Post-vaccination Period Research Articles

Characteristics and factors associated with severity of COVID-19 infections in primary care.

Primary care service plays a vital role in early clinical assessment of patients with COVID-19 in Malaysia. This study aimed to evaluate the potential risk factors of COVID-19 severity at presentation to primary care facilities in the post-vaccination period. Clinical records from the Selangkah system of all patients with COVID-19 aged above 18 years seen at COVID-19 assessment centres located in 10 government health clinics in Gombak district, Selangor, from 1 October to 31 December 2021 with complete documentation and outcomes were retrieved. Demographics, comorbidities, clinical features and vaccination statuses and types were retrospectively evaluated. The variables were compared between mild and severe diseases. Univariate and multivariable logistic regressions were used to identify the factors affecting disease severity. A total of 4406 patients (median age=37 years, men=51.2%) were analysed. Approximately 97.1% of the cases were mild, while 2.9% were severe. Fever, difficulty breathing, lethargy, throat irritation/runny nose, oxygen saturation of <95%, respiratory rate of >20 breaths per minute, CoronaVac vaccination and hypertension were the determinants of severity (P<0.05). The high proportion (97.1%) of mild cases in this study compared with an earlier report (81.8%) during the pre-vaccination period may suggest the impact of vaccine, as 84.9% of this cohort was fully vaccinated. Our study also demonstrated a significant difference in COVID-19 severity between the vaccine types. The identified clinical features and comorbidities could assist primary care doctors in stratifying patients with COVID-19 judiciously in terms of hospital referral or home quarantine.

Disparities in Pediatric Orthopedic Surgery Care During the COVID-19 Pandemic Pre-vaccine and Post-Vaccine Availability.

The COVID-19 pandemic has led to significant disruptions in medical care, resulting in an estimated 40% of US adults avoiding care. However, the return to baseline health care utilization following COVID-19 restrictions within the pediatric orthopedic population remains unexplored. We sought to analyze the visit volume and demographics of pediatric orthopedic patients at 3 timepoints: prepandemic (2019), pandemic (2020), and pandemic post-vaccine availability (2021), to determine the impact of COVID-19 restrictions on our single-center, multisite institution. We performed a retrospective cohort study of 6318 patients seeking treatment at our institution from May through August in 2019, 2020, and 2021. Patient age, sex, address, encounter date, and ICD-10 codes were obtained. Diagnoses were classified into fractures and dislocations, non-fracture-related trauma, sports, elective, and other categories. Geospatial analysis comparing incidence and geospatial distribution of diagnoses across the time periods was performed and compared with the Centers for Disease Control (CDC) social vulnerability index (SVI). The total number of pediatric orthopedic visits decreased by 22.2% during the pandemic ( P <0.001) and remained 11.6% lower post-vaccine availability compared with prepandemic numbers ( P <0.001). There was no significant difference in age ( P =0.097) or sex ( P =0.248) of the patients across all 3 timepoints; however, patients seen during the pandemic were more often White race (67.7% vs. 59.3%, P <0.001). Post-vaccine availability, trauma visits increased by 18.2% ( P <0.001) and total fractures remained 13.4% lower than prepandemic volume ( P <0.001). Sports volume decreased during the pandemic but returned to prepandemic volume in the post-vaccine availability period ( P =0.298). Elective visits did not recover to prepandemic volume and remained 13.0% lower compared with baseline ( P <0.001). Geospatial analysis of patient distribution illustrated neighborhood trends in access to care during the COVID-19 pandemic, with fewer patients from high SVI and low socioeconomic status neighborhoods seeking fracture care during the pandemic than prepandemic. Post-vaccine availability, fracture population distribution resembled prepandemic levels, suggesting a return to baseline health care utilization. Pediatric orthopedic surgery visit volume broadly decreased during the COVID-19 pandemic and did not return to prepandemic levels. All categories increased in the post-vaccine availability time point except elective visits. Geospatial analysis revealed that neighborhoods with a high social vulnerability index (SVI) were associated with decreased fracture visits during the pandemic, whereas low SVI neighborhoods did not experience as much of a decline. Future research is needed to study these neighborhood trends and more completely characterize factors preventing equitable access to care in the pediatric orthopedic population. Retrospective Study, Level III.

The Incidence of Graves’ Hyperthyroidism Before and After COVID-19 Messenger RNA Vaccination

ObjectiveCase reports of postvaccine early-onset Graves’ hyperthyroidism (PVGD) after the administration of COVID-19 vaccination have emerged. Our aim was to investigate whether the incidence of Graves’ hyperthyroidism (GD) has increased after the introduction of COVID-19 vaccination. MethodsWe compared the incidence of new-onset GD at a single academic center during 2 periods: December 2017 to October 2019 and December 2020 to October 2022, ie, before and after the implementation of COVID-19 vaccinations. We defined PVGD as laboratory-confirmed hyperthyroidism and GD within 4 weeks after the vaccination or clear onset of symptoms of thyrotoxicosis within 4 weeks of vaccination with evidence of hyperthyroidism and GD within 3 months. ResultsDuring the prevaccination period, 803 patients carried diagnoses of GD, and of these, 131 were new. During the postvaccination period, 901 patients carried diagnoses of GD, and of these, 138 were new. There was no statistically significant difference in the incidence of GD (P = .52), age at onset, gender, or race between the 2 groups. Twenty-four of 138 newly diagnosed patients in the post–COVID-19 group met the criteria for PVGD. The median free T4 was higher, but this was not statistically significant (3.9 vs 2.5 ng/dL, P = .05). There were no differences in age, gender, race, antibody titers, or type of vaccination between PVGD and controls. ConclusionThere was no increase in new-onset GD after COVID-19 vaccination. Median free T4 was higher in patients with PVGD, but this was not statistically significant.

SARS CoV-2 IgG positivity among the people in Dhaka city: An observation from the post vaccine period

Immunity status after mass vaccination program against SARS CoV-2 has not been evaluated in Bangladesh. This study aims to assess the IgG response against SARS-CoV-2 among the vaccine receivers in Bangladesh. After signed consent, blood samples were tested for SARS CoV-2 IgG from volunteers between March, 21 and April, 22 using ELISA where IgG index ≥0.9 was considered as positive Among 3034 participants, IgG positivity was calculated approximately 82% for vaccine recipients; lowest (58%) during March–April, 21 which increased to 85–95% later. IgG positivity and mean index was 82% and 3.04 in vaccinated whereas 56% and 1.5 in unvaccinated cases. IgG positivity and mean index reduced with age: 90% and 2.56, 79% and 2.23, 73% and 2.13 in 18–40 y, 41–60 y, >60 y group respectively. Vaccinated with COVID-19 history showed highest IgG positivity and index (94% and 3.1) compared to vaccinated without COVID-19 history (76% and 1.6), unvaccinated with COVID-19 history (75% and 1.5) and unvaccinated without COVID-19 history (51% and 0.9). IgG positivity and index reduced as interval between IgG testing and vaccination increases. Our findings suggest a robust IgG response among the vaccine recipients. Negative correlation of IgG positivity and index with age and time necessitates continuous monitoring of immunity status.

Long-term safety of COVID vaccination in individuals with idiopathic inflammatory myopathies: results from the COVAD study

Limited evidence on long-term COVID-19 vaccine safety in patients with idiopathic inflammatory myopathies (IIMs) continues to contribute to vaccine hesitancy. We studied delayed-onset vaccine adverse events (AEs) in patients with IIMs, other systemic autoimmune and inflammatory disorders (SAIDs), and healthy controls (HCs), using data from the second COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. A validated self-reporting e-survey was circulated by the COVAD study group (157 collaborators, 106 countries) from Feb–June 2022. We collected data on demographics, comorbidities, IIM/SAID details, COVID-19 history, and vaccination details. Delayed-onset (> 7 day) AEs were analyzed using regression models. A total of 15165 respondents undertook the survey, of whom 8759 responses from vaccinated individuals [median age 46 (35–58) years, 74.4% females, 45.4% Caucasians] were analyzed. Of these, 1390 (15.9%) had IIMs, 50.6% other SAIDs, and 33.5% HCs. Among IIMs, 16.3% and 10.2% patients reported minor and major AEs, respectively, and 0.72% (n = 10) required hospitalization. Notably patients with IIMs experienced fewer minor AEs than other SAIDs, though rashes were expectedly more than HCs [OR 4.0; 95% CI 2.2–7.0, p < 0.001]. IIM patients with active disease, overlap myositis, autoimmune comorbidities, and ChadOx1 nCOV-19 (Oxford/AstraZeneca) recipients reported AEs more often, while those with inclusion body myositis, and BNT162b2 (Pfizer) recipients reported fewer AEs. Vaccination is reassuringly safe in individuals with IIMs, with AEs, hospitalizations comparable to SAIDs, and largely limited to those with autoimmune multimorbidity and active disease. These observations may inform guidelines to identify high-risk patients warranting close monitoring in the post-vaccination period.

Temporal association between the age-specific incidence of Guillain-Barré syndrome and SARS-CoV-2 vaccination in Republic of Korea: a nationwide time-series correlation study.

The incidence of Guillain-Barré syndrome (GBS) changed significantly during the coronavirus disease 2019 (COVID-19) pandemic. Emerging reports suggest that viral vector-based vaccines may be associated with an elevated risk of GBS. In this nationwide time-series correlation study, we examined the age-specific incidence of GBS from January 2011 to August 2022, as well as data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations and infections from February 2021 to August 2022. We compared the forecasted estimates of age-specific GBS incidence, using the pre-SARS-CoV-2 period as a benchmark, with the actual incidence observed during the post-vaccination period of the pandemic. Furthermore, we assessed the temporal association between GBS, SARS-CoV-2 vaccinations, and COVID-19 for different age groups. In the age group of 60 and older, the rate ratio was significantly elevated during June-August and November 2021. A significant, strong positive association was observed between viral vector-based vaccines and GBS incidence trends in this age group (r=0.52, p=0.022). For the 30 to 59 years age group, the rate ratio was notably high in September 2021. A statistically significant, strong positive association was found between mRNA-based vaccines and GBS incidence in this age group (r=0.61, p=0.006). Viral vector-based SARS-CoV-2 vaccines were found to be temporally associated with an increased risk of GBS, particularly in older adults. To minimize age-specific and biological mechanism-specific adverse events, future vaccination campaigns should adopt a more personalized approach, such as recommending homologous mRNA-based SARS-CoV-2 vaccines for older adults to reduce the heightened risk of GBS.

P-070 SARS-CoV2 antibody isotypes in seminal fluid of vaccinated men

Abstract Study question Are SARS-CoV2 antibody isotypes detectable in seminal fluid of vaccinated men Summary answer Systemic circulating SARS-CoV2 antibodies are likely to be precluded from transport to seminal plasma following vaccination in males What is known already Expedited development of SARS-CoV-2 vaccines led to public concerns regarding impacts of the novel vaccine on gametes in patients seeking assisted reproduction. Recent studies on ovarian follicular fluid from women post SARS-CoV2 infection or BNT162b2 mRNA vaccination show similar levels of SARS-CoV2 IgG antibodies in follicular fluid as those found in serum. To our knowledge, no study to date has examined if SARS-CoV2 antibody isotypes are detectable in seminal fluid of vaccinated men. Study design, size, duration This was a longitudinal cohort study of 17 normospermic male patients attending a fertility clinic associated with a tertiary university maternity hospital. Semen and matched peripheral blood samples were collected prior to vaccination (t = 0), within 46 + 18.9 hours of vaccine completion (acute; t = 1) and at 88.4 + 12 days (3 months; t = 2) post vaccination. Participants/materials, setting, methods Serum and seminal plasma anti-SARS-CoV-2 spike isotypes (IgA, IgM and IgG1) and immune factors (IL-6, IL-8, IL-10, IFN-γ, TNF-α, IP-10; CXCL10, MCP-1, CCL2) were analysed using ELISA-based approaches at three time points. To rule out potential factors present in seminal plasma that could interfere with IgG detection, a commercial positive anti-Spike control was used to confirm detection in the ELISA assay. Self-reported symptoms and sperm parameters including count, motility, morphology, DNA damage were also quantified. Main results and the role of chance All semen samples were found to be negative for anti-SARS-CoV2 spike antibodies at all three time points indicating that systemic antibodies are likely precluded from transport to seminal plasma. Four out of 17 (23.5%) serum samples were negative for all three isotypes (IgM, IgA, IgG1) at &amp;lt; 72 hours post-vaccine completion, while one patient remained negative for all antibodies at 3 months post-vaccine. No global change from baseline was seen in reported symptoms, mean semen volume, semen pH, sperm concentration, motility, morphology or DNA damage in the acute or long phase. Two men showed a clinically relevant reduction in sperm motility alone in the acute phase that returned to normal by 3 months. Seminal plasma MCP-1 levels showed an acute but transient elevation post-vaccine, while IL-8 was marginally increased 3 months after completion of vaccination. Our findings also indicate a modest, positive correlation between serum levels of the anti-inflammatory cytokine IL-10 and self-reported symptoms in the acute post-vaccine period, with no correlation between serum IL-10 levels and change in sperm parameters from t = 0 to t = 1. Limitations, reasons for caution This study included a small population of only 17 men, all of whom were normospermic. Responses in men with subnormal baseline sperm parameters may differ and thus would be helpful to explore. Wider implications of the findings Our results show no significant adverse effect of vaccination. There may be temporary decline in sperm motility which could be more significant in men with poor baseline parameters. Further larger studies with inclusion of men with abnormal baseline parameters would be valuable to support timing of vaccination and treatment. Trial registration number not applicable

Safety of monovalent and bivalent BNT162b2 mRNA COVID-19 vaccine boosters in at-risk populations in Israel: a large-scale, retrospective, self-controlled case series study

COVID-19 continues to be a major health threat, particularly among at-risk groups, including individuals aged 60 years or older and people with particular medical conditions. Nevertheless, the absence of sufficient vaccine safety information is one of the key contributors to vaccine refusal. We aimed to assess the short-term safety profile of the BNT162b2 mRNA COVID-19 vaccine booster doses. In this self-controlled case series study, we used a database of members of the largest health-care organisation in Israel. We analysed the medical records of individuals at risk of COVID-19 complications who had received two doses of the monovalent BNT162b2 mRNA COVID-19 vaccine (tozinameran, Pfizer-BioNTech) as their primary course of vaccination and then also received BNT162b2 mRNA COVID-19 vaccine boosters between July 30, 2021, and Nov 28, 2022, as a monovalent first or second booster, or as a bivalent first, second, or third booster, or a combination of these. We included individuals who had active membership of the health-care organisation and who were alive (excluding COVID-19 deaths) throughout the entire study period. We excluded individuals who, during the study period, were either not active Clalit Health Services members or died of non-COVID-19 causes, and those who were infected with COVID-19 during the 7-day period after vaccination. Individuals' at-risk status was assessed on the day before the baseline period started. The primary outcome was non-COVID-19 hospitalisation for 29 adverse events that might be associated with vaccination. For each adverse event, we compared the risk difference of hospitalisation during a 28-day pre-vaccination baseline period versus during a 28-day post-vaccination period, using a non-parametric percentile bootstrap method. Of the 3 574 243 members of the health-care organisation, 1 073 110 received a first monovalent booster, 394 251 received a second monovalent booster, and 123 084 received a bivalent first, second, or third booster. Overall, we found no indication of an elevated risk of non-COVID-19 hospitalisation following administration of any of the booster vaccines (risk difference in events per 100 000 individuals: first monovalent booster -37·1 [95% CI -49·8 to -24·2]; second monovalent booster -37·8 [-62·2 to -13·2]; and bivalent booster -18·7 [-53·6 to 15·4]). Except for extremely rare elevated risks after the first monovalent booster-of myocarditis (risk difference 0·7 events per 100 000 individuals [95% CI 0·3-1·3]), seizures (2·2 [0·4-4·1]), and thrombocytopenia (2·6 [0·7-4·7])-we found no safety signals in other adverse events, including ischaemic stroke. This study provides the necessary vaccine safety assurances for at-risk populations to receive timed roll-out booster vaccinations. These assurances could reduce vaccine hesitancy and increase the number of at-risk individuals who opt to become vaccinated, and thereby prevent the severe outcomes associated with COVID-19. Israel Science Foundation and Israel Precision Medicine Partnership programme.

#3161 CLINICAL EFFICACY AND OPTIMAL REGIMEN OF BNT162B2 VACCINE IN CHRONIC DIALYSIS PATIENTS

Abstract Background and Aims Highly effective vaccines against severe acute respiratory syndrome virus 2 (SARS-CoV-2) have been developed and administered worldwide. Protection from coronavirus disease 2019 (COVID-19), however, is not absolute, and optimal vaccination regimens need to be established. Concerns regarding breakthrough COVID-19 disease in vaccinated patients are increasing, as vaccine efficacy appears to gradually decline in the months following vaccination. The emergence of highly infective variants, escalates these issues. This study assessed the clinical efficacy of the BNT162b2 vaccine and all-cause mortality among dialysis patients receiving varying numbers of vaccine doses. Method This study was conducted using the electronic database of Clalit Health Services in Israel. Patients receiving chronic hemodialysis or peritoneal dialysis during COVID-19 pandemic were included in the analysis. The control group consisted of age-and sex-matched individuals, in a 4:1 ratio to the dialysis group. The study included the pre- and post-vaccination periods. Results A total of 14,230 people were included; 2,846 on chronic dialysis and 11,384 controls. Mean age was 66.2±14.3 years (range 18-97). Before the vaccine was available in Israel, 223 dialysis patients were infected with SARS-CoV2. Their mortality rate was 18.4% compared to 10.8% among uninfected, unvaccinated patients in the same period (p = 0.001). On post-vaccination period, we compared the clinical efficacy of a fourth dose to patients who received only 3 doses of BNT162b2 vaccine. SARS-CoV-2 infection rates, hospitalizations due to severe COVID-19, COVID-19–related mortality and all-cause mortality rates were lower among chronic dialysis patients who received a fourth dose of vaccine as compared to those who received only 3 doses (after adjusting for age, sex and comorbidities). Despite lower mortality rates observed with the Omicron variant, an additional booster dose was associated with reduced COVID-19–related mortality (1.7% vs. 3.8%, p = 0.04, HR 0.44 (95% CI 0.2–0.98) in patients who received 4 doses compared to 3 doses. Conclusion As seen in the general population, and with previous vaccine boosters, the fourth dose of the BNT162b2 vaccine reduced rates of severe COVID-19 hospitalization and mortality among chronic dialysis patients. This study strengthens the recommendation to administer a fourth booster dose of vaccine to dialysis patients. Further studies are needed to establish the exact dose and schedule of the COVID-19 vaccine in the vulnerable population patients on chronic maintenance dialysis.

Life Cycle Air Pollution, Greenhouse Gas, and Traffic Externality Benefits and Costs of Electrifying Uber and Lyft.

Transportation network companies (TNCs), such as Uber and Lyft, have pledged to fully electrify their ridesourcing vehicle fleets by 2030 in the United States. In this paper, we introduce AgentX, a novel agent-based model built in Julia for simulating ridesourcing services with high geospatial and temporal resolution. We then instantiate this model to estimate the life cycle air pollution, greenhouse gas, and traffic externality benefits and costs of serving rides based on Chicago TNC trip data from 2019 to 2022 with fully electric vehicles. We estimate that electrification reduces life cycle greenhouse gas emissions by 40-45% (9-10¢ per trip) but increases life cycle externalities from criteria air pollutants by 6-11% (1-2¢ per trip) on average across our simulations, which represent demand patterns on weekdays and weekends across seasons during prepandemic, pandemic, and post-vaccination periods. A novel finding of our work, enabled by our high resolution simulation, is that electrification may increase deadheading for TNCs due to additional travel to and from charging stations. This extra vehicle travel increases estimated congestion, crash risk, and noise externalities by 2-3% (2-3¢ per trip). Overall, electrification reduces net external costs to society by 3-11% (5-24¢ per trip), depending on the assumed social cost of carbon.

The safety of seasonal influenza vaccination among patients prescribed immune checkpoint inhibitors: A self-controlled case series study using administrative data.

6606 Background: Immune checkpoint inhibitor (ICI) therapy for cancer patients carries a risk of severe immune-related adverse events (IRAEs). Since vaccines are immunomodulatory, administering seasonal influenza vaccinations to individuals on ICI therapy may exacerbate this risk. However, these vaccines provide substantial benefit to this at-risk population. As severe IRAEs are rare, previous vaccine safety studies in this population have been underpowered and have shown conflicting results. Methods: We used health administration data on adult Ontarians who initiated ICI therapy and received an influenza vaccine between January 1, 2012, and December 31, 2019. We conducted a self-controlled case series study, with a pre-vaccine control period (12-weeks post-ICI initiation to 14 days before vaccine), risk period (42 days post-vaccine), and a post-vaccine control period (until observation end). Each individual contributed a maximum of 2 years of person-time. Emergency department (ED) visit(s) and/or hospitalization for any cause was used as a surrogate measure of severe IRAE frequency. We fitted a fixed effect Poisson regression model incorporating seasonality and time to estimate incidence. Results: We identified 1133 patients who received an influenza vaccine on ICI therapy. The majority were aged ≥66 years (72.7%), male (62.8%), and had lung cancer (53.9%). A quarter (25.9%) experienced an ED visit and/or hospitalization during the observation period. The rate of ED visits and/or hospitalization per person-days in the risk and control periods were similar, with an incidence rate ratio of 1.04 (95% CI: 0.75, 1.45). Subgroup and sensitivity analyses revealed similar findings. Conclusions: Receipt of a seasonal influenza vaccine was not associated with an increased incidence of ED visit or hospitalization among adults on ICI therapy. The results from this analysis suggest no significant safety concern with administering influenza vaccines to this patient population.

Financial Health of Private Equity-Backed Groups: Perspectives From Eye Care.

In private equity (PE) buyouts of medical practices, it is common for the PE firm to raise significant levels of debt in order to finance the purchase. This debt is subsequently shouldered by the acquired practice(s). There remains a scarcity of literature quantifying the effect of PE acquisition on the subsequent financial performance of eye care practices. We aim to identify and characterize debt valuations of ophthalmology and optometry private equity-backed group (OPEG) practices, which serve as an indicator of practice financial performance. A cross-sectional study from March 2017 to March 2022 was conducted using business development company (BDC) quarterly/annual filings to the Securities and Exchange Commission (SEC). The 2021 BDC Report was used to identify all BDCs actively filing annual reports (Form 10-Ks) and quarterly reports (Form 10-Qs) in the United States in 2021. The public filings of BDCs lending to OPEGs were searched from the inception of the OPEG's debt instrument in a BDC's portfolio and the amortized cost and fair value of each debt instrument were tabulated. A panel linear regression was used to evaluate temporal changes in OPEG valuations. A total of 2,997 practice locations affiliated with 14 unique OPEGs and 17 BDCs were identified over the study period. Debt valuations of OPEGs decreased by 0.46% per quarter over the study period (95% CI: -0.88 to -0.03, P = 0.036). In the COVID-19 pre-vaccine period (March 2020 to December 2020), there was an excess (additional) 4.93% decrease in debt valuations (95% CI: -8.63 to -1.24, P = 0.010) when compared to pre-pandemic debt valuations (March 2017 to December 2019). Effects of COVID-19 on valuations stabilized during the pandemic post-vaccine period (February 2021 to March 2022), with no change in excess debt valuation compared to pre-pandemic baseline (0.60, 95% CI: -4.59 to 5.78, P = 0.822). There was an increase in practices that reported average discounted debt valuations from 20 practices (1.6%) associated with one OPEG to 1,213 practices (40.5%) associated with nine OPEGs (including 100% of newly acquired practices), despite the stabilization of COVID-19-related excess (additional) debt. Debt valuations of eye care practices have declined significantly post-PE investment from March 2017 to March 2022, suggesting that the financial health of these groups is volatile and vulnerable to economic contractions such as the COVID-19 pandemic. Eye care practice owners must consider long-term financial risks and impacts of subsequent patient care when selling their practice to a private equity group. Future research should assess the impact of secondary transactions of OPEGs on the financial health of practices, practitioner lifestyle, and patient outcomes.

The incidence of juvenile onset recurrent respiratory papillomatosis at Starship Children's Hospital before and after a national HPV vaccination programme: a retrospective review.

To review and compare the incidence of juvenile onset recurrent respiratory papillomatosis (JRRP) at Starship Children's Hospital (SSH) before and after the introduction of a national HPV vaccination programme. Patients treated for JRRP at SSH were identified retrospectively using ICD-10 code D14.1 over a 14-year period. The incidence of JRRP in the 10-year period prior to the introduction of HPV vaccination (1 September 1998 to 31 August 2008) was compared with the incidence after its introduction. A second comparison was made between the pre-vaccination incidence with the incidence over the most recent 6 years when the vaccination became more widely available. All New Zealand hospital ORL departments that referred children with JRRP to SSH exclusively were included. SSH manages about half of the New Zealand paediatric population with JRRP. The incidence of JRRP before the introduction of the HPV vaccination programme was 0.21 per 100,000 per year in children 14 years of age and younger. This remained stable between 2008 and 2022 (0.23 vs 0.21 per 100,000 per year). The mean incidence in the later post-vaccination period was 0.15 per 100,000 per year based on small numbers. The mean incidence of JRRP before and after the introduction of HPV has remained unchanged in children treated at SSH. More recently, a reduction in incidence has been noted, although this is based on small numbers. The low HPV vaccination rate (≤70%) may explain why a significant reduction in the incidence of JRRP seen overseas has not been observed in New Zealand. Ongoing surveillance and a national study would provide more insight into the true incidence and evolving trends.

Impact and effectiveness of Rotavin-M1 under conditions of routine use in two provinces in Vietnam, 2016–2021, an observational and case–control study

Half of diarrhea hospitalizations in children aged <5 years in Vietnam are due to rotavirus. Following introduction of a locally developed and licensed oral rotavirus vaccine, Rotavin-M1, into the routine immunization program in two Vietnamese provinces, Nam Dinh and TT Hue, we describe changes in rotavirus positivity among children hospitalized for diarrhea and calculate vaccine effectiveness against moderate-to-severe rotavirus hospitalizations. Active rotavirus surveillance among children <5 years began in December 2016at sentinel hospitals in districts where rotavirus vaccine was introduced in December 2017. To estimate reductions in rotavirus detection, we calculated risk ratios comparing rotavirus positivity pre- and post-vaccine introduction. We used a test-negative case-control design to calculate vaccine effectiveness. From December 2016 to May 2021, 7228 children <5 years hospitalized for diarrhea were enrolled. Following introduction, Rotavin-M1 coverage was 77% (1066/1377) in Nam Dinh and 42% (203/489) in TT Hue. In Nam Dinh, rotavirus positivity among children <5 years significantly declined by 40.6% (95% CI: 34.8%-45.8%) during the three-year post-vaccine introduction period. In TT Hue, no change in rotavirus positivity was observed. Among children aged 6-23 months, a 2-dose series of Rotavin-M1 was 57% (95% CI: 39%-70%) effective against moderate-to-severe rotavirus hospitalizations. Higher vaccination coverage in Nam Dinh than TT Hue likely contributed to substantial declines in rotavirus positivity observed in Nam Dinh following rotavirus vaccine introduction. Robust vaccine effectiveness was observed through the second year of life. National rotavirus vaccine introduction with high coverage may have substantial impact on reducing rotavirus disease burden in Vietnam. Bill and Melinda Gates Foundation.

Ophthalmologist Turnover in the United States: Analysis of Workforce Changes from 2014 through 2021

Physician turnover is costly to health care systems and affects patient experience due to discontinuity of care. This study aimed to assess the frequency of turnover by ophthalmologists and identify physician and practice characteristics associated with turnover. Retrospective cross-sectional study. Actively practicing United States ophthalmologists included in the Centers for Medicare and Medicaid Services Physician Compare and Physician and Other Supplier Public Use File between 2014 and2021. We collected data for each ophthalmologist that was associated with practice/institution and then calculated the rate of turnover both annually in each year window and cumulatively as the total proportion from 2014 to 2021. Multivariable logistic regression analysis was used to identify physician and practice characteristics associated with turnover. We also evaluated turnover characteristics surrounding the Coronavirus disease 2019 (COVID-19) pandemic. Ophthalmologist turnover, defined as a change of an ophthalmologist's National Provider Identifier practice affiliation from one year to the next. Of 13 264 ophthalmologists affiliated with 3306 unique practices, 34.1% separated from at least 1 practice between 2014 and 2021. Annual turnover ranged from 3.7% (2017) to 19.4% (2018), with an average rate of 9.4%. Factors associated with increased turnover included solo practice (adjusted odds ratio [aOR], 9.59), university affiliation (aOR, 1.55), practice location in the Northeast (aOR, 1.39), and practice size of 2 to 4 members (aOR, 1.21; P < 0.05 for all). Factors associated with decreased turnover included male gender (aOR, 0.87) and more than 5 years of practice: 6 to 10 years (aOR, 0.63), 11 to 19 years (aOR, 0.54), 20 to 29 years (aOR, 0.36), and ≥ 30 years (aOR, 0.18; P < 0.05 for all). In the initial year (2020) of the COVID-19 pandemic, annual turnover increased from 7.8% to 11.0%, then decreased to 8.7% in the postvaccine period (2021). One-third of United States ophthalmologists separated from at least 1 practice from 2014 through 2021. Turnover patterns differed by various physician and practice characteristics, which may be used to develop future strategies for workforce stability. Because administrative data cannot solely determine reasons for turnover, further investigation is warranted given the potential clinical and financial implications. Proprietary or commercial disclosure may be found after the references.

Impact of the COVID-19 Vaccination on Bike Sharing Demand in NYC: ARIMAX and Bayesian Time Series Analyses

The objective of this study is to investigate the impact of the COVID-19 vaccine on bike sharing demand in New York City (NYC). The vaccination’s impact was also compared with other known influences (COVID-19 cases counts, COVID-19 deaths, weather data, trip purpose, and more) to help improve bike share demand modeling in a pandemic setting. Autoregressive integrated moving average (ARIMAX) time series models were estimated for Brooklyn and Manhattan in both the pre-vaccine and post-vaccine periods. Mean absolute percentage error (MAPE) was used for model evaluation, and the average MAPE was below 5, suggesting a high-level accuracy in modeling. The Bayesian time series analysis results were very similar to the ARIMAX model results (with the exception of some parameters being significantly underestimated). The results of the time series analyses showed that vaccination did not have a significant effect on bike sharing demand in Manhattan but had a significant effect leading to increases in bike sharing demand in Brooklyn. Despite this, vaccination was not the main influence on bike sharing demand. For instance, in Brooklyn, grocery and retail/recreational shopping were strong influences both pre- and post-vaccine, indicating that regardless of vaccination, shopping is essential. COVID-19 cases counts had opposing effects in Brooklyn and Manhattan. Other findings include higher temperatures leading to increased bike demand, and precipitation and stronger winds leading to decreased bike sharing demand.

Detection of neutralizing antibody towards spike protein of SARS-Cov-2 in vaccinated subjects

Background: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged in December 2019 in Wuhan, China causing a severe acute respiratory disease (COVID-19). The virus has rapidly spread into a pandemic affecting over more than 40 million &amp; mortality more than 5 million as per recent data.Due to lack of specific treatment vaccination was considered as main measures to control the pandemic. India’s drugs regulator, Drugs Controller General of India (DCGI) authorized emergency use for AZD1222/Covishield (ChAdOx1-Recombinant) and BBV152/Covaxin in January 2021 and vaccination was started beginning with healthcare and frontline workers and to all aged above 18 years. The present study aimed to know the presence of neutralizing antibodies in vaccinated subjects with or without history of infection by SARSCov-2. Materials &amp; Methods: After obtaining Institutional Ethical Clearance 260 Vaccinated subjects who consented to participate were included for the study. Details were recorded in the proforma. After sterile precaution about 2 ml blood sample was collected in plain vacutainer tube &amp; Serum sample was separated and stored at -20 0C. The neutralizing antibody towards spike protein was detected by performing commercial ELISA (MICROLISA, J MITRA) according to the manufacturer’s guidelines. The results were interpreted by calculating Inhibition rate which is above 30% was considered as positive. Result: Among 260 vaccinated subjects 197(75.6%) positive for neutralizing antibody. Among them 178(76.2%) were Covishield and 82(74.07%) Covaxin vaccinees. Age &amp; sex distribution were recorded the highest in 18-40 years 35 106(53.8%) &amp; female 61(54.4%). Vaccinated and infected 151(86.2%) &amp; only vaccinated 46(54.1%). Good antibody titre was observed in 78.5% upto 4 months of vaccination. Conclusion: The vaccinated subjects with history of SARS-cov-2 infection showed better neutralizing antibody titre with good percentage of persistence Nab till 4th months of post vaccination period.

Do COVID-19 pandemic-related policy shocks flatten the bid-rent curve? Evidence from real estate markets in Shanghai.

The COVID-19 pandemic has drastically affected the socioeconomic activities and peoples' daily life, resulting in a change in locational preferences in the real estate markets. Although enormous efforts have been devoted to examining the housing price impacts of the COVID-19 pandemic, little is known about the responses of the real estate markets to the evolving pandemic control measures. This study investigates the price gradient effects of various pandemic-related policy shocks using a hedonic price model on the district-level property transaction data in Shanghai, China over a 48-month period from 2018 to 2021. We found that these shocks have significantly altered the bid-rent curves. The price gradient for residential property units decreased in absolute value to - 0.433 after Wuhan's lockdown, demonstrating peoples' preferences to avoid the high infection risks in districts closer to the city center. However, in the post-reopening and post-vaccine periods, the price gradient increased to - 0.463 and - 0.486, respectively, implying rational expectations of a recovering real estate market for the low infection and mortality rates. In addition, we discovered that Wuhan's lockdown has steepened the price gradient for commercial property units, suggesting a decline in business volumes and an increase in operating costs in the low-density districts imposed by the strict pandemic control measures. This study contributes to the empirical literature on the price gradient effects of the COVID-19 pandemic by extending the study period to the post-vaccine era.

COVID-19 Pandemisinde En Üst Koronavirüs Aşı Hisselerinin Performansı: Çoklu Fraktal Analiz

This study assesses how the coronavirus pandemic (COVID-19) affects the 5-day week multifractal properties of five vaccine stocks (i.e., Pfizer, BioNTech, Moderna, Johnson&amp;amp;Johnson, and AstraZeneca) using weekday index data ranging from 9 December 2019 to 6 January 2022. The main concern is to document whether the presence of herd investing and the level of market efficiency changed between pre-vaccination (i.e., 9 December 2019 - 8 December 2020) and post-vaccination (i.e., 9 December 2020 - 6 January 2022). The generalised Hurst exponents are calculated through multifractal detrended fluctuation analysis. Overall, the empirical results show multifractality for each vaccine stock during the COVID-19 outbreak. Besides, the efficiency level differs among the vaccine stocks based on multifractal properties. The results indicate that the post-vaccination period is more prone to herd investing in BioNTech and Moderna stocks. Considering the impacts of this far-reaching outbreak, the highest MLM (inefficiency) index value is also attributed to BioNTech before and after the COVID-19 vaccination process.

Healthy adults supplemented with a nutraceutical formulation containing Aloe vera gel, rosemary and Poria cocos enhances the effect of influenza vaccination in a randomized, triple-blind, placebo-controlled trial.

The study objective was to examine the role of a formulation, UP360, containing rosemary and Poria cocos extracts and Aloe vera gel powder, in healthy adults on supporting immune function with influenza vaccination. A 56-day randomized, triple-blind, placebo-controlled, parallel study consisted of a 28-day pre-vaccination period, an influenza vaccination on Day 28 and a 28-day post-vaccination period. Men and women ages 40-80 who had not yet been vaccinated for the flu were randomized to UP360 or Placebo (n = 25/group). At baseline, Days 28 and 56, blood lymphocyte populations, immunoglobulins (Ig), and cytokines were measured, and quality of life (QoL) questionnaires administered. The Wisconsin Upper Respiratory Symptom Survey (WURSS)-24 was completed daily by participants to measure incidence of upper respiratory tract infection (URTIs). In the post-vaccination period, TCR gamma-delta (γδ+) cells, known as γδ T cells, increased with UP360 supplementation compared to Placebo (p < 0.001). The UP360 group had a 15.6% increase in influenza B-specific IgG levels in the post-vaccination period (p = 0.0006). UP360 significantly increased the amount of circulating glutathione peroxidase (GSH-Px) from baseline at Day 28 (p = 0.0214), an enzyme that is important for neutralizing free radicals. While UP360 supplementation initially decreased levels of anti-inflammatory cytokine IL-1RA in the pre-vaccination period, IL-1RA levels were increased in the post-vaccination period (p ≤ 0.0482). Levels of IL-7 increased from baseline at Day 56 with UP360 supplementation (p = 0.0458). Despite these changes in immune markers, there were no differences in URTI symptoms or QoL between UP360 and Placebo. These results suggest UP360 supplementation was beneficial in eliciting a healthy, robust immune response in the context of vaccination. No changes in subjective measures of URTI illness or QoL demonstrated that participants' QoL was not negatively impacted by UP360 supplementation. There were no differences in clinical chemistry, vitals or adverse events confirming the good safety profile of UP360. The trial was registered on the International Clinical Trials Registry Platform (ISRCTN15838713).