Vaccination Period Research Articles

31047 Erythrodermic psoriasis secondary to the COVID-19 Moderna vaccine

Vaccination is an unusual trigger for dermatologic autoimmune conditions like psoriasis. Although a plausible association has been dilucidated between certain vaccines and psoriasis flares, to date, there have been no reports of psoriasis flares secondary to COVID vaccines. To our knowledge, we present the first case of a psoriasis flare secondary to the Moderna COVID-19 vaccine. Our patient is a 31-year-old Latino man with a medical history of well-controlled plaque psoriasis whose psoriasis flared 6 days after receiving the second dose of the Moderna COVID-19 vaccine. Upon presentation, he had approximately 15% body surface area (BSA) involvement. Interestingly, the patient had a severe COVID-19 infection 1 year prior to this but at that time had not flared from his psoriasis. He was treated with topical steroids, nbUVB, and oral prednisone, while awaiting risankizumab approval. During this time, the patient became erythrodermic. Once the patient started risankizumab injections, he achieved almost complete clearance by week 10 of treatment. The Moderna vaccine is an mRNA COVID-19 vaccine that induces a strong CD8 T cell response, along with a balanced Th1-Th2 antibody isotype response. In psoriasis, Th1 cells and CD8 T cells play a key role in keratinocyte proliferation; this upregulation in T cells by the Moderna vaccine could lead to a psoriatic flare. Clinicians should be aware of this side effect of the COVID-19 vaccine and advise patients to be compliant with psoriasis treatment and to inform their dermatologist if any worsening of their psoriasis occurs following the COVID-19 vaccination period.

Non-pharmacological interventions of travel restrictions and cancelation of public events had a major reductive mortality affect during pre-vaccination coronavirus disease 2019 period.

BackgroundThe coronavirus disease 2019 (COVID-19) is a severe acute respiratory disease that poses a continuous threat to global public health. Many non-pharmacological interventions (NPIs) have been implemented to control the COVID-19 pandemic since the beginning. The aim of this study was to assess the impact of various NPIs on COVID-19 mortality during pre-vaccination and vaccination periods.MethodsThe COVID-19 data used in this study comes from Our World in Data, we used the Oxford Strict Index (OSI) and its five combination interventions as independent variables. The COVID-19 mortality date (MRT) was defined as a date when daily rate of 0.02 COVID-19 deaths per 100,000 population in a country was reached, and the COVID-19 vaccination date (VRT) was defined as people vaccinated reaching 70%. Linear regression and random forest models were used to estimate the impact of various NPI implementation interventions during pre-vaccination and vaccination periods. The performance of models was assessed among others with Shapley Additive Explanations (SHAP) explaining the prediction capability of the model.ResultsDuring the pre-vaccination period, the various NPIs had strong protective effect. When the COVID-19 MRT was reached, for every unit increase in OSI, the cumulative mortality as of June 30, 2020 decreased by 0.71 deaths per 100,000 people. Restrictions in travel (SHAP 1.68) and cancelation of public events and gatherings (1.37) had major reducing effect on COVID-19 mortality, while staying at home (0.26) and school and workplace closure (0.26) had less effect. Post vaccination period, the effects of NPI reduced significantly: cancelation of public events and gatherings (0.25), staying at home (0.22), restrictions in travel (0.14), and school and workplace closure (0.06).ConclusionContinued efforts are still needed to promote vaccination to build sufficient immunity to COVID-19 in the population. Until herd immunity is achieved, NPI is still important for COVID-19 prevention and control. At the beginning of the COVID-19 pandemic, the stringency of NPI implementation had a significant negative association with COVID-19 mortality; however, this association was no longer significant after the vaccination rate reached 70%. As vaccination progresses, “cancelation of public events and gatherings” become more important for COVID-19 mortality.

Comparison of varicella outbreaks in schools in China during different vaccination periods

ABSTRACT The purpose of this study was to investigate the outbreak trend of chickenpox and the epidemiological characteristics of outbreak related cases from 2017 to 2021, and compare the impact of voluntary self-funded single dose vaccination versus mandatory two-dose vaccine vaccination on varicella outbreaks. The data of varicella outbreaks in Jiangsu Province from 2017 to 2021 come from the national public health emergency management information system. We randomly chose 70 outbreaks from 2019 to 2020 for study in order to better understand the features and regularity of breakthrough varicella(BV). In pilot cities with two doses of free VarV, the number of outbreaks decreased from 306 in 2017 to 123 in 2021, while the total number of cases related to the outbreak decreased by 64.6% (P < .01), the median size of the outbreak decreased from 24 cases (range:6–146) to 21 cases (range:10–93) (P < .01), and the incidence rate also decreased from 2.01/100 to 1.33/100. The proportion of cases with high fever, severe rash and complications in the BV group was lower than that in the primary varicella (PV), and the differences were statistically significant. The incidence rate of varicella among students who had post-exposure prophylaxis (PEP) activities was 1.42% (488/ 33,878), and 1.63% (2468/ 148,943) among those who did not (p = .005). The single-dose varicella vaccination was less effective in controlling the outbreaks, and the success of the full implementation of the routine two-dose varicella vaccination plan in the pilot cities provided a basis for implementation in the whole province, and long-term follow-up studies are needed to evaluate the effect of the new strategy in the future.

The impact of variants and vaccination on the mortality and resource utilization of hospitalized patients with COVID-19

BackgroundCOVID-19 outcomes among hospitalized patients may have changed due to new variants, therapies and vaccine availability. We assessed outcomes of adults hospitalized with COVID-19 from March 2020–February 2022.MethodsData were retrieved from electronic health medical records of adult COVID-19 patients hospitalized in a large community health system. Duration was split into March 2020–June 2021 (pre-Delta period), July–November 2021 (Delta period), and December 2021–February 2022 (Omicron period).ResultsOf included patients (n = 9582), 75% were admitted during pre-Delta, 9% during Delta, 16% during Omicron period. The COVID-positive inpatients were oldest during Omicron period but had lowest rates of COVID pneumonia and resource utilization (p < 0.0001); 46% were vaccinated during Delta and 61% during Omicron period (p < 0.0001). After adjustment for demographics and comorbidities, vaccination was associated with lower inpatient mortality (OR = 0.47 (0.34–0.65), p < 0.0001). The Omicron period was independently associated with lower risk of inpatient mortality (OR = 0.61 (0.45–0.82), p = 0.0010). Vaccination and Omicron period admission were also independently associated with lower healthcare resource utilization (p < 0.05). Magnitudes of associations varied between age groups with strongest protective effects seen in younger patients.ConclusionOutcomes of COVID-19 inpatients were evolving throughout the pandemic and were affected by changing demographics, virus variants, and vaccination.Key pointIn this observational study of almost 10,000 patients hospitalized from March 2020–February 2022 with COVID-19, age and having multiple comorbidities remained consistent risk factors for mortality regardless of the variant. Vaccination was high in our hospitalized patients. Vaccination conveyed less severe illness and was associated with lower inpatient mortality.

A mathematical model for equitable in-country COVID-19 vaccine allocation

Given the scarcity of COVID-19 vaccines, equitable (fair) allocation of limited vaccines across the main administrative units of a country (e.g. municipalities) has been an important concern for public health authorities worldwide. In this study, we address the equitable allocation of the COVID-19 vaccines inside countries by developing a novel, evidence-based mathematical model that accounts for multiple priority groups (e.g. elderly, healthcare workers), multiple vaccine types, and regional characteristics (e.g. storage capacities, infection risk levels). Our research contributes to the literature by developing and validating a model that proposes equitable vaccine allocation alternatives in a very short time by (a) minimising deviations from the so-called ‘fair coverage’ levels that are computed based on weighted pro-rata rations, and (b) imposing minimum coverage thresholds to control the allocation of vaccines to higher priority groups and regions. To describe the merits of our model, we provide several equity and effectiveness metrics, and present insights on different allocation policies. We compare our methodology with similar models in the literature and show its better performance in achieving equity. To illustrate the performance of our model in practice, we perform a comprehensive numerical study based on actual data corresponding to the early vaccination period in Turkey.

The Impact of the COVID-19 Pandemic and Vaccination on Dental Restorative Practices in the Geriatric Population

Objective: Vaccines were considered as one of the most important public health measures during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to quantify and compare restorative dental practices of geriatric patients during pre-pandemic, prevaccination, and post-vaccination periods. Materials and Methods: Dental records of patients aged older than 65 who presented to Bursa Oral and Dental Health Training and Research Hospital were included in the study. Restorative dental practices during the three periods: pre-pandemic period (01.01.2019−10.03.2020), pre-vaccination period (11.03.2020−13.02.2021) and post-vaccination period (14.02.2021−01.09.2021) were reviewed according to the patient’s age (young-old, middle-old and old-old), sex, tooth number (anterior and posterior), restoration type (occlusal, proximal, or cervical) and the type of restoration material (amalgam or composite). Results: Anterior restorations accounted for more than half (53%) of all restorations in the pre-COVID-19 pandemic period and 46.5% and 55.4% of restorations in the pre- and post-vaccination periods, respectively. The distribution of posterior amalgam restorations in the pre-pandemic period (31.5%) was higher than the pandemic period; in contrast, the composite restorations were higher during the pandemic pre-vaccination (73.9%) and post-vaccination (76.3%) periods (p&lt;0.001). The males (odds ratio (OR): 1.17, 95% CI: 1.03-1.34, p=0.02) and middle-old (OR: 0.79, 95% CI: 0.64-0.96, p=0.019) were more likely to use restorative dental services as compared to females and youngold age, respectively. Conclusion: Vaccination had a noticeable effect on increased admissions of geriatric patients and restorative dental treatments compared to the pre-vaccination period. In addition, in the post-COVID-19 vaccination period, composite restorations seem to have replaced amalgam restorations.

Measuring the Intention in Favour and Against Getting Vaccinated from COVID-19 Using the Health Belief Model: Cross-Sectional Study of Pakistan

Vaccination is without a doubt one of the most efficient ways to stop the COVID-19 pandemic from spreading. The goal of this study was to look into the acceptance and resistance to COVID-19 vaccination and its associated components using the Health Belief Model, which is a framework for changing health behaviours (HBM). The current study is quantitative; hence data was collected from attendants of patients admitted to hospitals in Pakistan's top-tier cities using a survey-based self-administered questionnaire. Nonprobability convenient sampling was utilised to approach the respondents. The model was tested in two stages using partial least squares (variance-based structural equation modelling). The measurement model's reliability and validity imply that the data is reliable and valid. Except for the impact of benefits on accepting behaviour, all of the study postulated relationships are supported by the results. The study agenda adds to our understanding of health care, immunisation, consumer behaviour, and behavioural research. It adds to the body of knowledge in the fields of immunisation and behavioural research by examining people's behaviours and changes during the worldwide mass vaccination period.

Correlation Between Education and Age to the Perception of COVID-19 Vaccination

Background: COVID-19, a pneumonia-like disease, started to spread at the end of 2019 and became a pandemic globally. Vaccination is one of the programs to reduce the severity of particular conditions, including COVID-19. However, in Indonesia, the response to COVID-19 vaccination remains low. This study aimed to assess the correlation between age and educational background to the perception of COVID-19 in Yogyakarta City, Indonesia. Method: This cross-sectional study was conducted from August to September 2021 at several vaccination centers in Yogyakarta City of Yogyakarta province. Total sampling was used to recruit participants during the mass vaccination period. Data were analyzed using univariate and bivariate analysis. Results: 1,068 participants joined this study, with an age average of 29.8. Most respondents graduated from senior high school 528 (49.4%). Bivariate analysis showed a significant correlation between education and knowledge about Adverse Events Following Immunization (p=0.01). Conclusion: Perception of the adverse event following immunization was significantly associated with education.

Serum-free purified Vero rabies vaccine is safe and immunogenic in children: Results of a randomized phase II pre-exposure prophylaxis regimen study

BackgroundA serum-free, highly purified Vero rabies vaccine (PVRV-NG) has been developed with no animal or human components and low residual DNA content. A phaseII randomized clinical study aimed to demonstrate the non-inferiority of the immune response and assess the safety profile of PVRV-NG versus a licensed human diploid cell culture rabies vaccine (HDCV) in a pre-exposure regimen in healthy children and adolescents in the Philippines. MethodologyChildren aged 2–11 years and adolescents aged 12–17 years were randomized (2:1) to receive three injections of either PVRV-NG or HDCV (on day [D] 0, D7 and D28). Rabies virus-neutralizing antibodies (RVNA) were measured at D0, D42 and 6 months after the first injection (month [M] 6). Safety was assessed during the vaccination period and up to 28 days after the last vaccination. Serious adverse events were followed until 6 months after last vaccination. Principal findings342 healthy participants (171 children and 171 adolescents) were randomized and followed for 6 months after the last dose. All participants in both groups had an RVNA titer ≥ 0.5 IU/ml at D42, demonstrating non-inferiority in seroconversion rate for PVRV-NG versus HDCV. Over 90% of participants had RVNA titer ≥ 0.5 IU/ml at M6. PVRV-NG was well tolerated after each vaccination and up to 6 months following the last dose. There were no major safety concerns during the study, and the type and severity of solicited adverse events was similar for both treatment groups. ConclusionsThis study demonstrated the non-inferior immune profile of PVRV-NG compared with HDCV in a pre-exposure setting within a pediatric population. PVRV-NG was well tolerated with no safety concerns. This study is registered at ClinicalTrials.gov (NCT01930357) and EU Clinical Trials Register (2015–003203-30).

Spontaneous Adverse Event Reporting by COVID-19 Vaccinated Healthcare Professionals Through an Electronic Form Implemented by the Hospital Pharmacy.

Aim: Implementation of a web-form based pharmacovigilance plan for the spontaneous notification of adverse events to the Comirnaty® COVID-19 vaccine during its administration to hospital healthcare professionals. Methods: An electronic pharmacovigilance form was developed containing 8 pre-defined event options, an open answer option for the description of other events and/or symptoms, and a question about the overall intensity of symptoms. The adverse events reports were standardized according to physiological and pathological condition. Results: A total of 4119 adverse events notifications were obtained with a 45% rate of electronic notification. The most clinically relevant events reported were:tachycardia (n = 19), dyspnea (n = 7), chest pain (n = 6), facial/labial edema (n = 6), lipothymia (n = 5), bronchospasm (n = 2), herpetic infection (n = 2), vasculitis (n = 2), arrhythmia (n = 1), difficult to control arterial hypertension (n = 1), gastritis (n = 1), and spontaneous abortion (n = 1). Regarding the intensity of symptoms (n = 2928), 70.0% were reported as mild, 25.8% as moderate, and 4.27% as severe, with higher intensity in the second dose compared to first dose. The highest frequency of severe events were reported in the groups from 40 to 59 years in both vaccination periods. During the vaccination process, no hospitalizations and no deaths were notified and/or recorded. Conclusion: In this real world study, comparing with Comirnaty clinical trials program, it was observed a higher frequency of adenomegaly and gastrointestinal disorders. Noteworthy, the notification of a case of miscarriage. The use of hospital pharmacy pharmacovigilance electronic forms, seemed to be relevant to notification adherence and to obtain a greater and faster knowledge of COVID-19 vaccine safety profile.

Evaluating the impact of universal varicella vaccination among preschool-aged children in Qingdao, China: An interrupted time-series analysis

ABSTRACT Varicella is a contagious disease of children. Qingdao administrated free one-dose and free two-dose universal varicella vaccination schedules in 2013 and 2016 for preschool children. The effectiveness of the vaccination was analyzed in this study. Monthly varicella incidence data of 1–6 years old children during 2007–2020 were obtained from the Qingdao Infectious Disease Reporting Information Management System. We applied Interrupted time series and segmented regression analyses to assess changes in varicella incidence at the beginning of each month and average monthly changes during the vaccination. The vaccination was associated with a reduction of 32.7% in varicella morbidity on average during the 8-year intervention, there is a statistically significant difference between the voluntary period and free vaccination period (χ2 = 290.80,P < 0.001). Immediately after the free one-dose vaccination implementation in 2013 and free two-dose vaccination implementation in 2016, varicella incidence decreased by 0.135 cases per 100 000 population (P < 0.001) and increased by 1.189 cases per 100 000 population (P = 0.039), respectively, the results were statistically significant. There were significant declining trends in varicella incidence after free vaccination: 0.135(P < 0.001) and 0.055 (P = 0.025) per month in 2013.7–2016.6 and 2016.7–2020.12, respectively. This study shows a further decaying trend of varicella incidence based on the impact of free two-dose vaccination. It is necessary to prolong free two-dose universal varicella vaccination to strengthen the immune barrier of preschool children sequentially.

De-isolation of vaccinated COVID-19 health care workers using rapid antigen detection test

BackgroundCOVID-19 de-isolation guidelines of health care workers (HCW) were formulated based on evidence describing the duration of infectious viral shedding of the wild SARS-CoV-2 virus. During the periods of COVID-19 vaccination and variants, a test-based approach was recommended to end isolation of HCW, based on emerging data describing the viral kinetics of COVID-19 variants. While Rapid antigen detection tests (RADT) are increasingly used in the diagnosis of COVID-19, their use is limited in de-isolation. MethodsWe described the use of RADT in the de-isolation of COVID-19 vaccinated HCW with mild infection who were asymptomatic on day 7 post diagnosis in a single center retrospective cohort study during the Omicron surge. ResultsOf the 480 HCWs, 173 (36%) had positive RADT. The positivity rate of RADT was not different in HCW who received two doses versus three doses of vaccine (34.4% versus 40.3%, p = 0.239). ConclusionsA symptom based, test-based approach using RADT is a useful tool in the de-isolation of HCW, with mild disease, in the era of Omicron. Further studies are required to evaluate the role of RADT in de-isolation of patients with severe COVID-19 disease.

Acceptance and accessibility to the early phase COVID-19 vaccination among the healthcare workers and hill tribe population in Thailand

Coronavirus disease 2019 (COVID-19) is a serious emerging disease and an extreme threat to human life. This study aimed to understand the perceptions of hill tribe people living in the border areas of Thailand-Myanmar and health workers regarding the acceptability and accessibility of the COVID-19 vaccine and health workers’ perceptions of the readiness to implement the vaccination program during the early period of national COVID-19 vaccination. A qualitative method was applied to elicit information from key informants who lived in hill tribe villages and the health professionals who served them. The study was conducted in seven hill tribe villages located along the Thailand-Myanmar borders in Mae Fah Luang District, Chiang Rai Province, Thailand. The participants were hill tribe villagers aged 20 years and over; public health care professionals working in village health centers who had primary roles in implementing disease prevention and control measures; and public health care professionals working in districts and provincial public health offices who had primary roles in policy development and implementation. A total of 63 participants (26 men and 37 women) from seven hill tribe villages provided information. Three acceptance choices regarding receiving the COVID-19 vaccine were found among the hill tribes: definite acceptance, likely acceptance, and no preference. Two factors related to obtaining access to the new COVID-19 vaccine were found: Thai citizenship and the level of literacy related to the vaccine. There was no process or protocol in place for implementing the new vaccine among health professionals working at the district, subdistrict, or community levels, but the national expanded immunization program (EPI) system was clearly demonstrated to extend throughout the health service chain in Thailand. During the early period of national COVID-19 vaccine implantation in Thailand, not all members of the hill tribes accepted the vaccine; participant acceptance depended on several factors, including a participant’s previous experience with vaccination, whether he or she required more information before making a decision, etc. While acceptance of the vaccine depended on the individual’s background, not everyone had an equal opportunity to access the vaccine. The new COVID-19 vaccine should be available at the village level, including in hill tribe villages, to reduce the systemic threat to the country.

Risk of Severe Coronavirus Disease 2019 Disease in Individuals With Down Syndrome: A Matched Cohort Study From a Large, Integrated Health Care System.

BackgroundDown syndrome (DS) is associated with an increased risk of infections attributed to immune defects. Whether individuals with DS are at an increased risk of severe coronavirus disease 2019 (COVID-19) remains unclear.MethodsIn a matched cohort study, we evaluated the risk of COVID-19 infection and severe COVID-19 disease in individuals with DS and their matched counterparts in a pre-COVID-19 vaccination period at Kaiser Permanente Southern California. Multivariable Cox proportion hazard regression was used to investigate associations between DS and risk of COVID-19 infection and severe COVID-19 disease.ResultsOur cohort included 2541 individuals with DS and 10 164 without DS matched on age, sex, and race/ethnicity (51.6% female, 53.3% Hispanic, median age 25 years [interquartile range, 14–38]). Although the rate of COVID-19 infection in individuals with DS was 32% lower than their matched counterparts (adjusted hazard ratio [aHR], 0.68; 95% confidence interval [CI], .56–.83), the rate of severe COVID-19 disease was 6-fold higher (aHR, 6.14; 95% CI, 1.87–20.16).ConclusionsAlthough the risk of COVID-19 infection is lower, the risk of severe disease is higher in individuals with DS compared with their matched counterparts. Better infection monitoring, early treatment, and promotion of vaccine for COVID-19 are warranted for DS populations.

P1009: PREDICTORS OF HOSPITALIZATION AND SEVERE OUTCOMES IN PATIENTS WITH MPN AND COVID-19

Background: Risk factors for severe COVID-19 in myeloproliferative neoplasms (MPN) have been extensively explored. However, no information is available on risk factors to hospitalization at COVID-19 diagnosis. Aims: To provide an evidence-based triage and inform for a timely and antiviral therapy prescription in early phases of viral replication. Methods: The MPN-COVID study is still enrolling consecutive adult MPN patients with COVID-19 infection since February 15, 2020. Among 479 patients (ET n=175, PV n=158, MF n=91, and pre-PMF n=55) with COVID-19 from Feb 2020 to Jun 2021, 248 (52%) were managed at home and 231 (48%) were hospitalized. Results: Univariate analysis Compared to outpatients, those admitted to hospital were more likely to be men (58.9% vs. 45.2%, p=0.003), older than 70 years (61.3% vs. 29.0%, p<.001), with at least one comorbidity (79.7% vs. 55.5%, p<.001) and a history of thrombosis (26.5% vs. 16.6%, p=0.008). Overt myelofibrosis (MF) cases were more frequent in hospital (38.5% vs. 18.1%, p<.001) than PV, ET or pre-PMF. Ruxolitinib was more frequently used in patients who underwent to hospital than managed at home. (25.7% vs. 12.1%, p<.001). In comparison with outpatients, hospitalized cases had a significantly lower median values of hemoglobin (12.1 vs. 13.3 g/dL, p<.001), platelets (250 vs. 390 x109/L, p<.001), absolute lymphocytes (0.8 vs. 1.4 x109/L, p<.001) and higher neutrophil counts (5.1 vs. 4.5 x109/L, p=0.022), leading to a significant increase of neutrophil to lymphocyte ratio (NLR) (6.6 vs. 3.2, p<.001). Compared to lymphocytopenia, the best sensitivity and specificity was found for NLR, whose AUC was 77.28% by ROC analysis. Multivariate analysis By adjusting for sex, comorbidity, fever, systemic symptoms, O2 saturation, previous thrombosis, MPN type, ruxolitinib exposure, and first vs. subsequent waves and vaccination period, three factors emerged as independent predictors of hospitalization: age over 70 years, (OR=3.02, p=0.038), dyspnea (OR=7.23, p<.001) and NLR ≥4, (OR=6.94, p<.001). Interaction model of risk factors In a model fitted to test the interaction terms of the three significant variables, we evaluated the marginal effect of NLR and dyspnea across different age classes (Figure) and found that in younger patients (i.e., from 50 to 70 years) dyspnea was the stronger predictor than increased NLR; conversely, both dyspnea and NLR showed a high and comparable marginal effect in age >80 years. Remarkably, the probability of hospitalization consistently exceeded 90% for any age group when dyspnea and NLR were concomitantly present, and their combination was more prevalent in MF (42%) than in the other phenotypes (24%, 25% and 29% in pre-PMF, PV and ET patients, respectively). In addition to predict hospitalization, dyspnea and NLR≥4 were also associated with severity of COVID-19 illness in terms of respiratory support at hospitalization (OR=2.44, p=0.023). Of note, only age >70 years and NLR higher than 6 were predictors of survival in hospitalized patients (OR=3.24, p=0.007 and OR=5.41, p=0.041, respectively). Image:Summary/Conclusion: For triage purposes of MPN patients tested positive for COVID-19, dyspnea, age and NLR are powerful predictors of hospitalization and identify patients at higher probability of invasive or non-invasive respiratory support and survival, particularly in overt MF. This MPN subgroup at high risk for progression to severe COVID-19 disease should be prioritized for antiviral therapy, even in the ambulatory setting.

Protection Motivation and Travel Intention after the COVID-19 Vaccination: Fear and Risk Perception

ABSTRACT This study aimed to identify the factors influencing tourists’ travel intention following the COVID-19 vaccination program. It also examined the mediating role of fear in the context of the threat severity, vulnerability, and protection motivation pathways. Based on a quantitative method, a cross-sectional survey was employed and data were collected from 320 prospective domestic tourists through an online survey in Malaysia during the COVID-19 vaccination period. The researchers primarily adopted the protection motivation theory (PMT) model for developing a conceptual framework to empirically test the structural equation modeling (SEM) analysis technique using AMOS software. The study confirmed that protection motivation is positively related to tourists’ travel intention, trust is negatively related to this intention, and perceived risk is not related to this intention. The study concludes that threat severity, threat vulnerability, fear, response efficacy, response cost, and self-efficacy affect the protection motivation of tourists. The main contribution of this study is to develop a model and confirm it through an empirical study. The findings indicate that companies should consider some of the factors identified so they can influence protection motivation and travel intention. This study extended the PMT model by integrating cognitive constructs and newly developed measurement scales.

Changes in diagnostic usefulness of the JRS scoring system in COVID-19 pneumonia by SARS-CoV-2 vaccination

IntroductionThe Japanese Respiratory Society (JRS) scoring system is a useful tool for the rapid presumptive diagnosis of atypical pneumonia in non-elderly (aged <60 years) patients. As SARS-CoV-2 vaccination progresses, COVID-19 in elderly people has markedly reduced. We investigated changes in diagnostic usefulness of the JRS scoring system in COVID-19 pneumonia between the Delta variant group (vaccination period) and non-Delta variant group (before the vaccination period). MethodsThis study was conducted at five institutions and assessed a total of 1121 patients with COVID-19 pneumonia (298 had the Delta variant). During the vaccination period, the Delta variant has spread and replaced the Alfa variant. We evaluated the vaccination period as the Delta variant group. ResultsAmong the six parameters of the JRS scoring system, matching rates of two parameters were higher in the Delta variant group than the non-Delta variant group (pre-vaccination period): age <60 years (77.5% vs 42.2%, P < 0.0001) and no or minor comorbid illness (69.1% vs 57.8%, p = 0.0007). The sensitivity of the diagnosis of atypical pneumonia in patients with COVID-19 pneumonia was significantly higher in the Delta variant group compared with the non-Delta variant group (80.2% vs 58.3%, p < 0.0001). When the diagnostic sensitivity was analyzed for different ages, the diagnostic sensitivities for the Delta variant and non-Delta variant groups were 92.6% and 95.5% for non-elderly patients and 39.1% and 32.5% for elderly patients, respectively. ConclusionsOur results demonstrated that the JRS scoring system is a useful tool for distinguishing between COVID-19 pneumonia and bacterial pneumonia in the COVID-19 vaccination period, but not before the vaccination period.

Evaluation of the diagnostic features and clinical course of COVID-19 vaccine-associated subacute thyroiditis.

ObjectiveThis study aimed to identify cases of coronavirus disease 2019 (COVID-19) vaccine–associated subacute thyroiditis (SAT) during the active vaccination period of the pandemic, analyze the characteristics of these cases, and compare them with cases of non-vaccine associated SAT diagnosed in the same period.MethodsA total of 55 patients diagnosed with SAT in our outpatient clinic between February and October, 2021, were included in this retrospective single-center study.ResultsOf the study population, 16 (29.1%) were diagnosed with COVID-19 vaccine-associated SAT (10 with CoronaVac® and six with Pfizer-BioNTech® vaccine), with a median time to onset of symptoms after vaccination of 6.5 (range, 2–20) days. There was no statistically significant difference between the vaccine-associated (VA) and non-vaccine associated (NVA) groups in terms of age, gender, time to diagnosis, thyroid volumes, thyroid function tests, and acute phase reactants. Seven (43.8%) and 25 (64.1%) patients were treated with methylprednisolone in the VA group and NVA group, respectively (p = 0.16). Follow-up data of 45 patients (16/16 for VA and 29/39 for NVA) were available. The mean follow-up of these patients was 47.4 ± 19.4 days, and the follow-up periods of the VA group and NVA group were comparable (p = 0.24). There was no difference between the two groups in terms of the frequency of euthyroidism at the follow-up visit (12/16 vs.14/29, p = 0.08).ConclusionWith the increase in COVID-19 vaccination rates during the current pandemic, VA SAT cases are seen more frequently. The present study demonstrated that these cases have similar diagnostic features and clinical course to that of classic forms of SAT. In addition, most patients with VA SAT had a mild clinical course that improved with non-steroidal anti-inflammatory drugs.

Immunogenicity of COVID-19 Vaccination in Melanoma Patients under Immune Checkpoint Blockade

Background: Immunogenicity of SARS-CoV-2 vaccines is modestly impaired in cancer patients due to a generally weakened immune system. Immune checkpoint inhibitors (ICI) are expected to enhance immune response. This has already been described to be the case in influenza vaccines, and first data about COVID-19 vaccines show a trend in this direction. Aim: We aimed to investigate the immune response of patients with melanoma under ICI therapy after COVID-19 vaccination. Patients and Methods: In the Skin Cancer Center Hanover (Germany), we recruited 60 patients with advanced melanoma who either received ICI therapy during or before the vaccination period. Serological blood analysis was performed using quantitative ELISA for Anti-SARS-CoV-2 spike protein 1 IgG antibodies. Results: We did not observe an enhanced humoral immune response in patients under active or past ICI therapy after COVID-19 vaccination. Nevertheless, there is a tendency of higher antibody levels when ICI therapy was received within the last 6 months before vaccination. Subgroup analysis revealed that patients in our study population under ongoing targeted therapy during vaccination period had significantly higher median antibody levels than patients without any active antitumor treatment. Conclusion: Melanoma patients under ICI therapy show comparable antibody response after SARS-CoV-2 vaccination to healthy health care professionals. This finding is independent of the timing of ICI therapy.

MO828: The Humoral Response of SARS-COV-2 Vaccine in Haemodialysis

BACKGROUND AND AIMSAlthough vaccination against COVID-19 infection in dialysis patients is an urgent issue of worldwide concern, literature data regarding the antibody level and their kinetics over time and the efficacy towards complete COVID-19 vaccination and booster dose in these patients is inconclusive.METHODWe retrospectively assessed the response to COVID-19 vaccination, after the completion of vaccine series and after a booster dose in haemodialysis (HD) patients. IgG antibodies to the spike protein S1 subunit of SARS-CoV-2 were measured using ELISA at least 15 days after completion of a vaccination series, 1 month and finally 15–30 days after the booster dose.RESULTSAmong the 28 vaccinated HD patients (mean age = 59.8 years, 100% male) with two doses of mRNA vaccine, a seroconversion was documented in all the patients (100%) with a median antibody titre of 3270.6 U/mL (IQR: 94–40.000). We recorded 9 out of 28 early responders (peak level at 2 weeks) and 19/28 late responders (peak level at 1 month). The early responders were younger (56.25 years versus 61.63; P = 0.07), without cardiovascular history (88% versus 44%; P = 0.042) or diabetes (100% versus 63%; P = 0.042), compared with late responders. On multivariate analysis, combined haemoperfusion and haemodialysis (HR = 0.167, 95% confidence interval: 0.034–0.826; P = 0.028) was an independent prognostic factor for early responders. After 6 months, all the patients received a booster mRNA dose. The patients presented median antibody levels of 33.939 U/mL (IQR: 1112–181.223), much higher titre than the first peak. Finally, four patients, all from the late responders group, presented COVID-19 infection during the vaccination period (two patients in the early period <1 month and two patients in the late period >5 months).CONCLUSIONHD patients develop a substantial humoral response against SARS-CoV2 and the booster dose much higher response. The early responders presented more rapidly and more efficacious antibody levels, while the combined haemoperfusion and haemodialysis emerged as a positive predictor factor.