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Risk of Alzheimer Dementia After High-Dose vs Standard-Dose Influenza Vaccination
Previous studies, including large cohort analyses comparing vaccinated and unvaccinated adults, suggest that routine immunizations such as inactivated influenza vaccines (IIVs) may reduce Alzheimer dementia (AD) risk. Whether AD risk differs after high-dose IIV (H-IIV) vs standard-dose IIV (S-IIV) remains unexamined. Authors hypothesized that AD risk would be lower among adults ≥65 years after H-IIV compared with S-IIV. This retrospective cohort study analyzed data spanning 2014–2019 from IQVIA PharMetrics Plus for Academics, a U.S. health care claims database. Eligible participants were ≥65 years with ≥2 years of continuous medical and pharmaceutical coverage and no previous diagnostic or pharmacotherapeutic indicators of cognitive impairment. Vaccinations were identified by name and Current Procedural Terminology codes. Participants were followed for up to three years postvaccination. The H-IIV group included 120,775 unique participants (185,183 person-trials; mean age 74.4 years, SD 5.5; 57.3% female), and the S-IIV group included 44,022 participants (53,918 person-trials; mean age 73.0, SD 6.1; 56.4% female). H-IIV was associated with significantly lower AD risk during months 1–25 postvaccination (minimum NNT = 185.2 at 25 months). After sex stratification, risk reduction persisted longer among women (months 1–13, minimum NNT = 416.7) than men (months 17–24, significant only in intention-to-treat analysis, minimum NNT = 232.6).
Paxlovid Shows Organ-specific and Age-specific Impacts on Risk of Developing Post-Acute Sequelae of COVID-19
Investigators analyzed data from 19,413 patients (age > 18) from a validated PASC research cohort in New England who experienced at least one COVID-19 infection episode between January 1, 2022, and June 7, 2022, totaling 22,094 episodes. They found that across all age groups, Paxlovid shows no statistically significant effect in lowering overall PASC risk. Stratification by organ system revealed a 37% reduction in gastrointestinal PASC (OR: 0.63; 95% CI: [0.468, 0.850]; p < 0.05) but a 97.4% increase in the risk of eye and ear-related PASC (OR: 1.974; 95% CI: [1.048, 3.718]; p < 0.05). Among patients aged 65 to 75 years who were not hospitalized, Paxlovid was associated with a 16.8% reduction in PASC risk (OR: 0.832; 95% CI: [0.7, 0.989]; p < 0.05). No statistically significant effects were observed for other organ-specific outcomes.
The Effect of Fluvoxamine and Metformin for Fatigue in Patients With Long COVID: An Adaptive Randomized Trial
This was a randomized, placebo-controlled, adaptive trial designed to assess the efficacy of fluvoxamine and metformin for Long COVID. They looked at 399 adults with fatigue persisting 90 or more days after confirmed SARS-CoV-2 infection. Participants were randomly assigned to fluvoxamine (100 mg twice daily), metformin (750 mg twice daily), or matching placebo for 60 days. The primary outcome was change in Fatigue Severity Scale (FSS) score. Fluvoxamine showed a significant reduction in fatigue compared with placebo at day 60 (mean difference, −0.43 [95% credible interval {CrI}, −0.80 to −0.07]), with a sustained effect at day 90 (mean difference, −0.58 [CrI, −0.98 to −0.16]). Fluvoxamine also improved quality-of-life scores with high posterior probability. Metformin showed no significant benefit. Adverse events were less frequent with fluvoxamine (20.0%) than with metformin (28.8%) or placebo (29.7%).
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