Additional Protective Measures Research Articles

Causal network linking honey bee (Apis mellifera) winter mortality to temperature variations and Varroa mite density

Winter season is a critical time for honey bees (Apis mellifera) colonies when individual mortalities may lead to total colony losses or diminish productivity in subsequent seasons. A deeper understanding of the causes and consequences of winter mortality is required. In this study, we analyzed winter (November–March) individual bee mortality in an apiary in Central Europe from 1991 to 2023. We observed consistency in mortality times among years, but also some systematic departures from the shared trend. We distinguished four clusters of year-specific mortality trajectories. However, we found no statistically significant differences in means of spring (March–May), autumn (October), winter (November–March) temperatures, or autumn Varroa destructor density among clusters. Nevertheless, our insights into the dynamics of individual bee mortality may be important for determining critical moments during wintering when implementing additional protective measures could prove beneficial. Hypothesis-driven path analysis indicated causal links in our study system, including both direct and indirect influences. The density of V. destructor in autumn was positively related to temperature, especially in the preceding spring, but to a lesser extent also in autumn. Increased winter mortality was related to lower winter temperatures and a higher mite infestation in autumn. We found no significant effects of individual winter mortality on honey harvests in subsequent seasons. Honey harvest was determined by bee abundance in spring, and the latter, unexpectedly, was not related to winter mortality. Our study adds to accumulating evidence of the major role of weather and climatic conditions in the resilience of honey bee colonies and improves our understanding of mortality processes. We highlighted the importance of causative factors, especially seasonal temperatures and V. destructor density, and their potential as predictive indicators of individual winter mortality, bee colony fate, and honey productivity.

Machine Advisors: Integrating Large Language Models Into Democratic Assemblies

ABSTRACT Could the employment of large language models (LLMs) in place of human advisors improve the problem-solving ability of democratic assemblies? LLMs represent the most significant recent incarnation of artificial intelligence and could change the future of democratic governance. This paper assesses their potential to serve as expert advisors to democratic representatives. While LLMs promise enhanced expertise availability and accessibility, they also present specific challenges. These include hallucinations, misalignment and value imposition. After weighing LLMs’ benefits and drawbacks against human advisors, I argue that time-tested democratic procedures, such as deliberation and aggregation by voting, provide safeguards that are effective against human and machine advisor shortcomings alike. Additional protective measures may include custom training for advisor LLMs or boosting representatives’ competencies in query formulation. Implementation of adversarial proceedings in which LLM advisors would debate each other and provide dissenting opinions is likely to yield further epistemic benefits. Overall, promising interventions that would mitigate the LLM risks appear feasible. Machine advisors could thus empower human decision-makers to make more autonomous, higher-quality decisions. On this basis, I defend the hypothesis that LLMs’ careful integration into policymaking could augment democracy’s ability to address today’s complex social problems.

Study on the Effect of Multi-Gap Arrester Truncation on the Overvoltage of Lightning Intrusion Wave

Lightning protection near the fan is the key point of lightning protection in wind farm, which affects the safe and effective delivery of wind power resources. At present, the three-phase multi-gap arrester installed on a base tower behind the collector can cooperate with the zinc oxide arrester to reduce the system failure caused by the arrester failure. However, the chopped wave generated by the multi-gap arrester when it acts is transmitted to the fan box transformer along the line, which may threaten the insulation of the transformer winding. Based on the above problems, this paper builds a simulation model on ATP to analyze the impact of wave clipping of multi-gap arrester on the insulation of fan transformer windings, considers the conventional installation mode and the limit installation mode of multi-gap arrester, and calculates that the wave clipping overvoltage generated by multi-gap arrester after being struck by lightning in two cases is the impact on the insulation of fan transformer. Through the simulation analysis, it is found that the higher the amplitude of the lightning current, the larger the amplitude of the overvoltage generated by the truncated wave, the steeper the wave head, and the greater the threat to the insulation of the fan box. The damage degree of round lightning is less than that of counter lightning. When a multi-gap arrester is installed in a collector tower, the 100[Formula: see text]kA lightning current may destroy the insulation of the fan box transformer winding and require additional protective measures. It is recommended that the multi-gap arrester be installed from the next pole tower of the collector tower in the wind farm.

Risk of COVID­-19 Infection among Employees of a Large Anti­tuberculosis Institution in Moscow: Survey Results

Relevance. Studying the experience of working under the conditions of COVID-19 allows us to more effectively assess the functioning of anti-epidemic measures in the event of the occurrence or threat of new pandemics, including those caused by new pathogens. The risk of contracting COVID-19 among employees of medical organizations is higher compared to the rest of the population of the metropolis, which determines the need to develop additional measures in medical organizations to protect workers. Timely assessment of risks and preventive measures during a pandemic allow building a system to protect medical institutions from various biological threats when providing medical care. Aim. Assessment of the risks of contracting COVID-19 among employees of a large anti-tuberculosis medical organization in a metropolis. Materials & Methods. A survey of employees of a large anti-tuberculosis medical organization in Moscow was conducted. The survey was conducted on 46 key questions of epidemiological history, compliance with the requirements of the sanitary and anti-epidemic regime, alleged sources of infection, prognostic risks of the occurrence and course of COVID-19. During the period from August 1 to October 1, 2022, 1225 employees of the institution were surveyed (43.8% of the total number). The survey was conducted on a voluntary basis and was anonymous. When answering questions, participants provided information about demographic factors (age, gender), place of actual residence, the fact of contracting a new coronavirus infection, frequency of laboratory testing for SARS-CoV-2, immunization against COVID-19, possible places of contact with patients with COVID-19, the use of personal protective equipment (PPE) at home and at work, the regular use of skin antiseptics, as well as other information that allowed us to establish the risks of infection of workers at home and at work. To assess the risks of infection, respondents were divided into two groups depending on the presence of a positive test for SARS-CoV-2 (group I) or its absence (group II) as of October 1, 2022. The material for testing was nasal/oropharyngeal swabs. The research of employees was carried out on the basis of the laboratory of the anti-tuberculosis medical organization, as well as in other accredited laboratories of the metropolis using the molecular genetic method, and since February 2022 also using the express method that determines the SARS-CoV-2 antigen. Results. Among the survey participants and according to the questionnaire data, 797 employees suffered from the new coronavirus infection COVID-19, and 138 (17.3%) of them had repeated cases of the disease. Factors that increase the risk of COVID-19 among personnel of anti-tuberculosis medical organizations directly involved in the fight against the new coronavirus infection have been identified. The results of the study demonstrated that important factors influencing the incidence of workers were the frequency of examination for COVID-19, the regular use of skin antiseptics, contact with sources of infection, the use of glasses for vision correction, the use of public transport and eating at work. Conclusion. The need to study the risks of contracting COVID-19 among employees of medical organization and, based on them, develop a set of additional anti-epidemic protection measures was confirmed.

Electrochemical Investigation of PEDOT:PSS/Graphene Aging in Artificial Sweat.

Herein, we investigate the potential application of a composite consisting of PEDOT:PSS/Graphene, deposited via spray coating on a flexible substrate, as an autonomous conducting film for applications in wearable biosensor devices. The stability of PEDOT:PSS/Graphene is assessed through electrochemical impedance spectroscopy (EIS), cyclic voltammetry (CV) and linear polarization (LP) during exposure to an artificial sweat electrolyte, while scanning electron microscopy (SEM) was employed to investigate the morphological changes in the layer following these. The results indicate that the layers exhibit predominant capacitive behavior in the potential range of -0.3 to 0.7 V vs. Ag/AgCl, with a cut-off frequency of approximately 1 kHz and retain 90% capacity after 500 cycles. Aging under exposure to air for 6 months leads only to a minor increase in impedance, demonstrating potential for storage under non-demanding conditions. However, prolonged exposure (>48 h) to the artificial sweat causes significant degradation, resulting in an impedance increase of over 1 order of magnitude. The observed degradation raises important considerations for the long-term viability of these layers in wearable biosensor applications, prompting the need for additional protective measures during prolonged use. These findings contribute to ongoing efforts to enhance the stability and reliability of conducting materials for biosensors in health care and biotechnology applications.

Developing and Evaluating the Operating Region of a Grid-Connected Current Source Inverter from Its Mathematical Model

Grid-connected power inverters are indispensable in modern electrical systems, playing a pivotal role in enhancing the integration of renewable energies into power grids. Their significance, primarily when functioning as grid-forming inverters, extends to maintaining the grid’s inertia and strength—a distinct advancement over traditional grid-following operations. As grid-forming inverters, these devices emulate the characteristics of synchronous generators and can act as robust voltage sources, providing essential ancillary services. This behavior is particularly relevant when integrating energy storage systems on the converters’ direct current side. Among the various inverter topologies, the current source inverter (CSI) has emerged as a promising yet underexplored alternative for grid-forming applications. CSIs, when paired with their AC output filters, can effectively operate as voltage sources, utilizing control strategies that facilitate the integration of renewable energies into the electrical system. Their design inherently manages output current fluctuations, reducing the need for restrictive current limitations or additional protective measures. This paper examines the operational region of CSIs, obtained through detailed modeling, to explore their advantages, challenges, and potential for enhancing grid-connected systems. Analyzing the operating region from the converter model verifies the limits of where the converter can operate in a plane of active and reactive powers. For a small prototype model operating with 7 amperes in DC and 120 V in AC, it is possible to supply or absorb active power exceeding 1000 W and manage maximum reactive power values around 500 VAr, as determined by its operating region. Simulations also confirm that small changes in the control reference, as little as 5%, towards the region’s right limits cause significant oscillations in the dynamic control responses. This research aims to deepen our understanding of CSIs’ operational capabilities and highlight their unique benefits in advancing grid-connected systems and promoting the integration of renewable energy using this technology.

Development Perspectives for Curative Technologies in Primary Demyelinating Disorders of the Central Nervous System with Neuromyelitis Optica Spectrum Disorder (NMOSD) and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) at the Forefront.

Primary demyelinating disorders of the central nervous system (CNS) include multiple sclerosis and the orphan conditions neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein IgG-associated disease (MOGAD). Curative technologies under development aim to selectively block autoimmune reactions against specific autoantigens while preserving the responsiveness of the immune system to other antigens. Our analysis focused on target patient selection for such developments, carefully considering the relevant clinical, regulatory, and market-related aspects. We found that the selection of patients with orphan conditions as target populations offers several advantages. Treatments for orphan conditions are associated with limited production capacity, qualify for regulatory incentives, and may require significantly shorter and lower-scale clinical programs. Furthermore, they may meet a higher acceptable cost-effectiveness threshold in order to compensate for the low numbers of patients to be treated. Finally, curative technologies targeting orphan indications could enter less competitive markets with lower risk of generic price erosion and would benefit from additional market protection measures available only for orphan products. These advantages position orphan conditions and subgroups as the most attractive target indications among primary demyelinating disorders of the CNS. The authors believe that after successful proof-of-principle demonstrations in orphan conditions, broader autoimmune patient populations may also benefit from the success of these pioneering developments.

잠정조치 이행 여부에 따른 스토킹가해자의 특성에 대한 판결문 분석

This study sought to identify the characteristics of stalking perpetrators who violated interim measures. For this purpose, 453 stalking court decision cases during the last two years (2022-2023) were collected. In detail, the study analyzed the group differences of interim measure compliant vs. violating perpetrator group regarding the demographics of perpetrators and victims, criminal demographics of perpetrators, stalking crime characteristics and perpetrator risk factors coded according to the Stalking Risk Assessment Scale (K-SAS). The main findings are as follows. Competing crimes, criminal histories on the same or similar crimes were significantly higher among the interim measure violating perpetrator group. Stalking offense characteristics regarding self/other harm threats, persistent and severity of stalking and also offender risk factors including anger and hostility, pathological obsession or suspicion, antisocial lifestyle, one-sided thinking, and interpersonal problems were higher among them. Finally, same crime recidivism and one-sided thinking were variables that significantly explained the violation of interim measures. Based on the findings, suggestions were made on additional protective measures in light of interim measure violation and ways to protect victims as well as preventing recidivism.

Activity concentration of NORM at reclaimed ex-coal mines in South Sumatra, Indonesia

Unbeknownst to us, natural radiation is in close proximity to human existence. Post-mining practices can generate naturally occurring radionuclides that have the potential to cause radiological effects on human health. This study utilized soil samples obtained from ex-mining reclamation land in Banko Barat, South Sumatra Province, to assess the concentration of natural radioactivity and the corresponding radiation dose. Eight composite soil samples were collected from reclaimed land. The samples underwent processing and analysis through gamma spectrometry in order to ascertain the activity concentration of the radionuclides 226Ra, 232Th, and 40K. The RESRAD-ONSITE 7.2 software utilizes the activity concentration of soil samples as an input parameter to accurately predict the dose rate for workers. The projected dose rate was determined by considering four routes of exposure: external gamma radiation, inhalation, radon, and ingestion of soil. The measured activity values of soil samples from reclamation land for 226Ra ranged from 25.6704 ± 0.5082 to 58.8555 ± 0.6917 Bq/kg. The activity values for 232Th ranged from 30.5546 ± 0.1757 to 42.53020.3004 Bq/kg. Lastly, the activity values for 40K ranged from 533.902 ± 6.4023 to 988.081 ± 9.6948 Bq/kg. The total effective dose rate measured in the reclaimed land falls between 0.08673 and 0.1469 millisieverts per year. The value does not surpass the maximum limit set by BAPETEN, which is one mSv/year. Therefore, no additional protective measures are required for workers.

Numerical Simulation of Compensation Injection Problems Near Deep Excavations

The stress-strain state (SSS) of the “ground foundation – foundation pit under the protection of a fence – compensation injection zone” system is complex, multifactorial and transforming in space. Taking into account a wide range of phenomena when changing the SSS of the soil base is associated with significant difficulties, especially without the use of numerical modeling using software and computer systems. Numerical modeling in the implementation of the finite element method (FEM) for the problems of complex interaction of a soil basis with underground structures during compensatory grouting makes it possible to assign injection zones in any position in space (horizontally, vertically, at an angle), determine the necessary injection parameters to achieve the building lifting of the soil basis when solving the inverse problem. In this study, using examples of numerical modeling of compensation grouting problems near the pit fence with different locations of existing buildings, the authors identified the determining factors affecting the distribution of internal forces in the enclosing structures of the excavation, as well as on the existing structures of the underground structure. The results of comparison of calculations in two-dimensional and three-dimensional formulations are presented, an increase in the bending moment of the retaining wall when carrying out work on compensatory injection by 187–279% is shown for different parameters of the distance to the grouting horizon. The results of the conducted studies confirm the need to take into account the increase in internal efforts during the work on compensatory injection in the structures of the pit fences when assigning reinforcement. In addition, in some cases it is necessary to provide additional protective measures to prevent a negative impact on the constructed underground structures to reduce emergency situations.

The security of IOT from the perspective of the observability of complex networks

The Internet of Things (IOT) is based on the computer Internet, using RFID, wireless data communication and other technologies to construct a network covering everything in the world. It contains numerous entities such as sensors, processors, transmitters and actuators, meanwhile the interactions of which are complicated. These characteristics of IOT are consistent with those of the complex network. Motivated by this, this paper comprehends the security issue of IOT from the sight of the observability of complex network and regards the ability of reconstruction as a security threat to IOT network. We try to identify the minimum vertices whose data could reconstruct the whole data of network, in other words, we need to implement additional protective measures on these vertices to enhance the security of IOT network. By analyzing the topology of IOT network, an identification strategy is adopted and the corresponding algorithm is proposed to identify the minimum protection vertices.

Do perception factors affect adaptation behaviours against air pollution among vulnerable occupation groups? Evidence from Chittagong and Dehradun.

Abstract Air pollution is a key environmental issue affecting the urban population in the urban cities of Hindu Kush Himalaya (HKH) countries. It is particularly detrimental to marginalized occupation groups like street vendors, labourers and drivers who work outdoors for their livelihood. There are mitigation strategies to reduce the brunt of air pollution that work in the long run. However, these strategies will need time to implement and operationalize. Adaptation behaviours and measures, in this context, are urgently required and become vital to cope with the impacts of air pollution exposure especially for highly exposed informal workers who have very little means of avoiding it. Adaptation behaviour is very complex and depends on socioeconomic and psychological factors. In this paper, we assess the impact of psychological factors like perception and motivation on the adaptive behaviour of the informal workers using Protection Motivation Theory (PMT). Our findings from Dehradun show that concern behaviour towards air pollution was strongly affected by motivation and perception factors. Adaptive behaviour in the form of both concern behavior and the extent of use of additional protective measures is dependent on how the risks of air pollution and related adaptation measures are perceived by the workers. In addition to this, certain adaptation behaviours like changing or adjusting the daily normal behaviour to avoid air pollution exposure are not feasible as they have direct implications on daily wage earnings.

Physico-chemical analysis and characterization of the flammability of metallic powders

When fine particles known as flammable powders are suspended in the air under specific circumstances, they have the potential to explode. There could be many serious fatalities, injuries, and structural damage as a result of a dust explosion. By being aware of the flammability parameters and the physico-chemical analysis for flammable powders and taking additional protective measures as a result of the occurrence of these kinds of catastrophic mixes, the risk of such incidents can be decreased. The goal of this study was to determine the flammability characteristics of two combustible powders, magnesium and aluminum powder. These characteristics included the lowest ignition temperature of the dust cloud and dust layer as well as certain physicochemical studies of the composition.

학교폭력 피해학생 보호와 가해학생 선도 조치의 현황, 문제점 및 개선방안에 관한 소고

The purpose of this study was to examine the current status and issues of protecting school violence victims, leading measures for perpetrators to prevent school violence recurrence and propose improvement measures. For this purpose, an analysis was conducted based on data related to current legal regulations, the status of the deliberation committee's measures to protect victims and lead perpetrators, and the awareness of the protection and guidance of victims and perpetrators. The results pointed out the weakness of protection measures for student victims, the lack of protection measures for many student victims by the committee, and the fact that protection measures are focused on counseling areas. However, there are not enough counseling institutions for student victims, and the counseling agency does not report or recognize that the student victims received official help. Accordingly, improvement proposals were made, such as legal guarantees for the treatment and recovery of victim students, additional protection measures by the committee, strict intervention in cases of casual and emotional violence, and assistance with school adaptation after the protection measures. More issues were pointed out, such as the regulations for leading measures for perpetrator students, the problems of committee measures with written apologies and special education, and the problem of perpetrators themselves recognizing that they had not received any action. To address these
 issues, improvement measures have been proposed, including supplementing regulations regarding immediate separation from victim students, emergency measures, written apology measures, improvements in special education, and emphasizing the need for apology and responsibility from perpetrators.

Evaluation of Compressive Strength of UHPC Cured in A Winter Low-temperature

Deteriorating concrete quality is a typical problem reported in a low-temperature environment in winter. Therefore, efforts to evaluate and secure the quality of concrete are always carried out. In this study, the researchers primarily focused on developing curing methods and improving the quality of mixing materials, including chemical admixture, to secure compressive strength of concrete. The study investigated the compressive strength of concrete according to its age and observed that the compressive strength increases under the experimental conditions without any additional protection measures for the winter season. The compressive strength of the cured concrete was measured at 0 and -15 ℃ for 100 MPa Ultra-high-performance concrete (UHPC). Additionally, the property of compressive strength was compared with that of UHPC, which suffered damage due to the cold, went through a certain recovery period at room temperature. Consequently, it was confirmed that UHPC, damaged from the cold weather, achieved the specific compressive strength after 84 days. The findings from this study can enhance further understanding of the characteristics of UHPC in winter environments and contribute to establishing a construction plan for withstanding the winter seasons.

Risk of Severe COVID-19 and Protective Effectiveness of Vaccination Among Solid Organ Transplant Recipients.

Solid organ transplant recipients (SOTRs) are at higher risk for severe infection. However, the risk for severe COVID-19 and vaccine effectiveness among SOTRs remain unclear. This retrospective study used a nationwide health care claims database and COVID-19 registry from the Republic of Korea (2020 to 2022). Adult SOTRs diagnosed with COVID-19 were matched with up to 4 non-SOTR COVID-19 patients by propensity score. Severe COVID-19 was defined as treatment with high-flow nasal cannulae, mechanical ventilation, or extracorporeal membrane oxygenation. Among 6783 SOTRs with COVID-19, severe COVID-19 was reported with the highest rate in lung transplant recipients (13.16%), followed by the heart (6.30%), kidney (3.90%), and liver (2.40%). SOTRs had a higher risk of severe COVID-19 compared to non-SOTRs, and lung transplant recipients showed the highest risk (adjusted odds ratio, 18.14; 95% confidence interval [CI], 8.53-38.58). Vaccine effectiveness against severe disease among SOTRs was 47% (95% CI, 18%-65%), 64% (95% CI, 49%-75%), and 64% (95% CI, 29%-81%) for 2, 3, and 4 doses, respectively. SOTRs are at significantly higher risk for severe COVID-19 compared to non-SOTRs. Vaccination is effective in preventing the progression to severe COVID-19. Efforts should be made to improve vaccine uptake among SOTRs, while additional protective measures should be developed.

Cementitious materials limitations for concrete exposed to deicing salt plus repeated cycles of freezing and thawing

AbstractReducing the carbon footprint of concrete generally involves reducing the amount of calcium oxide in the cementitous materials by blending flyash and/or ground limestone into the cement or by replacing some of the cement with supplementary cementitious materials. This increases the ratio of SiO2+Al2O3+Fe2O3 to CaO+MgO in the cementitious material. While reducing the CaO content of cementitious materials is good for the environment, it may not be good for concrete exposed to deicing salts plus repeated cycles of freezing and thawing due to the effect of carbonation. Though carbonation can refine the pore structure when using only portland cement, it coarsens the pore structure when using high levels of cement replacement. This leads to increased scaling potential. A review of the effects of different cementitious materials combinations on carbonation along with an examination of field performance of concrete exposed to deicing salt plus repeated cycles of freezing and thawing is used to develop a relationship based on the ratio of SiO2+Al2O3+Fe2O3 to CaO+MgO in order to determine when limitations on cement replacement, or additional protective measures may be needed when scaling is a concern.

Impact of ground surface subsidence caused by underground coal mining on natural gas pipeline

Underground mining of minerals is accompanied by a change in the rock mass geomechanical situation. This leads to the redistribution of stresses in it and the occurrence of unexpected displacements and deformations of the earth's surface. A significant part of the civil and industrial infrastructure facilities are located within the mine sites, where mining and tunneling operations are constantly conducted. Irrational planning of mining operations can lead to loss of stability and destruction of undermined facilities. Therefore, it is important to study the earth’s surface deformation processes during mining operations, which ensures safe and sustainable operating conditions. The research objective of this paper is to analyse the behaviour of a natural gas pipeline under the influence of underground mining activities, with a particular focus on understanding the effects of horizontal surface deformations and their potential impact on pipeline safety and structural integrity. Its performance and safety are determined on the basis of the found parameters of the earth's surface horizontal deformations and their comparison with permissible parameters characterizing the conditions for laying pipelines, depending on the mining-geological conditions and the degree of their undermining. Based on determined conditions for the safe undermining of the natural gas pipeline, it has been revealed that in its section between the PK212+40 and PK213+80 (140 m) pickets, the estimated parameters of the earth's surface horizontal deformations exceed their permissible values. This can cause deformation and damage to the pipeline. For the safe operation of the pipeline during the period of its undermining, in order to eliminate the hazardous impact of mining the longwall face, additional protection measures must be applied. It is therefore recommended that the gas pipeline between the PK212 and PK214+20 pickets be opened prior to the displacement process (200 m from the stoping face), thus reducing the density of the gas pipeline-soil system. Recommendations for controlling the earth’s surface deformations within the natural gas pipeline route are also proposed, which will ensure premature detection of the negative impact of mining operations.

Association Between Low Anti-spike Antibody Levels After the Third Dose of SARS-CoV-2 Vaccination and Hospitalization due to Symptomatic Breakthrough Infection in Kidney Transplant Recipients.

Whether anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody levels post-third coronavirus disease (COVID-19) vaccination correlate with worse outcomes due to breakthrough infection is unclear. We evaluated the association between anti-SARS-CoV-2 antibody levels and symptomatic breakthrough infection or hospitalization during the Omicron surge in kidney transplant recipients. In total, 287 kidney transplant recipients expected to receive a third vaccination were enrolled between November 2021 and February 2022. The Abbott SARS-CoV-2 IgG II Quant test (Abbott, Chicago, IL, USA) was performed within three weeks before and four weeks after the third vaccination. The incidence of symptomatic breakthrough infection and hospitalization from two weeks to four months post-third vaccination was recorded. After the third vaccination, the seropositive rate and median antibody titer of the 287 patients increased from 57.1% to 82.2% and from 71.7 (interquartile range [IQR] 7.2-402.8) to 1,612.1 (IQR 153.9-5,489.1) AU/mL, respectively. Sixty-four (22.3%) patients had symptomatic breakthrough infections, of whom 12 required hospitalization. Lower anti-receptor-binding domain (RBD) IgG levels (<400 AU/mL) post-third vaccination were a risk factor for symptomatic breakthrough infection (hazard ratio [HR]=3.46, P<0.001). Anti-RBD IgG levels <200 AU/mL were a critical risk factor for hospitalization (HR=36.4, P=0.007). Low anti-spike IgG levels after third vaccination in kidney transplant recipients were associated with symptomatic breakthrough infection and, particularly, with hospitalization during the Omicron surge. These data can be used to identify patients requiring additional protective measures, such as passive immunization using monoclonal antibodies.

Estimates of protection levels against SARS-CoV-2 infection and severe COVID-19 in Germany before the 2022/2023 winter season: the IMMUNEBRIDGE project

PurposeDespite the need to generate valid and reliable estimates of protection levels against SARS-CoV-2 infection and severe course of COVID-19 for the German population in summer 2022, there was a lack of systematically collected population-based data allowing for the assessment of the protection level in real time.MethodsIn the IMMUNEBRIDGE project, we harmonised data and biosamples for nine population-/hospital-based studies (total number of participants n = 33,637) to provide estimates for protection levels against SARS-CoV-2 infection and severe COVID-19 between June and November 2022. Based on evidence synthesis, we formed a combined endpoint of protection levels based on the number of self-reported infections/vaccinations in combination with nucleocapsid/spike antibody responses (“confirmed exposures”). Four confirmed exposures represented the highest protection level, and no exposure represented the lowest.ResultsMost participants were seropositive against the spike antigen; 37% of the participants ≥ 79 years had less than four confirmed exposures (highest level of protection) and 5% less than three. In the subgroup of participants with comorbidities, 46–56% had less than four confirmed exposures. We found major heterogeneity across federal states, with 4–28% of participants having less than three confirmed exposures.ConclusionUsing serological analyses, literature synthesis and infection dynamics during the survey period, we observed moderate to high levels of protection against severe COVID-19, whereas the protection against SARS-CoV-2 infection was low across all age groups. We found relevant protection gaps in the oldest age group and amongst individuals with comorbidities, indicating a need for additional protective measures in these groups.