Mental health treatment rate rose early in pandemic

mental health

A detailed analysis of mental health treatment trends during the COVID-19 pandemic found a 7% increase in visits during the initial shelter-in-place period in 2020, compared with the same three-month period in 2019.

The study, published in The Journal of Clinical Psychiatry on March 3, examined patient visits for psychiatric diagnoses among members of Kaiser Permanente in Northern California.

The greatest increases in visits were for substance use (up 51%), adjustment disorder (up 15%), anxiety (up 12%), bipolar disorder (up 9%), and psychotic disorder (up 6%). Adjustment disorder is diagnosed when someone responds to a stressful life event with symptoms such as sadness and hopelessness.

“The increases we found in patients seeking care for substance use and anxiety are consistent with other data showing the pandemic and shelter-in-place orders were difficult for many people,” said lead author Kathryn Erickson-Ridout, MD, a psychiatrist with Kaiser Permanente in Northern California and a member of the Physician Researcher Program with the Kaiser Permanente Northern California Division of Research. “These findings reflect what I experienced with my patients who sought out care.”

The analysis focused on a period when Kaiser Permanente pivoted to virtual visits by video and telephone to ensure that patients continued to have access to care when shelter-in-place orders were implemented. “COVID-19 has created huge psychosocial disruption,” Dr. Erickson-Ridout said. “It’s impacting people’s ability to work, socialize, and have relationships, and that is having mental health consequences. We were able to respond to that with a robust telehealth system, to reach those patients and give them good care.”

The study was a retrospective observational analysis comparing 165,696 psychiatric outpatient contacts between March 9 and May 31, 2019, with 181,015 during the same period in 2020, an increase of 7%. The researchers also confirmed the shift away from in-person visits, tallying a 264% increase in telephone and video visits from the year before. Kaiser Permanente clinicians also offer mental health support by secure email message, but this study did not count those.

The study found 42% more addiction clinic visits than the same period in 2019. This could be related to patients having more difficulty coping with the pandemic, but it could also reflect existing patients having good connections with their addiction medicine providers, said study senior author Esti Iturralde, Ph.D., a research scientist with the Division of Research. “They may have been able to seek care more easily from the health system because of the strong connections and supports Kaiser Permanente provides, including case management,” she said.

The results also suggest some people did not immediately adjust to the new virtual visit format. Visits with new patients declined by 42%, as did visits by children and adolescents (down 23%), and older adults (down more than 5%).

The authors said these results may reflect which patients were most comfortable reaching out for telehealth care, at least during the first few months of the pandemic. Reliance on caregivers to facilitate visits, or healthcare avoidance during this time, may be behind these changes. Future research may reflect how patients adjusted to virtual visits past May 2020.

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Accelerating gains in abdominal fat during menopause tied to heart disease risk

heart

Women who experience an accelerated accumulation of abdominal fat during menopause are at greater risk of heart disease, even if their weight stays steady, according to a University of Pittsburgh Graduate School of Public Health-led analysis published today in the journal Menopause.

The study—based on a quarter century of data collected on hundreds of women—suggests that measuring waist circumference during preventive health care appointments for midlife women could be an early indicator of heart disease risk beyond the widely used body mass index (BMI)—which is a calculation of weight vs. height.

“We need to shift gears on how we think about heart disease risk in women, particularly as they approach and go through menopause,” said senior author Samar El Khoudary, Ph.D., M.P.H., associate professor of epidemiology at Pitt Public Health. “Our research is increasingly showing that it isn’t so important how much fat a woman is carrying, which doctors typically measure using weight and BMI, as it is where she is carrying that fat.”

El Khoudary and her colleagues looked at data on 362 women from Pittsburgh and Chicago who participated in the Study of Women’s Health Across the Nation (SWAN) Heart study. The women, who were an average age of 51, had their visceral adipose tissue—fat surrounding the abdominal organs—measured by CT scan and the thickness of the internal carotid artery lining in their neck measured by ultrasound, at a few points during the study. Carotid artery thickness is an early indicator of heart disease.

The team found that for every 20% increase in abdominal fat, the thickness of the carotid artery lining grew by 2% independent of overall weight, BMI and other traditional risk factors for heart disease.

They also found that abdominal fat started a steep acceleration, on average, within two years before the participants’ last period and continued a more gradual growth after the menopausal transition.

Saad Samargandy, Ph.D., M.P.H., who was a doctoral student at Pitt Public Health at the time of the research, explained that fat that hugs the abdominal organs is related to greater secretion of toxic molecules that can be harmful to cardiovascular health.

“Almost 70% of post-menopausal women have central obesity—or excessive weight in their mid-section,” said Samargandy, also the first author of the journal article. “Our analysis showed an accelerated increase of visceral abdominal fat during the menopausal transition of 8% per year, independent of chronological aging.”

Measuring abdominal fat by CT scan is expensive, inconvenient and could unnecessarily expose women to radiation—so El Khoudary suggests that regularly measuring and tracking waist circumference would be a good proxy to monitor for accelerating increases in abdominal fat. Measuring weight and BMI alone could miss abdominal fat growth because two women of the same age may have the same BMI but different distribution of fat in their body, she added.

“Historically, there’s been a disproportionate emphasis on BMI and cardiovascular disease,” said El Khoudary. “Through this long-running study, we’ve found a clear link between growth in abdominal fat and risk of cardiovascular disease that can be tracked with a measuring tape but could be missed by calculating BMI. If you can identify women at risk, you can help them modify their lifestyle and diet early to hopefully lower that risk.”

Late last year, El Khoudary led a team in publishing a new scientific statement for the American Heart Association that calls for increased awareness of the cardiovascular and metabolic changes unique to the menopausal transition and the importance of counseling women on early interventions to reduce cardiovascular disease risk factors.

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Austria plans vaccine drive in area hit by SA virus variant

Austria plans vaccine drive in area hit by SA virus variant

Austrian officials said Wednesday that they plan to offer vaccinations to most residents in a district that has seen significant numbers of infections with the South African coronavirus variant.

Tyrol province’s Schwaz district, east of the provincial capital of Innsbruck and home to about 84,000 people, has been a source of concern for weeks.

Schwaz accounts for 66 of 88 currently active confirmed cases of the more transmissible variant in the province, the Austria Press Agency reported.

The plan announced Wednesday calls for a vaccination drive starting next week. Health Minister Rudolf Anschober said the rollout will see vaccinations offered to all aged 16 and over.

APA reported that from around March 10, coinciding with the start of the drive and until it is complete, people will be required to get a negative coronavirus test before they could leave the Schwaz district.

The plan “is our opportunity to eliminate the variant in the Schwaz district,” Chancellor Sebastian Kurz said. He said numbers of active cases have already fallen.

The variant first identified in South Africa is a source of particular concern because of doubts over whether all vaccines currently available are fully effective against it.

Austrian officials said they have been able to bring forward the delivery of 100,000 doses of the Pfizer-BioNTech vaccine for Tyrol in cooperation with the European Union’s executive Committee and the manufacturers.

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Nanoparticle-delivered COVID-19 vaccine candidate shows promise in preclinical studies

Nanoparticle-delivered COVID-19 vaccine candidate shows promise in preclinical studies

Researchers from Cleveland Clinic’s Global Center for Pathogen Research & Human Health have developed a promising new COVID-19 vaccine candidate that utilizes nanotechnology and has shown strong efficacy in preclinical disease models.

According to new findings published in mBio, the vaccine produced potent neutralizing antibodies among preclinical models and also prevented infection and disease symptoms in the face of exposure to SARS-CoV-2 (the virus that causes COVID-19). An additional reason for the vaccine candidate’s early appeal is that it may be thermostable, which would make it easier to transport and store than currently authorized COVID-19 vaccines.

“Our vaccine candidate delivers antigens to trigger an immune response via nanoparticles engineered from ferritin—a protein found in almost all living organisms,” said Jae Jung, Ph.D., director of the Global Center for Human Health & Pathogen Research and co-senior author on the study. “This protein is an attractive biomaterial for vaccine and drug delivery for many reasons, including that it does not require strict temperature control.”

Added Dokyun (Leo) Kim, a graduate student in Dr. Jung’s lab and co-first author on the study, “This would dramatically ease shipping and storage constraints, which are challenges we’re currently experiencing in national distribution efforts. It would also be beneficial for distribution to developing countries.”

Other benefits of the protein nanoparticles include minimizing cellular damage and providing stronger immunity at lower doses than traditional protein subunit vaccines against other viruses, like influenza.

The team’s vaccine uses the ferritin nanoparticles to deliver tiny, weakened fragments from the region of the SARS-CoV-2 spike protein that selectively binds to the human entry point for the virus (this fragment is called the receptor-binding domain, or RBD). When the SARS-CoV-2 RBD binds with the human protein called ACE2 (angiotensin-converting enzyme 2), the virus can enter host cells and begin to replicate.

The researchers tested their vaccine candidate on a ferret model of COVID-19, which reflects the human immune response and disease development better than other preclinical models. Dr. Jung, a foremost authority in virology and virus-induced cancers, previously developed the world’s first COVID-19 ferret model—a discovery that has significantly advanced research into SARS-CoV-2 infection and transmission.

In this study, the researchers administered an initial dose of the vaccine candidate followed by two booster vaccines given 14 and 28 days later. One group received the vaccines intramuscularly, while another group received them both intramuscularly and intranasally.

After the second booster, all vaccinated models produced strong neutralizing antibodies. This suggests that repeated exposure to the RBD antigen successfully prepared the immune systems to rapidly fight the virus.

A few days after the second booster (31 days after the initial vaccine dose), the researchers exposed the models to high concentrations of SARS-CoV-2. Compared to the placebo group that received adjuvant-only vaccines (adjuvants are added ingredients that help vaccines work better), those that received the RBD-nanoparticle vaccine were better protected from clinical symptoms and lung damage associated with infection. The findings suggest the vaccine candidate helped prevent infection and serious disease.

Combination intramuscular and intranasal immunization showed more potent protective immunity and faster viral clearance than intramuscular immunization alone. Both were significantly more effective than the adjuvant-only vaccine. More research will be important to uncover the mechanisms behind these differential benefits.

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A new blindness gene uncovered in a canine study

A new blindness gene uncovered in a canine study

Inherited retinal dystrophy is a common cause of blindness, with as many as two million people suffering from the disorder globally. No effective treatment is available for retinal dystrophies. Gene therapy is expected to offer a solution, but developing such therapies is possible only when the genetic cause of the disease is known. Related mutations have been identified in more than 70 genes so far, but the genetic background of the disease remains unknown in as many as half of the patients.

“Retinal dystrophy has been described in over 100 dog breeds, with related investigations helping to identify new genes associated and pathogenic mechanisms with blindness across different breeds. IFT122 is a good example, offering a potential explanation for unsolved human cases as well,” Professor Hannes Lohi states.

Data encompassing more than a thousand Lapponian Herders and Finnish Lapphunds from a canine DNA bank were utilized in the study. Previously, several retinal dystrophy genes have been described in both breeds.

“Among other finds, two eye disease genes have previously been identified in Lapponian Herders, but they have not accounted for all cases. In some dogs, the disease is caused by the IFT122 gene. The finding is significant since gene tests can now distinguish between retinal dystrophies associated with different genes in breeds, which makes a difference in monitoring disease progression, making prognoses, and developing novel treatments. Diagnostics are getting better and making the job of veterinarians easier,” explains Maria Kaukonen, Doctor of Veterinary Medicine.

The gene discovery also facilitates the understanding of retinal biology. IFT122 is part of a protein complex linked with ciliary function in the retina.

“The age of onset varies, and the disease progresses slowly in some dogs. IFT122 is known to contribute to the transport of opsin in photoreceptor cells. The gene variant disturbs this transport and results in progressive blinding. Since IFT122 is associated with cilia’s function, which is important to the body, we studied some of the dogs even more closely with regard to other issues potentially linked with cilia-related disturbances, such as renal abnormalities or serious developmental disorders of the internal organs. We found that the damage seems to be limited to the retina alone. This information helps us understand the gene’s mechanisms of action,” Kaukonen adds.

The findings are also significant for further plans to remove the disease from different breeds. In the Lapponian Herders and Finnish Lapphunds, the share of individuals carrying the gene variant was 28% and 12%, respectively.

“This is a recessively inherited disease, which means that a dog that will become blind inherits the variant from both parents, who are both carriers of the variant. Gene testing can help avoid carrier-carrier combinations, easily preventing the birth of sick dogs. A new concrete tool has been developed based on the study for the benefit of breeders,” says Lohi.

The new study is part of a broader research project on the genetic background of inherited diseases by Professor Lohi’s research group. Kaukonen recently transferred to a research group active at the University of Oxford, focusing on developing gene therapies for retinal dystrophy. At the same time, Kaukonen and Lohi are continuing close collaboration to survey a range of eye diseases together with the Helsinki University Hospital and other operators.

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Why Nigeria must include parents in plans to protect girls from cervical cancer

Why Nigeria must include parents in plans to protect girls from cervical cancer

Cervical cancer is the second most common cancer among women in Nigeria. There were 31,955 new cervical cancer cases in West Africa in 2018, and Nigeria accounted for almost half (14,943). There were also 10,403 deaths (28 deaths every day) from cervical cancer in the country in the same year.

About 70% of all cervical cancer cases are caused by the human papilloma virus (HPV) serotypes 16 and 18. The most common mode of transmission is through sex, but it can also be transmitted through the use of contaminated hospital equipment and from mother to child. The cancer is ranked second in the number of years lost to disability among women in Nigeria.

There are screening programs geared towards the prevention of this cancer, including Papanicolaou (Pap) smear and HPV screening. These are secondary preventive measures that detect early-stage cervical cell abnormality and the virus’s presence. However, only 8.7% of Nigerian women had a pap smear in 2018, and fewer had HPV screening.

This low uptake results from poorly organized services, the relatively high cost, and the shortage of resources and skills required for the services.

The HPV vaccine is an effective primary prevention measure for cervical cancer. The vaccine is most effective when started before sexual debut, which is the reason for the recommendation of its administration in early adolescence.

There are, however, two main obstacles on this path. First, the vaccine is currently being marketed at exorbitant costs. It is therefore out of reach of the average family. The Nigerian government is seeking ways to meet the conditions for accessing subsidized HPV vaccines under the global assistance program.

Second, Nigeria is yet to identify an organized structure through which most of the eligible adolescents can be reached with the HPV vaccine. A multi-pronged approach will be required for this as many Nigerian adolescents are out of school.

Case for early vaccination

The HPV vaccine has been introduced in some African countries. But it is yet to be integrated into the routine vaccine schedule in Nigeria. Part of the preparation to ensure the successful introduction of the HPV vaccine is to ensure that all stakeholders have correct perspectives about the vaccine.

Vaccinating both girls and boys has been shown to be more cost-effective because it can lead to the development of herd immunity, curbing the spread of the virus, and prevent other HPV-related cancers like anogenital cancers and cancer of the head and neck.

Parents are essential stakeholders in the HPV vaccine program for adolescents because they are the primary caregivers. They will play significant roles in the decision making process for the uptake of HPV vaccination. If Nigeria uses the school-based or community-based HPV vaccination program, parents’ consent is crucial for the success of the program.

The importance of parental consent was emphasized by the parents of adolescents that we interviewed in five selected communities in Ibadan, a city home to 3.5 million in southwest Nigeria. This is not only right legally as these adolescents are minors, but the parents are their primary caregivers. They should be involved in decisions about the uptake of healthcare services, including HPV vaccination.

Almost all the parents we spoke to had the intention to vaccinate their adolescents with the HPV vaccine despite being informed that the virus was sexually transmitted. However, parents who were older than 45 years were reluctant to vaccinate their adolescents. Findings from this study showed that many parents in this age group did not believe that HPV was responsible for cervical cancer and did not appreciate the importance of the HPV vaccine in preventing cancer. Also, these older parents significantly did not have formal education. Older people have been reluctant in the uptake of new technology, which might have affected these parents’ views about the HPV vaccine.

Way forward

It is essential to carry all stakeholders along in this pre-introduction era of the HPV vaccine in Nigeria to ensure the program’s success in the future. A concerted effort is required to demonstrate the relationship between HPV and cervical cancer and the role of the vaccine in the prevention of cancer.

This will require special health education skills as most of the parents do not have formal education. All parents should also be involved at each stage of the introduction of the HPV vaccine for the program to succeed.

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In Boost for COVID-19 Battle, Pfizer Vaccine Found 94% Effective in Real World

JERUSALEM (Reuters) – The first big real-world study of the Pfizer/BioNTech vaccine to be independently reviewed shows the shot is highly effective at preventing COVID-19, in a potentially landmark moment for countries desperate to end lockdowns and reopen economies.

Up until now, most data on the efficacy of COVID-19 vaccines has come under controlled conditions in clinical trials, leaving an element of uncertainty over how results would translate into the real world.

The research in Israel – two months into one of the world’s fastest rollouts, providing a rich source of data – showed two doses of the Pfizer shot cut symptomatic COVID-19 cases by 94% across all age groups, and severe illnesses by nearly as much.

The study of about 1.2 million people also showed a single shot was 57% effective in protecting against symptomatic infections after two weeks, according to the report published in the New England Journal of Medicine on Wednesday.

The results of the study for the Clalit Research Institute were close to those in clinical trials last year which found two doses were found to be 95% effective.

“We were surprised because we expected that in the real-world setting, where cold chain is not maintained perfectly and the population is older and sicker, that you will not get as good results as you got in the controlled clinical trials,” senior study author Ran Balicer told Reuters. “But we did and the vaccine worked as well in the real world.”

“We have shown the vaccine to be as effective in very different sub-groups, in the young and in the old in those with no co-morbidities and in those with few co-morbidities,” he added.

The study also suggests the vaccine, developed by U.S drugmaker Pfizer and Germany’s BioNTech, is effective against the coronavirus variant first identified in the UK. Researchers said they could not provide a specific level of efficacy, but the variant was the dominant version of the virus in Israel at the time of the study.

The research did not shed light on how the Pfizer shot will fare against another variant, now dominant in South Africa, that has been shown in lab experiments and trials to reduce the efficacy of current vaccines.

‘THIS IS MORE GREAT NEWS’

Of the nine million people in Israel, a nation with universal healthcare, nearly half have received a first dose, and a third have received both doses since the rollout began on Dec. 19.

This made the country a prime location for a real-world study into the vaccine’s ability to stem the pandemic, along with its advanced data capabilities.

The study examined about 600,000 vaccinated people against the same sized control group of unvaccinated people. Researchers at Harvard T.H. Chan School of Public Health, Harvard Medical School and Boston Children’s Hospital also collaborated.

“This is more great news, confirming that the vaccine is around 90% effective at preventing documented infection of any degree of severity from 7 days after the second dose,” said Peter English, a British government consultant in communicable disease control.

“Previous recently studied papers from Israel were observational studies. This one used an experimental design known as a case-control study … giving greater confidence that differences between the groups are due to their vaccination status, and not to some other factor.”

The study published on Wednesday was the first analysis of a national COVID-19 vaccination strategy to be peer-reviewed. It also offered a more detailed look at how the vaccine was faring at weekly intervals, while matching people who received the shot to unvaccinated individuals with similar medical histories, sex, age and geographical characteristics.

Other research centres in Israel, including the Weizmann Institute of Science and the Israel Institute of Technology have shared several studies in recent weeks that show the vaccine to be effective.

At least three studies out of Israel have also suggested the vaccine can reduce coronavirus transmission, but the researchers have cautioned that wider studies must be conducted in order to establish clear-cut conclusions.

GOT YOUR IMMUNITY PASS?

The Weizmann Institute’s latest data shows a dramatic drop in illness – which began this month with the first age group vaccinated, the over-60s – has now extended to the two subsequent groups to have completed both doses.

As infections have fallen in Israel, the country has eased its third national lockdown and reopened swathes of its economy including malls, shops, schools and many workplaces in the past two weeks.

Recreational venues such as theatres, gyms and hotels opened on Sunday, but are open only to those deemed immune – holders of a “Green Pass”, a health ministry document available for download only by people seven days after their second dose or people who have recovered from COVID-19.

On Wednesday, Tel Aviv held one of the country’s first live concerts after months of gatherings being banned under coronavirus restrictions.

“This is so exciting, we are really so happy to be here today. It’s unbelievable after one year of staying at home, it’s great to be out to see some culture,” said 60-year-old Gabi Shamir as she took her seat at the open-air show.

Still, the vaccine’s efficacy does not mean the country will be pandemic free any time soon. Like elsewhere in the world, a large proportion of the population are under 16 – about a third in Israel – meaning that they cannot yet get vaccinated as there have not been clinical trial results for children.

“This is definitely not the end of the pandemic,” said Eran Kopel, an epidemiologist at Tel Aviv University. “Once there is a safe vaccine for the children in Israel and all over the world we can then start to say that we could be approaching herd immunity.”

SOUREC: https://bit.ly/3utMHLJ The New England Journal of Medicine, online February 24, 2021.

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COVID-19 vaccine acceptance falling globally and in the U.S., survey finds

vaccine

The percentage of people globally who say they will get a COVID-19 vaccine has fallen in recent weeks, even as tens of millions of doses have been administered around the world, new survey data suggest.

The Johns Hopkins Center for Communication Programs, along with MIT, Facebook, and WHO, have been overseeing a global COVID behavior survey since July 2020 from nearly 1.7 million participants across 67 countries. The most recent data, drawn from more than 86,000 participants in 23 countries including the U.S., were collected in the two weeks ending February 1. The Center for Communication Programs is based at the Johns Hopkins Bloomberg School of Public Health.

After a slight increase to 66 percent of people saying they would get a COVID-19 vaccine at the beginning of January 2021, the average acceptance level across the 23 countries in this analysis fell to 63 percent. This overall decline comes amidst increased focus and media discussion on the rollout and access to COVID-19 vaccines. Broken down by country, the latest survey found that, in the final two weeks of January, vaccine acceptance declined in seven countries, remained similar in another seven, and rose in nine more.

Since March 2020, when WHO declared COVID-19 a pandemic, more than 112 million cases have been recorded and nearly 2.5 million people have died from it, according to Johns Hopkins University. More than 500,000 people have died from COVID-19 in the United States, the largest number of deaths in any country.

“We had hoped we would find that acceptance of COVID vaccines was on the rise in more countries, since vaccination is a critical part of ending the pandemic,” says CCP’s executive director Susan Krenn. “This means we have more work to do in helping people understand why getting vaccinated is so crucial to helping them, their families, and their communities.”

A key point to communicate is that a large percentage of people in a community need to be vaccinated in order to reach herd immunity, the level at which the spread of SARS-CoV-2—the virus that causes COVID-19—becomes difficult. Herd immunity levels vary depending on the infectiousness of a disease. Dr. Anthony Fauci, director the National Institute of Allergy and Infectious Diseases, has estimated that 70 to 85 percent of Americans need to be vaccinated to reach herd immunity for COVID-19. That threshold is much higher than the percentage of people in many countries reporting that they would be willing to get a vaccine.

The surveys leveraged Facebook’s reach of more than two billion global users, an average of 112,000 of whom participated in surveys roughly every 14 to 17 days since July. The questions have been about COVID-19 prevention behaviors such as mask wearing and social distancing, vaccine acceptance and trusted COVID influencers. This work has informed both global and national COVID-19 policies, and in the coming month the survey will evolve to include more countries and richer data to better describe global efforts to address the pandemic.

Of five countries in the Americas, the latest data found, only the United States saw a decline in vaccine acceptance in late January (from 69 percent to 65 percent). The other four countries— Mexico, Argentina, Brazil, and Colombia—saw an increase of five percentage points in vaccine acceptance. Argentina saw much higher acceptance rates among certain demographics. For example, in the most recent survey, acceptance rates in Argentina are higher among older (+18 percent), college educated (+12 percent), urban residents (+20 percent), and men (+5 percent) than they were two weeks earlier.    

The survey found that reported vaccine acceptance rates in European countries remained constant, with Italy and the United Kingdom well into the range of achieving herd immunity. Some countries (Italy, the UK, and Germany) have very low rates of reported non-acceptance (8 percent, 10 percent, and 13 percent, respectively). By contrast, respondents in Turkey and France are consistently among the lowest reported rates of vaccine acceptance within the 23 countries surveyed in this study: 24 percent and 56 percent, respectively.  

After a recent dip, acceptance levels in Nigeria are beginning to rise. Gender differences there continue to exist among participants, but since the last data collection period women’s acceptance rates increased 4 percentage points from 51 percent to 55 percent.

Along with the new data on vaccine acceptance rates, CCP released another wave of data about other COVID-19 prevention behaviors for the last two weeks in January. From the first survey in July, reported handwashing in the United States is down in every group except rural residents. Over the same period, reported mask wearing and physical distancing are up in the U.S. And while a smaller percentage of Americans report they have trust in scientists, they are still the most trusted sources of COVID-19 information.

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Pfizer COVID-19 vaccine works well in big ‘real world’ test

Pfizer COVID-19 vaccine works well in big 'real world' test

A real-world test of Pfizer’s COVID-19 vaccine in more than half a million people confirms that it’s very effective at preventing serious illness or death, even after one dose.

Wednesday’s published results, from a mass vaccination campaign in Israel, give strong reassurance that the benefits seen in smaller, limited testing persisted when the vaccine was used much more widely in a general population with various ages and health conditions.

The vaccine was 92% effective at preventing severe disease after two shots and 62% after one. Its estimated effectiveness for preventing death was 72% two to three weeks after the first shot, a rate that may improve as immunity builds over time.

It seemed as effective in folks over 70 as in younger people.

“This is immensely reassuring … better than I would have guessed,” said the Mayo Clinic’s Dr. Gregory Poland.

Vanderbilt University’s Dr. Buddy Creech agreed: “Even after one dose we can see very high effectiveness in prevention of death,” he said.

Neither doctor had a role in the Israel study but both are involved in other coronavirus vaccine work.

Both doctors also said the new results may boost consideration of delaying the second shot, as the United Kingdom is trying, or giving one dose instead of two to people who have already had COVID-19, as France is doing, to stretch limited supplies.

“I would rather see 100 million people have one dose than to see 50 million people have two doses,” Creech said. “I see a lot of encouragement on one dose” in the results from Israel, which were published by the New England Journal of Medicine.

The vaccine, made by Pfizer and its German partner BioNTech, is given as two shots, three weeks apart, in most countries.

The study was led by researchers from the Clalit Research Institute and Ben-Gurion University of the Negev in Israel, with Harvard University in the U.S. It did not report on safety of the vaccine, just effectiveness, but no unexpected problems arose in previous testing.

Researchers compared nearly 600,000 people 16 and older in Israel’s largest health care organization who were given shots in December or January to an equal number of people of similar age, sex and health who did not receive vaccine. None of the participants had previously tested positive for the virus.

The vaccine was estimated to be 57% effective at preventing any symptoms of COVID-19 two to three weeks after the first dose, and 94% a week or more after the second dose.

Effectiveness was 74% after one shot and 87% after two for preventing hospitalization, and 46% and 92% for preventing confirmed infection. Reducing infections gives hope that the vaccine may curb spread of the virus, but this type of study can’t determine if that’s the case.

There were 41 COVID-19-related deaths, 32 of them in people who did not get vaccine.

Overall, the numbers compare well to the 95% effectiveness after two doses that was seen in the limited testing that led U.S. regulators to authorize the vaccine’s emergency use, Poland said. How much benefit there would be from one dose has been a big question, “and now there’s some data” to help inform the debate, he added.

“Maybe the right thing to do here to protect the most number of people … is to give everybody one dose as soon as you can. I think that’s a very acceptable strategy to consider,” Poland said.

Israel now has vaccinated nearly half of its population. A newer variant of the virus that was first identified in the United Kingdom became the dominant strain in Israel during the study, so the results also give some insight into how well the vaccine performs against it.

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Report highlights tremendous burden from infectious diseases in SEAR countries

bangladesh

Researchers at CDDEP, in collaboration with leading experts in the field, have produced the “Infectious Diseases in the South-East Asia Region” report, which examines cross-boundary challenges in communicable disease control in countries in the South-and South-East Asia region. The report emphasizes infectious diseases related to other sources of disease burden in the region and communicates overall trends in the health and economic burden they impose.

Despite substantial progress in recent years, which has seen reductions in deaths from HIV and malaria and an increase in tuberculosis treatment coverage, the South-East Asia region continues to bear a significant proportion of the communicable disease burden worldwide. South Asia has the third largest HIV epidemic globally and the highest TB burden, accounting for more than a quarter of the global burden. The second highest incidence of malaria, amongst all WHO regions, occurs in the southeast Asia region, and India bears the third-highest proportion of malaria cases globally.

Malnutrition makes the South-East Asian population particularly vulnerable to neglected tropical diseases (NTDs) alongside emerging infectious diseases from arbovirus infections, dengue, chikungunya, Japanese encephalitis, and the continuing concern of a pandemic influenza outbreak. Furthermore, drug-resistant infections cause 58,000 deaths in newborns every year, in India alone, and continue to threaten the effectiveness of life-saving antibiotics across the region.

COVID-19 has disrupted the control of other infectious diseases in myriad ways, hindering routine vaccination programs, impeding the distribution of bed nets against malaria, and reducing TB services, among others. With the rollout of vaccines against the novel coronavirus and the ebbing of COVID-19, it will be essential to devote our full collective attention to the control of infectious diseases that have long plagued this region and continue to constitute a significant proportion of the avertable disease burden.

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