August 2021; other countries have begun to administer a booster shot as well. OBJECTIVE To evaluate the initial short-term additional benefit of a 3-dose vs a 2-dose regimen against infection of SARS-CoV-2. DESIGN, SETTING, AND PARTICIPANTS This preliminary retrospective case-control study used 2 complementary approaches: a test-negative design and a matched case-control design. Participants were included from the national centralized database of Maccabi Healthcare Services, an Israeli healthcare maintenance organization covering 2.5 million members. Data were collected between March 1, 2020, and October 4, 2021, and analyses focused on the period from August 1, 2021, to October 4, 2021, because the booster dose was widely administered from August 1 onward. EXPOSURES Either 2 doses or 3 doses of the BNT162b2 vaccine. MAIN OUTCOMES AND MEASURES The reduction in the odds of a positive SARS-CoV-2 polymerase chain reaction (PCR) test at different time intervals following receipt of the booster dose (0-6, 7-13, 14-20, 21-27, and 28-65 days) compared with receiving only 2 doses. RESULTS The study population included 306 710 members of Maccabi Healthcare Services who were 40 years and older (55% female) and received either 2 or 3 doses of the BNT162b2 vaccine and did not have a positive PCR test result for SARS-CoV-2 prior to the start of the follow-up period. During this period, there were 500 232 PCR tests performed, 227 380 among those who received 2 doses and 272 852 among those who received 3 doses, with 14 989 (6.6%) and 4941 (1.8%) positive test results in each group, respectively. Comparing those who received a booster and those who received 2 doses, there was an estimated odds ratio of 0.14 (95% CI, 0.13-0.15) 28 to 65 days following receipt of the booster (86% reduction in the odds of testing positive for SARS-CoV-2). CONCLUSION AND RELEVANCE Previous studies have demonstrated that vaccine-derived protection against SARS-CoV-2 wanes over time. In this case-control analysis, we showed an association between receipt of the booster dose and a reduction in the odds of testing positive for SARS-CoV-2, potentially counteracting waning immunity in the short term. Further monitoring of data from this population is needed to determine the duration of immunity following the booster.
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Affiliation(s)
- Tal Patalon
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel.,Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel.,Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Virginia E Pitzer
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, Connecticut.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Ottavia Prunas
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, Connecticut.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Joshua L Warren
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, Connecticut.,Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Daniel M Weinberger
- Public Health Modeling Unit, Yale School of Public Health, Yale University, New Haven, Connecticut.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
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29
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Abstract
BACKGROUND The short-term effectiveness of a two-dose regimen of the BioNTech/Pfizer mRNA BNT162b2 vaccine for adolescents has been demonstrated. However, little is known about the long-term effectiveness in this age group. It is known, though, that waning of vaccine-induced immunity against infection in adult populations is evident within a few months. METHODS Leveraging the centralized computerized database of Maccabi Healthcare Services (MHS), we conducted a matched case-control design for evaluating the association between time since vaccination and the incidence of infections, where two outcomes were evaluated separately: a documented SARS-CoV-2 infection (regardless of symptoms) and a symptomatic infection (COVID-19). Cases were defined as individuals aged 12 to 16 with a positive PCR test occurring between June 15 and December 8, 2021, when the Delta variant was dominant in Israel. Controls were adolescents who had not tested positive previously. RESULTS We estimated a peak vaccine effectiveness between 2 weeks and 3 months following receipt of the second dose, with 85% and 90% effectiveness against SARS-CoV-2 infection and COVID-19, respectively. However, in line with previous findings for adults, waning of vaccine effectiveness was evident in adolescents as well. Long-term protection conferred by the vaccine was reduced to 75-78% against infection and symptomatic infection, respectively, 3 to 5 months after the second dose, and waned to 58% against infection and 65% against COVID-19 after 5 months. CONCLUSIONS Like adults, vaccine-induced protection against both SARS-CoV-2 infection and COVID-19 wanes with time, starting three months after inoculation and continuing for more than five months.
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Affiliation(s)
- Ottavia Prunas
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, Yale University; New Haven, CT USA.,Corresponding author
| | - Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, Yale University; New Haven, CT USA
| | - Virginia E. Pitzer
- Department of Epidemiology of Microbial Diseases and Public Health Modeling Unit, Yale School of Public Health, Yale University; New Haven, CT USA
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel.,Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel.,Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Israel
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Ben-Tov A, Lotan R, Gazit S, Chodick G, Perez G, Mizrahi-Reuveni M, Patalon T. Dynamics in COVID-19 symptoms during different waves of the pandemic among children infected with SARS-CoV-2 in the ambulatory setting. Eur J Pediatr 2022; 181:3309-3318. [PMID: 35778524 PMCID: PMC9395901 DOI: 10.1007/s00431-022-04531-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/22/2022] [Accepted: 06/12/2022] [Indexed: 12/04/2022]
Abstract
UNLABELLED The aim of this real-life, big data population-based study was to evaluate differences in symptomatic presentation of children infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) between the third and fourth waves of the pandemic in Israel, dominated by the Alpha and Delta variants, respectively. Our cohort included all children and adolescents, members of the second-largest Health Maintenance Organization in Israel that had positive real-time polymerase chain reaction (RT-PCR) test during the third and fourth waves of the pandemic (December 1, 2020, to April 30, 2021, and June 1, 2021, to October 10, 2021, respectively). A total of 32,485 and 44,130 children and adolescents in the third and fourth waves were included in the final analysis. The rate of children with symptomatic disease among patients with documented SARS-CoV-2 infection was higher in the fourth wave compared to the third wave (49.9% vs. 37.5%). The most commonly reported symptom and the only symptom that substantially differed between waves was fever, with 33% of SARS-CoV-2 infected children in the fourth wave vs. 13.6% in the third wave. Preschool children had the lowest prevalence of febrile illness compared to other age groups. CONCLUSION Children and adolescents infected during the fourth wave of the pandemic in Israel, a Delta-dominant period, had a significantly higher rate of symptomatic febrile illness than the Alpha-dominant period. This phenomenon occurred across all age groups. WHAT IS KNOWN • There are differences in COVID-19 severity among adults and children during different waves of the pandemic. • There is a paucity of data regarding symptomatic characteristics in children in large-scale cohorts aside from hospital settings. WHAT IS NEW • In a time period dominated by the Delta variant, there were substantially more children with symptomatic disease and febrile illness compared to a period dominated by the alpha variant. • Preschool children had the lowest rate of febrile illness among all age groups.
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Affiliation(s)
- Amir Ben-Tov
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
- Pediatric Gastroenterology Unit, Dana-Dwek Children’s Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roni Lotan
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Galit Perez
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
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Prunas O, Warren JL, Crawford FW, Gazit S, Patalon T, Weinberger DM, Pitzer VE. Vaccination with BNT162b2 reduces transmission of SARS-CoV-2 to household contacts in Israel. medRxiv 2021:2021.07.13.21260393. [PMID: 34981074 PMCID: PMC8722617 DOI: 10.1101/2021.07.13.21260393] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The individual-level effectiveness of vaccines against clinical disease caused by SARS-CoV-2 is well-established. However, few studies have directly examined the effect of COVID-19 vaccines on transmission. We quantified the effectiveness of vaccination with BNT162b2 (Pfizer-BioNTech mRNA-based vaccine) against household transmission of SARS-CoV-2 in Israel. We fit two time-to-event models - a mechanistic transmission model and a regression model - to estimate vaccine effectiveness against susceptibility to infection and infectiousness given infection in household settings. Vaccine effectiveness against susceptibility to infection was 80-88%. For breakthrough infections among vaccinated individuals, the vaccine effectiveness against infectiousness was 41-79%. The overall vaccine effectiveness against transmission was 88.5%. Vaccination provides substantial protection against susceptibility to infection and slightly lower protection against infectiousness given infection, thereby reducing transmission of SARS-CoV-2 to household contacts. ONE-SENTENCE SUMMARY Vaccination reduced both the rate of infection with SARS-CoV-2 and transmission to household contacts in Israel.
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Affiliation(s)
- Ottavia Prunas
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University; New Haven, CT USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University; New Haven, CT USA
| | - Joshua L. Warren
- Public Health Modeling Unit, Yale School of Public Health, Yale University; New Haven, CT USA
- Department of Biostatistics, Yale School of Public Health, Yale University; New Haven, CT USA
| | - Forrest W. Crawford
- Public Health Modeling Unit, Yale School of Public Health, Yale University; New Haven, CT USA
- Department of Biostatistics, Yale School of Public Health, Yale University; New Haven, CT USA
| | - Sivan Gazit
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services; Tel Aviv, Israel
| | - Tal Patalon
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services; Tel Aviv, Israel
| | - Daniel M. Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University; New Haven, CT USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University; New Haven, CT USA
| | - Virginia E. Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University; New Haven, CT USA
- Public Health Modeling Unit, Yale School of Public Health, Yale University; New Haven, CT USA
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Banon T, Wortsman J, Ben Moshe S, Gazit S, Peretz A, Ben Tov A, Chodick G, Perez G, Patalon T. Evaluating red blood cell distribution width from community blood tests as a predictor of hospitalization and mortality in adults with SARS-CoV-2: a cohort study. Ann Med 2021; 53:1410-1418. [PMID: 34409900 PMCID: PMC8381942 DOI: 10.1080/07853890.2021.1968484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/10/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Red blood cell distribution width (RDW) has been assessed during COVID-19 patient hospitalization, however, further research should be done to evaluate RDW from routine community blood tests, before infection, as a risk factor for COVID-19 related hospitalization and mortality. PATIENTS AND METHODS RDW was measured as a predictor along with age, sex, chronic illnesses, and BMI in logistic regressions to predict hospitalization and mortality. Hospitalization and mortality odds ratios (ORs) were estimated with 95% confidence intervals (CI). RDW was evaluated separately as continuous and discrete (High RDW ≥ 14.5) variables. RESULTS Four thousand one hundred and sixty-eight patients were included in this study, where 824 patients (19.8%) had a high RDW value ≥14.5% (High RDW: 64.7% were female, mean age 58 years [±22] vs. Normal RDW: 60.2% female, mean age 46 years [±19]). Eight hundred and twenty-nine patients had a hospitalization, where the median time between positive PCR and hospital entry was 5 [IQR 1-18] days. Models were analyzed with RDW (continuous) and adjusted for age, sex, comorbidities, and BMI suggested an OR of 1.242 [95% CI = 1.187-2.688] for hospitalization and an OR of 2.911 [95% CI = 1.928-4.395] for mortality (p < .001). RDW (discrete) with the same adjustments presented an OR of 2.232 [95% CI = 1.853-1.300] for hospitalization and an OR of 1.263 [95% CI = 1.166-1.368] for mortality (p < .001). CONCLUSIONS High RDW values obtained from community blood tests are associated with greater odds of hospitalization and mortality for patients with COVID-19.KEY MESSAGESRDW measures before SARS-CoV-2 infection is a predictive factor for hospitalization and mortality.RDW threshold of 14.5% provides high sensitivity and specificity for COVID-19 related mortality, comparatively to other blood tests.Patient records should be accessed by clinicians for prior RDW results, if available, followed by further monitoring.
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Affiliation(s)
- Tamar Banon
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Joshua Wortsman
- Kahn Sagol Maccabi Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Shay Ben Moshe
- Kahn Sagol Maccabi Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Computer Science, Ben-Gurion University, Beer Sheva, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Asaf Peretz
- Head Internal Medicine COVID-19 Ward, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Amir Ben Tov
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Chodick
- Maccabitech Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galit Perez
- Kahn Sagol Maccabi Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
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33
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Mizrahi B, Lotan R, Kalkstein N, Peretz A, Perez G, Ben-Tov A, Chodick G, Gazit S, Patalon T. Correlation of SARS-CoV-2-breakthrough infections to time-from-vaccine. Nat Commun 2021; 12:6379. [PMID: 34737312 PMCID: PMC8569006 DOI: 10.1038/s41467-021-26672-3] [Citation(s) in RCA: 164] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/12/2021] [Indexed: 11/12/2022] Open
Abstract
The short-term effectiveness of a two-dose regimen of the BioNTech/Pfizer mRNA BNT162b2 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine was widely demonstrated. However, long term effectiveness is still unknown. Leveraging the centralized computerized database of Maccabi Healthcare Services (MHS), we assessed the correlation between time-from-vaccine and incidence of breakthrough infection between June 1 and July 27, the date of analysis. After controlling for potential confounders as age and comorbidities, we found a significant 1.51 fold (95% CI, 1.38-1.66) increased risk for infection for early vaccinees compared to those vaccinated later that was similar across all ages groups. The increased risk reached 2.26- fold (95% CI, 1.80-3.01) when comparing those who were vaccinated in January to those vaccinated in April. This preliminary finding of vaccine waning as a factor of time from vaccince should prompt further investigations into long-term protection against different strains.
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Affiliation(s)
| | - Roni Lotan
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel.
| | | | - Asaf Peretz
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel
- Internal Medicine COVID-19 Ward, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Galit Perez
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel
| | - Amir Ben-Tov
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Tel Aviv, 68125, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
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34
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Ben-Tov A, Banon T, Chodick G, Kariv R, Assa A, Gazit S. BNT162b2 Messenger RNA COVID-19 Vaccine Effectiveness in Patients With Inflammatory Bowel Disease: Preliminary Real-World Data During Mass Vaccination Campaign. Gastroenterology 2021; 161:1715-1717.e1. [PMID: 34224740 PMCID: PMC8252826 DOI: 10.1053/j.gastro.2021.06.076] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Amir Ben-Tov
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel; Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Tamar Banon
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Gabriel Chodick
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Revital Kariv
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Gastroenterology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Amit Assa
- Department of Pediatrics, Assuta Ashdod University Hospital, Ashdod, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sivan Gazit
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
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35
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Grupel D, Gazit S, Schreiber L, Nadler V, Wolf T, Lazar R, Supino-Rosin L, Perez G, Peretz A, Ben Tov A, Mizrahi-Reuveni M, Chodick G, Patalon T. Kinetics of SARS-CoV-2 anti-S IgG after BNT162b2 vaccination. Vaccine 2021; 39:5337-5340. [PMID: 34393018 PMCID: PMC8354802 DOI: 10.1016/j.vaccine.2021.08.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/04/2021] [Accepted: 08/07/2021] [Indexed: 01/30/2023]
Abstract
Deployment of the BNT162b2 mRNA Covid-19 Vaccine in Israel began in December 2020. This is a retrospective analysis of serological data, showing SARS-CoV-2 anti-S IgG kinetics in 116 Israeli health care workers receiving BNT162b2. Sero-conversion occurred in 14 days in all study participants, with IgG levels peaking approximately 30 days after initiation of the vaccination series. A statistically significant difference was observed in IgG levels between subjects younger than 50 years and older participants, although in all cases, IgG levels were well above the level considered reactive by the test's manufacturer. The importance of this difference needs to be studied further, but a potential difference in vaccine efficacy and vaccine effect length could possibly be present between these two groups.
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Affiliation(s)
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Israel
| | - Licita Schreiber
- Maccabi Healthcare Services, Central Laboratory, Rehovot, Israel
| | - Varda Nadler
- Maccabi Healthcare Services, Central Laboratory, Rehovot, Israel
| | - Tamar Wolf
- Maccabi Healthcare Services, Central Laboratory, Rehovot, Israel
| | - Rachel Lazar
- Maccabi Healthcare Services, Central Laboratory, Rehovot, Israel
| | - Lia Supino-Rosin
- Maccabi Healthcare Services, Central Laboratory, Rehovot, Israel
| | - Galit Perez
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Israel
| | - Asaf Peretz
- Internal Medicine COVID-19 Ward, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Amir Ben Tov
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research & Innovation Center, Maccabi Healthcare Services, Israel
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Shmueli E, Mansuri R, Porcilan M, Amir T, Yosha L, Yechezkel M, Patalon T, Handelman-Gotlib S, Gazit S, Yamin D. A multi-layer model for the early detection of COVID-19. J R Soc Interface 2021; 18:20210284. [PMID: 34343454 PMCID: PMC8331231 DOI: 10.1098/rsif.2021.0284] [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: 04/03/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022] Open
Abstract
Current COVID-19 screening efforts mainly rely on reported symptoms and the potential exposure to infected individuals. Here, we developed a machine-learning model for COVID-19 detection that uses four layers of information: (i) sociodemographic characteristics of the individual, (ii) spatio-temporal patterns of the disease, (iii) medical condition and general health consumption of the individual and (iv) information reported by the individual during the testing episode. We evaluated our model on 140 682 members of Maccabi Health Services who were tested for COVID-19 at least once between February and October 2020. These individuals underwent, in total, 264 516 COVID-19 PCR tests, out of which 16 512 were positive. Our multi-layer model obtained an area under the curve (AUC) of 81.6% when evaluated over all the individuals in the dataset, and an AUC of 72.8% when only individuals who did not report any symptom were included. Furthermore, considering only information collected before the testing episode-i.e. before the individual had the chance to report on any symptom-our model could reach a considerably high AUC of 79.5%. Our ability to predict early on the outcomes of COVID-19 tests is pivotal for breaking transmission chains, and can be used for a more efficient testing policy.
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Affiliation(s)
- Erez Shmueli
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel
- MIT Media Lab, Cambridge, MA 02139-4307, USA
| | - Ronen Mansuri
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Matan Porcilan
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Tamar Amir
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Lior Yosha
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Matan Yechezkel
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel
| | - Tal Patalon
- Kahn Sagol Maccabi (KSM) Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Sharon Handelman-Gotlib
- Kahn Sagol Maccabi (KSM) Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Sivan Gazit
- Kahn Sagol Maccabi (KSM) Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Dan Yamin
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 69978, Israel
- Center for Combatting Pandemics, Tel Aviv University, Tel Aviv 6997801, Israel
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Chodick G, Tene L, Patalon T, Gazit S, Ben Tov A, Cohen D, Muhsen K. Assessment of Effectiveness of 1 Dose of BNT162b2 Vaccine for SARS-CoV-2 Infection 13 to 24 Days After Immunization. JAMA Netw Open 2021; 4:e2115985. [PMID: 34097044 PMCID: PMC8185600 DOI: 10.1001/jamanetworkopen.2021.15985] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE The BNT162b2 vaccine showed high efficacy against COVID-19 in a phase III randomized clinical trial. A vaccine effectiveness evaluation in a real-world setting is needed. OBJECTIVE To assess the short-term effectiveness of the first dose of the BNT162b2-vaccine against SARS-CoV-2 infection 13 to 24 days after immunization in a real-world setting. DESIGN, SETTING, AND PARTICIPANTS This comparative effectiveness study used data from a 2.6 million-member state-mandated health care system in Israel. Participants included all individuals aged 16 years and older who received 1 dose of the BNT162b2 vaccine between December 19, 2020, and January 15, 2021. Data were analyzed in March 2021. EXPOSURE Receipt of 1 dose of the BNT162b2 vaccine. MAIN OUTCOMES AND MEASURES Information was collected regarding medical history and positive SARS-CoV-2 polymerase chain reaction test and COVID-19 symptoms from 1 day after first vaccine to January 17, 2021. Daily and cumulative infection rates in days 13 to 24 were compared with days 1 to 12 after the first dose using Kaplan-Meier survival analysis and generalized linear models. RESULTS Data for 503 875 individuals (mean [SD] age, 59.7 [14.7] years; 263 228 [52.4%] women) were analyzed, of whom 351 897 had follow-up data for days 13 to 24. The cumulative incidence of SARS-CoV-2 infection was 2484 individuals (0.57%) during days 1 through 12 and 614 individuals (0.27%) in days 13 through 24. The weighted mean (SE) daily incidence of SARS-CoV-2 infection in days 1 through 12 was 43.41 (12.07) infections per 100 000 population and 21.08 (6.16) infections per 100 000 population in days 13 through 24, a relative risk reduction (RRR) of 51.4% (95% CI, 16.3%-71.8%). The decrease in incidence was evident from day 18 after the first dose. Similar RRRs were calculated in individuals aged 60 years or older (44.5%; 95% CI, 4.1%-67.9%), those younger than 60 years (50.2%; 95% CI, 14.1%-71.2%), women (50.0%; 95% CI, 13.5%-71.0%), and men (52.1%; 95% CI, 17.3%-72.2%). Findings were similar in subpopulations (eg, ultraorthodox Jewish: RRR, 53.5% [95% CI, 19.2%-73.2%]) and patients with various comorbidities (eg, cardiovascular diseases: RRR, 47.2% [95% CI, 7.8%-69.8%]). Vaccine effectiveness against symptomatic COVID-19 was 54.4% (95% CI, 21.4%-73.6%). CONCLUSIONS AND RELEVANCE In this comparative effectiveness study of a single dose of the BNT162b2 vaccine, results were comparable to that of the phase III randomized clinical trial.
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Affiliation(s)
- Gabriel Chodick
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lilac Tene
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Tal Patalon
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Sivan Gazit
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Amir Ben Tov
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Dani Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Chodick G, Tene L, Rotem RS, Patalon T, Gazit S, Ben-Tov A, Weil C, Goldshtein I, Twig G, Cohen D, Muhsen K. The effectiveness of the TWO-DOSE BNT162b2 vaccine: analysis of real-world data. Clin Infect Dis 2021; 74:472-478. [PMID: 33999127 PMCID: PMC8240867 DOI: 10.1093/cid/ciab438] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [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: 04/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background COVID-19 mRNA vaccines were shown to be highly efficacious in preventing the
disease in randomized controlled trials; nonetheless, evidence on the
real-world effectiveness of this vaccine is limited. Study objective was to
evaluate the effectiveness of BNT162b2 vaccine in preventing SARS-CoV-2
infection and COVID-19-related hospitalization and mortality. Methods This historical cohort study included members of a large health provider in
Israel that were vaccinated with at least one dose of BNT162b2. The primary
outcome was incidence rate of a SARS-CoV-2 infection confirmed with rt-PCR,
between 7 to 27 days after second dose (protection-period), as compared to
days 1 to 7 after the first dose, where no protection by the vaccine is
assumed (reference-period). Results Data of 1,178,597 individuals vaccinated with BNT162b2 were analyzed (mean
age 47.7 years [SD=18.1], 48.4% males) of whom 872,454 (74.0%) reached the
protection period. Overall, 4514 infections occurred during the reference
period compared to 728 during the protection period, yielding a weighted
mean daily incidence of 54.8 per 100,000 (95%CI: 26.1-115.0 per 100,000) and
5.4 per 100,000 (95%CI: 3.5-8.4 per 100,000), respectively. The vaccine
effectiveness in preventing infection was 90% (95%CI:79%- 95%) and 94%
(95%CI:88%-97%) against COVID-19. Among immunosuppressed patients, vaccine
effectiveness against infection was 71% (95%CI:37%-87%). The adjusted hazard
ratios for hospitalization in those infected were 0.82 (95%CI:0.36-1.88),
0.45 (95%CI:0.23-0.90), and 0.56 (95%CI:0.36-0.89) in the age groups 16-44,
45-64 and 75 and above, respectively. Conclusions The effectiveness of the BNT162b2 vaccine is comparable to the one reported
in the phase III clinical trial.
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Affiliation(s)
- Gabriel Chodick
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Kaufman 4, Tel, Aviv Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel
| | - Lilac Tene
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Kaufman 4, Tel, Aviv Israel
| | - Ran S Rotem
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Kaufman 4, Tel, Aviv Israel.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Tal Patalon
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Kaufman 4, Tel, Aviv Israel
| | - Sivan Gazit
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Kaufman 4, Tel, Aviv Israel
| | - Amir Ben-Tov
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Kaufman 4, Tel, Aviv Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel
| | - Clara Weil
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Kaufman 4, Tel, Aviv Israel
| | - Inbal Goldshtein
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Kaufman 4, Tel, Aviv Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel
| | - Gilad Twig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel.,Israel Defense Forces Medical Corps, Ramat-Gan, Israel.,Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Institute of Endocrinology, Sheba Medical Center, Ramat-Gan, Israel
| | - Dani Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel
| | - Khitam Muhsen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel
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Levine-Tiefenbrun M, Yelin I, Katz R, Herzel E, Golan Z, Schreiber L, Wolf T, Nadler V, Ben-Tov A, Kuint J, Gazit S, Patalon T, Chodick G, Kishony R. Initial report of decreased SARS-CoV-2 viral load after inoculation with the BNT162b2 vaccine. Nat Med 2021; 27:790-792. [PMID: 33782619 DOI: 10.1038/s41591-021-01316-7] [Citation(s) in RCA: 319] [Impact Index Per Article: 106.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/09/2021] [Indexed: 01/12/2023]
Abstract
Beyond their substantial protection of individual vaccinees, coronavirus disease 2019 (COVID-19) vaccines might reduce viral load in breakthrough infection and thereby further suppress onward transmission. In this analysis of a real-world dataset of positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test results after inoculation with the BNT162b2 messenger RNA vaccine, we found that the viral load was substantially reduced for infections occurring 12-37 d after the first dose of vaccine. These reduced viral loads hint at a potentially lower infectiousness, further contributing to vaccine effect on virus spread.
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Affiliation(s)
| | - Idan Yelin
- Faculty of Biology, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Rachel Katz
- Maccabitech, Maccabi Health Services, Tel Aviv, Israel
| | - Esma Herzel
- Maccabitech, Maccabi Health Services, Tel Aviv, Israel
| | - Ziv Golan
- Maccabi Mega-Lab, Maccabi Healthcare Services, Rehovot, Israel
| | | | - Tamar Wolf
- Maccabi Mega-Lab, Maccabi Healthcare Services, Rehovot, Israel
| | - Varda Nadler
- Maccabi Mega-Lab, Maccabi Healthcare Services, Rehovot, Israel
| | - Amir Ben-Tov
- Maccabitech, Maccabi Health Services, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Jacob Kuint
- Maccabitech, Maccabi Health Services, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Sivan Gazit
- Maccabitech, Maccabi Health Services, Tel Aviv, Israel
| | - Tal Patalon
- Maccabitech, Maccabi Health Services, Tel Aviv, Israel
| | - Gabriel Chodick
- Maccabitech, Maccabi Health Services, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Roy Kishony
- Faculty of Biology, Technion - Israel Institute of Technology, Haifa, Israel. .,Faculty of Computer Science, Technion - Israel Institute of Technology, Haifa, Israel.
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Sidorenko P, Dikopoltsev A, Zahavy T, Lahav O, Gazit S, Shechtman Y, Szameit A, Tannor DJ, Eldar YC, Segev M, Cohen O. Improving techniques for diagnostics of laser pulses by compact representations. Opt Express 2019; 27:8920-8934. [PMID: 31052703 DOI: 10.1364/oe.27.008920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/09/2019] [Indexed: 06/09/2023]
Abstract
We propose and demonstrate, numerically and experimentally, use of sparsity as prior information for extending the capabilities and performance of techniques and devices for laser pulse diagnostics. We apply the concept of sparsity in three different applications. First, we improve a photodiode-oscilloscope system's resolution for measuring the intensity structure of laser pulses. Second, we demonstrate the intensity profile reconstruction of ultrashort laser pulses from intensity autocorrelation measurements. Finally, we use a sparse representation of pulses (amplitudes and phases) to retrieve measured pulses from incomplete spectrograms of cross-correlation frequency-resolved optical gating traces.
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Gazit S, Elkana O, Dawidowicz L, Yeshayahu L, Biran I. Downwards Vertical Attention Bias in Conversion Disorder vs Controls: A Pilot Study. Psychosomatics 2017; 58:633-642. [PMID: 28844417 DOI: 10.1016/j.psym.2017.07.004] [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] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 07/04/2017] [Accepted: 07/06/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Conversion disorder (CD) is a largely enigmatic disorder, one that requires a thorough ruling-out process. Prior research suggests that metaphors and conceptualization are rooted in physical experience, and that we interpret our affective world through metaphors. Spatial metaphors (interaction of affect and vertical space) are a prominent example of the grounding of metaphors. This is a relatively unpaved direction of research of CD. OBJECTIVES The present pilot study sought to explore this view by investigating the "healthy is up, sick is down" spatial metaphors (e.g., "fell ill" and "top shape") in patients with CD, examining the correlation between the processing of bodily-related words, CD, and vertical space. We hypothesized that patients with CD, who experience their bodies as ill, will demonstrate a downwards bias when processing bodily-related words; corresponding to the "healthy is up, sick is down" spatial metaphor. METHODS A total of 8 female patients (ages M-38.13 SD-10.44) and 42 female controls (ages M-36.4 SD-14.57) performed a visual attention task. Participants were asked to identify a spatial probe at the top or the bottom of a screen, following either a bodily related (e.g., arm) or non-bodily related (e.g., clock) prime word. RESULTS As predicted, when processing bodily-related words, patients with CD demonstrated a downwards attention bias. Moreover, the higher the patient's level of somatization, the faster the patient detected lower (vs upper) spatial targets. CONCLUSIONS This study suggests that the changed health paradigm of patients with CD is grounded in sensorimotor perception. Further research could propose new diagnostic and treatment options for CD.
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Affiliation(s)
- Sivan Gazit
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Odelia Elkana
- Department of Behavioral Sciences, Academic College of Tel Aviv-Yafo, Tel-Aviv, Israel
| | - Liraz Dawidowicz
- Department of Behavioral Sciences, Academic College of Tel Aviv-Yafo, Tel-Aviv, Israel
| | - Liel Yeshayahu
- Department of Behavioral Sciences, Academic College of Tel Aviv-Yafo, Tel-Aviv, Israel
| | - Iftah Biran
- Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Szameit A, Shechtman Y, Osherovich E, Bullkich E, Sidorenko P, Dana H, Steiner S, Kley EB, Gazit S, Cohen-Hyams T, Shoham S, Zibulevsky M, Yavneh I, Eldar YC, Cohen O, Segev M. Sparsity-based single-shot subwavelength coherent diffractive imaging. Nat Mater 2012; 11:455-9. [PMID: 22466747 DOI: 10.1038/nmat3289] [Citation(s) in RCA: 24] [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] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 02/29/2012] [Indexed: 05/08/2023]
Abstract
Coherent Diffractive Imaging (CDI) is an algorithmic imaging technique where intricate features are reconstructed from measurements of the freely diffracting intensity pattern. An important goal of such lensless imaging methods is to study the structure of molecules that cannot be crystallized. Ideally, one would want to perform CDI at the highest achievable spatial resolution and in a single-shot measurement such that it could be applied to imaging of ultrafast events. However, the resolution of current CDI techniques is limited by the diffraction limit, hence they cannot resolve features smaller than one half the wavelength of the illuminating light. Here, we present sparsity-based single-shot subwavelength resolution CDI: algorithmic reconstruction of subwavelength features from far-field intensity patterns, at a resolution several times better than the diffraction limit. This work paves the way for subwavelength CDI at ultrafast rates, and it can considerably improve the CDI resolution with X-ray free-electron lasers and high harmonics.
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Affiliation(s)
- A Szameit
- Physics Department and Solid State Institute, Technion, Haifa 32000, Israel
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Perkas N, Amirian G, Dubinsky S, Gazit S, Gedanken A. Ultrasound-assisted coating of nylon 6,6 with silver nanoparticles and its antibacterial activity. J Appl Polym Sci 2007. [DOI: 10.1002/app.24728] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Litz RE, Knight RL, Gazit S. Somatic embryos from culture ovules of polyembryonic Mangifera indica L. Plant Cell Rep 1982; 1:264-266. [PMID: 24257771 DOI: 10.1007/bf00272635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/1982] [Indexed: 06/02/2023]
Abstract
Ovules were aseptically removed from 2 month old fruits of 9 naturally polyembryonic cultivars and 1 monoembryonic cultivar of mango (Mangifera indica L.). Ovules were placed into culture on solid Murashige and Skoog medium that had been modified by the addition of half strength major salts and chelated iron, 6% sucrose, 400 mg/l glutamine, 100 mg/l ascorbic acid with or without the following growth regulators: 20% (v/v) CW, 1 or 2 mg/1 BA. Somatic embryogenesis occurred from the nucellus excised from the ovules of 5 of the naturally polyembryonic cultivars after 1-2 months in culture. Somatic embryogenesis was not apparently affected by the growth regulator composition of the media; however, efficient somatic embryogenesis only occurred in liquid containing 20% CW.
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Affiliation(s)
- R E Litz
- Institute of Food and Agricultural Sciences, University of Florida Agricultural Research and Education Center, 33031, Homestead, FL, USA
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