Differences in clinical outcomes of COVID-19 among vaccinated and unvaccinated kidney transplant recipients

IntroductionThe remarkable efficacy and effectiveness of COVID-19 vaccines have been described in healthy individuals, but kidney transplant recipients have been excluded from these studies. Therefore, real-world evidence of these vaccines can guide clinicians in predicting complications in kidney transplant recipients and how many doses of vaccines are protective. In this study, we aimed to investigate the impact of the COVID-19 vaccines on kidney transplant recipients with SARS-CoV-2 infection.Material and methodThis matched case-control study included vaccinated kidney transplant recipients with COVID-19 from two centers between 1 May and 1 October 2021. All patients in the vaccinated group received a minimum of two doses of the vaccine and were diagnosed with COVID-19 at least one month after the last dose. Each vaccinated patient was matched with an unvaccinated kidney transplant recipient diagnosed with COVID. The endpoints were all-cause mortality, hospitalization, intensive care unit admission, acute kidney injury, cytokine storm, and acute respiratory distress syndrome.ResultsThe median age of vaccinated seventy-two participants was 45 years, and 41 of the participants were men in the vaccinated group. Four patients in the vaccinated group and nine patients in the control group died during follow-up (p = 0.247). Seventeen patients in the vaccinated group, thirty-four participants in the control group were hospitalized (p = 0.004); five vaccinated patients and ten unvaccinated patients were followed-up in the ICU during follow-up (p = 0.168). Thirteen of the vaccinated and twelve unvaccinated patients developed acute kidney injury (p = 0.16). The occurrence of cytokine storm (n = 4 vs. n = 11; p = 0.061) and acute respiratory distress syndrome (n = 5 vs. n = 10; p = 0.168) was higher in the patient group compared to the control group.ConclusionCOVID-19 remains a fatal disease despite advancing treatment modalities and preventive strategies. COVID-19 vaccines can't prevent death in all kidney transplant recipients, but they decrease hospitalization rate and duration in most patients.     

Evaluation of weekly COVID-19 vaccination and case data supports negative correlation between incidence and vaccination in German federal states and cities during 4th wave

Global efforts have been made to end the COVID-19 pandemic. Among other things, various vaccines against SARS-CoV-2, partly based on novel principles, have been developed internationally within a short time.While initially the hardly available vaccines were distributed according to criteria according to defined priorities, in Germany, after the prioritization has been lifted, attempts are being made to provide as many people as possible with vaccinations.The study examines the relationship between vaccination and incidence in 16 German federal states and city states using data from the Robert Koch Institute (RKI).Clear trends became apparent, showing a negative correlation between the vaccination rate and the infection incidence. This indicates that during the 4th corona wave in Germany, the lower the incidence, the higher the vaccination rate.     

Immunocompromise among vaccinated versus unvaccinated COVID-19 cases admitted to critical care in Ireland,July to October 2021

As the COVID-19 pandemic progressed, so too did the proportion of cases admitted to critical care in Ireland who were fully vaccinated. Reporting of this observation has public health implications as incorrect interpretation may affect public confidence in COVID-19 vaccines. A potential explanation is the reduced ability of those who are immunocompromised to produce an adequate, sustained immune response to vaccination. We conducted an analysis of the association between COVID-19 vaccination status and underlying degree of immunocompromise among a cohort of critical care patients all with a confirmed diagnosis of COVID-19 admitted to critical care between July and October 2021. Multinomial logistic regression was used to estimate an odds ratio of immunocompromise among vaccinated COVID-19 cases in critical care compared to unvaccinated cases. In this study, we found a statistically significant association between the vaccination status of severe COVID-19 cases requiring critical care admission and underlying immunocompromise. Fully vaccinated patients were significantly more likely to be highly (OR = 19.3, 95 % CI 7.7–48.1) or moderately immunocompromised (OR = 9.6, 95 % CI 5.0–18.1) compared to unvaccinated patients with COVID-19. These findings support our hypothesis, that highly immunocompromised patients are less likely to produce an adequate and sustained immune response to COVID-19 vaccination, and are therefore more likely to require critical care admission for COVID-19 infection.     

Impact of COVID-19 vaccination in post-COVID cardiac complications

BackgroundAfter the acute infection, COVID-19 can produce cardiac complications as well as long-COVID persistent symptoms. Although vaccination against COVID-19 represented a clear reduction in both mortality and ICU admissions, there is very little information on whether this was accompanied by a decrease in the prevalence of post-COVID cardiac complications. The aim of this study was to analyze the relationship between COVID-19 vaccination and the prevalence of post-COVID cardiac injury assessed by echocardiogram, and long-COVID persistent cardiac symptoms. Methods: All patients who consulted for post-COVID evaluation 14 days after discharge from acute illness were included. Patients with heart disease were excluded. The relationship between complete vaccination scheme (at least two doses applied with 14 days or more since the last dose) and pathological echocardiographic findings, as well as the relationship of vaccination with persistent long-COVID symptoms, were evaluated by multivariate analysis, adjusting for age, sex and clinical variables that would have shown significant differences in univariate analysis. Results: From 1883 patients, 1070 patients (56.8%) suffered acute COVID-19 without a complete vaccination scheme. Vaccination was associated with lower prevalence of cardiac injury (1.35% versus 4.11%, adjusted OR 0.33; 95% CI 0.17–0.65, p=0.01). In addition, vaccinated group had a lower prevalence of persistent long-COVID symptoms compared to unvaccinated patients (10.7% versus 18.3%, adjusted OR 0.52; 95% CI 0.40–0.69, p<0.001). Conclusion: Vaccination against COVID-19 was associated with lower post-COVID cardiac complications and symptoms, reinforcing the importance of fully vaccinating the population.     

Intention to participate in a COVID-19 vaccine clinical trial and to get vaccinated against COVID-19 in France during the pandemic

IntroductionThe world is facing the COVID-19 pandemic. The development of a vaccine is challenging. We aimed to determine the proportion of people who intend to get vaccinated against COVID-19 in France or to participate in a vaccine clinical trial.MethodsWe conducted an anonymous on-line survey from the 26th of March to the 20th of April 2020. Primary endpoints were the intention to get vaccinated against COVID-19 if a vaccine was available or participate in a vaccine clinical trial.ResultsThree thousand two hundred and fifty nine individuals answered the survey; women accounted for 67.4% of the respondents. According to their statements, 2.512 participants (77.6%, 95% CI 76.2–79%) will certainly or probably agree to get vaccinated against COVID-19. Older age, male gender, fear about COVID-19, being a healthcare worker and individual perceived risk were associated with COVID-19 vaccine acceptance. Vaccine hesitancy was associated with a decrease in COVID-19 vaccine acceptance. One thousand and five hundred and fifty respondents (47.6% 95% CI 45.9–49.3%) will certainly or probably agree to participate in a COVID-19 vaccine clinical trial. Older age, male gender, being a healthcare worker and individual perceived risk were associated with potential acceptance to participate in a COVID-19 vaccine clinical trial. Vaccine hesitancy was associated with refusal for participation in a COVID-19 vaccine clinical trial.ConclusionsNearly 75% and 48% of the survey respondents were respectively likely to accept vaccination or participation in a clinical trial against COVID-19. Vaccine hesitancy will be the major barrier to COVID-19 vaccine uptake.     

Specialist confirmed allergic reactions to COVID-19 mRNA vaccines at a mass vaccination site

Healthcare providers can play a key role in reaching the target for vaccine uptake through educating the public on the risk may be of severe allergic reactions to COVID-19 vaccines. Thus, it is important to resolve reports in the literature which present conflicting data on vaccine safety. We performed a prospective study of Pfizer-BioNTech vaccinations administered at the Albany Community Vaccination Center. All potential vaccinees to the site were screened for allergic history prior to triage by a board-certified allergist. In the first 14 days of operation, our site vaccinated 14,655 individuals, 3.9% of which had a personal history of anaphylaxis. While some vaccine recipients had non-allergic complications, none of the visitors suffered any objective, immediate allergic symptoms. Our findings indicate that specialist-confirmed rates of immediate allergic reaction to mRNA SARS-CoV-2 vaccination are far lower than self-reported rates defined by subjective, unconfirmed symptoms.     

新型冠状病毒疫苗接种对成都市境外输入病例流行病学及临床特征的影响分析

目的:分析新型冠状病毒（新冠病毒）疫苗接种对成都市境外输入病例流行病学及临床特征的影响,为新型冠状病毒肺炎疫情防控提供参考依据。方法:截至2021年4月15日,经成都市入境的新冠病毒感染病例,根据新冠病毒疫苗接种史被分为疫苗接种组和疫苗未接种组。回顾性收集和分析病例的流行病学及临床特征资料。实验室检测项目包括新冠病毒核...     

COVID-19 vaccination rates vary by community vulnerability: A county-level analysis

We used the COVID-19 Community Vulnerability Index and 7 theme scores to assess associations between vulnerability and county-level COVID-19 vaccination (n = 2415 counties) through May 25th, 2021. When comparing vaccination rates among quintiles of CCVI scores, Theme 3 (housing type, transportation, household composition, and disability) was associated with the largest disparity, with the least vulnerable counties (Q1) having 33% higher rates of vaccination among individuals aged 18+ (53.5% vs 40.2%) compared to counties with the highest vulnerability (Q5). Using generalized linear models with binomial distributions and log links, we found that a 10-point increase in the CCVI index, socioeconomic vulnerability, housing type and composition, and epidemiological factors were associated with at least a 1.0 percentage point decline in county-level vaccination. The association between community vulnerability and lower vaccination rates suggests the need for continued efforts for equitable COVID-19 vaccination across marginalized communities.     

Occupation,Worker Vulnerability,and COVID-19 Vaccination Uptake: Analysis of the Virus Watch prospective cohort study

BackgroundOccupational disparities in COVID-19 vaccine uptake can impact the effectiveness of vaccination programmes and introduce particular risk for vulnerable workers and those with high workplace exposure. This study aimed to investigate COVID-19 vaccine uptake by occupation, including for vulnerable groups and by occupational exposure status.MethodsWe used data from employed or self-employed adults who provided occupational information as part of the Virus Watch prospective cohort study (n = 19,595) and linked this to study-obtained information about vulnerability-relevant characteristics (age, medical conditions, obesity status) and work-related COVID-19 exposure based on the Job Exposure Matrix. Participant vaccination status for the first, second, and third dose of any COVID-19 vaccine was obtained based on linkage to national records and study records. We calculated proportions and Sison-Glaz multinomial 95% confidence intervals for vaccine uptake by occupation overall, by vulnerability-relevant characteristics, and by job exposure.FindingsVaccination uptake across occupations ranged from 89-96% for the first dose, 87–94% for the second dose, and 75–86% for the third dose, with transport, trade, service and sales workers persistently demonstrating the lowest uptake. Vulnerable workers tended to demonstrate fewer between-occupational differences in uptake than non-vulnerable workers, although clinically vulnerable transport workers (76%-89% across doses) had lower uptake than several other occupational groups (maximum across doses 86%–96%). Workers with low SARS-CoV-2 exposure risk had higher vaccine uptake (86%-96% across doses) than those with elevated or high risk (81–94% across doses).InterpretationDifferential vaccination uptake by occupation, particularly amongst vulnerable and highly-exposed workers, is likely to worsen occupational and related socioeconomic inequalities in infection outcomes. Further investigation into occupational and non-occupational factors influencing differential uptake is required to inform relevant interventions for future COVID-19 booster rollouts and similar vaccination programmes.     

Hesitation of the Tunisian population to COVID-19 vaccination,and its associated factors

Background: Many people are reluctant to be vaccinated against COVID-19. Aim: To determine the intention to accept COVID19 vaccine and its associated factors among Tunisians. Methods: We conducted a cross-sectional study among Tunisians from December 2020 to January 2021 using an online questionnaire. Factors associated with intention to accept coronavirus vaccine were analysed using multinomial logistic regression. Results: In total, 169 Tunisians participated in our study. The majority were female (85.2%). The mean age was 48.3 ± 11.8 years. Only 33.1% intended to accept to be vaccinated when COVID-19 vaccine will be available in Tunisia and 22.5% were still hesitant. In multinomial logistic regression, participants having high or very high perceived personal risk of COVID-19 infection (aOR:3.257, 95% CI :1.204 – 8.815) were more prone to hesitate to accept COVID-19 vaccine rather than those being willing to accept it. Respondents undergoing seasonal influenza vaccination (aOR: 0.091, 95% CI : 0.019 – 0.433)were less prone to refuse COVID-19 vaccine rather than those being willing to accept it. Young ones aged less than 40 years (aOR: 4.324, 95% CI: 1.180 – 15.843) were more prone to refuse COVID-19 vaccine rather than those being willing to accept it. Conclusion: The acceptance rate of coronavirus vaccination was moderate. Therefore, a good communication and health education at a community level are needed.     

新型冠状病毒肺炎与吸烟的相关性研究进展

目的 着重从新型冠状病毒肺炎（Coronavirus disease 2019 ,COVID-19）患者的吸烟率、吸烟对COVID-19患者预后的影响、吸烟与严重急性呼吸综合征冠状病毒2（Severe acute respiratory syndrome coronavirus 2，SARS-CoV-2）感染机制这三个层面阐述了COVID-19与吸烟的最新潜在关系，为COVID-19与吸烟关系的进一步研究提供理论参考。方法 提取世界卫生组织报道的COVID-19最新资料，检索PubMed和中国知网数据库2000年至2021年间收录的与吸烟和COVID-19相关的文章进行综述。结果 吸烟的COVID-19患者发展为重症和出现死亡的风险更高，但关于COVID-19在吸烟者中的发病率是否比非吸烟者高，即吸烟是否会增加SARS-CoV-2感染风险，尚无定论和结论。结论 目前关于COVID-19与吸烟的研究仍处于初级阶段，在将来需要完善更多的分子、细胞水平实验和进行更严谨的调查研究，这将使COVID-19患者获益，尤其是吸烟的COVID-19患者。     

COVID-19疫情下肺结核病人的COVID-19疫苗接种策略

COVID-19疫情流行形势依旧严峻,对于疫苗的普及接种刻不容缓。肺结核是中国高发的慢性传染病,由于病发肺部,肺结核患者合并感染COVID-19之后病情更重,治疗效果差。而目前对于肺结核患者接种COVID-19疫苗的保护效力、免疫原性及安全性仍知之甚少,也缺乏相应的循证医学证据。本文回顾了肺结核的发病机制与流行病学,探讨了肺结核患者体内的免疫状态,对目前国内外已有的对肺结核患者疫苗接种的提议进行了总结,同时结合其他特殊人群已有的疫苗接种的临床研究进行分析,探讨了COVID-19疫情下肺结核病人的疫苗接种策略和开展以肺结核患者为目标人群的COVID-19疫苗临床研究的必要性。     

Number of COVID-19 hospitalisations averted by vaccination: Estimates for the Netherlands,January 6, 2021 through August 30, 2022

BackgroundVaccines against COVID-19 have proven effective in preventing COVID-19 hospitalisation. In this study, we aimed to quantify part of the public health impact of COVID-19 vaccination by estimating the number of averted hospitalisations. We present results from the beginning of the vaccination campaign (‘entire period’, January 6, 2021) and a subperiod starting at August 2, 2021 (‘subperiod’) when all adults had the opportunity to complete their primary series, both until August 30, 2022.MethodsUsing calendar-time specific vaccine effectiveness (VE) estimates and vaccine coverage (VC) by round (primary series, first booster and second booster) and the observed number of COVID-19 associated hospitalisations, we estimated the number of averted hospitalisations per age group for the two study periods. From January 25, 2022, when registration of the indication of hospitalisation started, hospitalisations not causally related to COVID-19 were excluded.ResultsIn the entire period, an estimated 98,170 (95 % confidence interval (CI) 96,123–99,928) hospitalisations were averted, of which 90,753 (95 % CI 88,790–92,531) were in the subperiod, representing 57.0 % and 67.9 % of all estimated hospital admissions. Estimated averted hospitalisations were lowest for 12–49-year-olds and highest for 70–79-year-olds. More admissions were averted in the Delta period (72.3 %) than in the Omicron period (63.4 %).ConclusionCOVID-19 vaccination prevented a large number of hospitalisations. Although the counterfactual of having had no vaccinations while maintaining the same public health measures is unrealistic, these findings underline the public health importance of the vaccination campaign to policy makers and the public.     

COVID-19 differentiated measures for unvaccinated individuals: The need for clear goals and strong justifications

Numerous countries and jurisdictions have implemented differential COVID-19 public health restrictions based on individual vaccination status to mitigate the public health risks posed by unvaccinated individuals. Although it is scientifically and ethically justifiable to introduce such vaccination-based differentiated measures as a risk-based approach to resume high-risk activities in an ongoing pandemic, their justification is weakened by lack of clarity on their intended goals and the specific risks or potential harms they intend to mitigate. Furthermore, the criteria for the removal of differentiated measures may not be clear, which raises the possibility of shifting goalposts without clear justification and with potential for unfairly discriminatory consequences. This paper seeks to clarify the ethical justification of COVID-19 vaccination-based differentiated measures based on a public health risk-based approach, with focus on their deployment in domestic settings. We argue that such measures should be consistent with the principal goal of COVID-19 vaccination programmes, which is to reduce the incidence of severely ill patients and associated healthcare burdens so as to protect a health system. We provide some considerations for the removal of vaccination-based differentiated measures based on this goal.     

Influenza vaccination in the time of COVID-19: A national U.S. survey of adults

IntroductionDecisions about influenza vaccination for fall-winter 2020 were made against the backdrop of the COVID-19 pandemic. During May 2020, the authors examined intended vaccination in the next 12 months in relationship to demographic variables, healthcare attitudes, and personal COVID-19 experiences for two samples of adults--those who did not receive influenza vaccine during the prior 12 months, and those who did.MethodsIn May 2020, a cross-sectional online survey was conducted with a national US sample. Participants reported prior influenza vaccination (yes/no during prior 12 months) and anticipated vaccination (yes/no during next 12 months). Covariates included demographic characteristics (e.g., gender, race-ethnicity, political ideology), general beliefs (e.g., benefits of vaccines, altruistic attitudes), and COVID-19 health beliefs and experiences (COVID-19 worry and severity, perception of COVID-19 as a community threat, knowing someone with COVID-19). For each group, hierarchical multivariable logistic regression was conducted with intent to vaccinate as the outcome.ResultsAmong participants (n = 3502), 47% did not receive influenza vaccine in the prior 12 months and 53% had; 25.5% of non-vaccinators and 91.9% of vaccinators intended future vaccination. For non-vaccinators, odds of intending vaccination was associated with race/ethnicity (Hispanics were more likely to intend than white-NH; AOR = 1.74; 95% CI = 1.23–2.4), greater perceived benefits of vaccination (AOR = 2.19; 95% CI = 1.88–2.54), and perception of COVID-19 as a community threat (AOR = 1.91; 95% CI = 1.49–2.45). For vaccinators, odds of intending vaccination was associated with age (AOR = 1.04; 95% CI = 1.03–1.05), race/ethnicity (Black-NH and Other-NH were less likely to intend than white-NH, AOR = 0.60; 95% CI = 0.36–0.999; and AOR = 0.45; 95% CI = 0.24–0.84, respectively), greater perceived benefits of vaccination (AOR = 1.88; 95% CI = 1.45–2.45) and greater perception of collective benefits of vaccines (AOR = 1.48; 95% CI = 1.15–1.90).ConclusionsThe COVID-19 pandemic may have served as a cue to action for influenza vaccination intention among some prior non-vaccinators whereas intention among prior vaccinators is more related to positive attitudes toward vaccination.     

Persistent SARS-COV-2 infection in vaccinated individual with three doses of COVID-19 vaccine

We describe a case of a 24-year-old Brazilian woman previously vaccinated with CoronaVac and a booster dose of Pfizer-BioNTech, with mild-to-moderate COVID-19, with persistent viral shedding. We evaluated viral load, antibody dynamics for SARS-CoV-2 and performed genomic analysis to identify the viral variant. The female remained positive for 40 days following symptom onset (cycle quantification mean: 32.54 ± 2.29). The humoral response was characterized by absence of IgM for the viral spike protein, increased IgG for the viral spike (1800.60 to 19558.60 AU/mL) and for the nucleocapsid (from 0.03 to 8.9 index value) proteins, and high titers of neutralizing antibodies (>488.00 IU/mL). The variant identified was the sublineage BA. 5.1. of Omicron (B.1.1.529). Our results suggest that even though the female produced an antibody response against SARS-CoV-2, the persistent infection can be explained by antibody decline and/or the immune evasion by the Omicron variant, illustrating the need to revaccinate or update vaccines.     

COVID-19 vaccine confidence and reasons for vaccination among health care workers and household members

BackgroundThe majority of healthcare workers (HCW) in the US report being fully vaccinated against COVID-19, yet little is known about vaccine decision-making for their household members, including children.MethodsCross-sectional survey July–August 2021 of HCW and their household members in Minnesota.Results94 % of eligible participants were vaccinated with the most common reasons being wanting to protect oneself, family and loved ones. Safety concerns were the most commonly reported reasons for not being vaccinated; a significantly higher proportion of unvaccinated compared to vaccinated HCW (58 % vs 12 %, p = 0.0035) and household adults (25 % vs 5 %, p = 0.03) reported prior SARS-CoV-2 infection. Nearly half of unvaccinated adults and two-thirds of unvaccinated children would be vaccinated if a vaccine mandate were in place.ConclusionsDespite high COVID-19 vaccine acceptance among HCWs, more research is required to identify and address the needs and concerns of healthcare workers who decline COVID-19 vaccination despite availability.     

新型冠状病毒肺炎病例流行特征及临床特征分析

目的 分析新型冠状病毒肺炎（COVID-19）流行病学特征、临床特点及CT影像变化,为当地疫情防治提供参考依据。方法 收集商城县人民医院和罗山县人民医院2020年1月23日至2月23日收治的所有COVID-19确诊病例的病历资料及影像学资料。采用描述流行病学分析方法进行分析。结果 共收治确诊COVID-19病例50例,男女性别比为1.38∶1,平均年龄为（50.92 ± 14.63）岁,其中45~64岁31例（占62%）。39例（占78%）具有流行病学暴露史,11例（占22%）无明确的流行病学暴露史。有6起家族聚集发病现象,共涉及13例病例。潜伏期1~23 d,平均为（5.95 ± 4.24）d。发热（占84%）和咳嗽（占72%）是该病例人群主要症状。入院时43例（占86%）白细胞计数正常或者淋巴细胞计数绝对值减少,40例（占80%）红细胞沉降率增快,26例（占52%）C反应蛋白升高。15例（占30%）合并原发基础疾病。40例（占80%）使用2种及以上抗病毒药物。入院2周后40例（占80%）CT显示病灶逐渐吸收。结论 多数患者具有明确的流行病学暴露史,存在家族聚集性发病现象,临床症状以发热、咳嗽为主,白细胞正常或者减少、血沉增快较多见,对临床诊断具有参考价值,CT表现病灶面积呈先扩大后逐渐吸收的变化趋势,积极抗病毒及对症治疗症状多能好转。