August 22, 2024

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COVID: Active Vaccination/Immunity

What Is the Economic Benefit of Annual COVID-19 Vaccination From the Adult Individual Perspective?
Researchers developed a Markov model representing the potential clinical/economic outcomes from an individual perspective in the United States of getting versus not getting an annual COVID-19 vaccine. Their modeling suggests that for an 18–49 year old, getting vaccinated at its current price ($60) can save the individual on average $30–$603 if the individual is uninsured and $4–$437 if the individual has private insurance, as long as the starting vaccine efficacy against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is ≥50% and the weekly risk of getting infected is ≥0.2%, corresponding to an individual interacting with 9 other people in a day under winter 2023–2024 Omicron SARS-CoV-2 variant conditions with an average infection prevalence of 10%. For a 50–64 year old, these cost-savings increase to $111–$1278 and $119–$1706 for someone without and with insurance, respectively. The risk threshold increases to ≥0.4% (interacting with 19 people/day), when the individual has 13.4% preexisting protection against infection (eg, vaccinated 9 months earlier). They calculate probabilities of getting infected based on how many people one interacts with and then all the outcomes from asymptomatic, to mild, to moderate, severe, hospitalization, ICU, death and Long COVID. They focus on medical costs.
Early COVID-19 XBB.1.5 Vaccine Effectiveness Against Hospitalisation Among Adults Targeted for Vaccination, VEBIS Hospital Network, Europe, October 2023–January 2024
These are the results of a multicentre test-negative case–control study covering the period from October 2023 to January 2024 among adult patients aged ≥ 18 years hospitalized with severe acute respiratory infection in Europe. They provide early estimates of the effectiveness of the newly adapted XBB.1.5 COVID-19 vaccines against PCR-confirmed SARS-CoV-2 hospitalization. Vaccine effectiveness was 49% overall, ranging between 69% at 14–29 days and 40% at 60–105 days post vaccination. The adapted XBB.1.5 COVID-19 vaccines conferred protection against COVID-19 hospitalization in the first 3.5 months post vaccination, with VE > 70% in older adults (≥ 65 years) up to one month post vaccination.
Uptake of COVID-19 vaccines and association with hospitalisation due to COVID-19 in pregnancy: Retrospective cohort study
These are results of a retrospective cohort study including all pregnancies ending between 18 June 2021 and 22 August 2022, among adult women registered with a Northwest London general practice. They conducted a nested case-control analysis to quantify the relationship between vaccine uptake by end of pregnancy and hospitalization for COVID-19 during pregnancy. This study included 47,046 pregnancies among 39,213 women. In 26,724 (57%) pregnancies, women had at least one dose of vaccine by the end of pregnancy. Women admitted to hospital were much less likely to be vaccinated (22%) than those not admitted (57%, OR 0.22, 95% CI: 0.15 to 0.31).
The Novavax Heterologous Coronavirus Disease 2019 Booster Demonstrates Lower Reactogenicity Than Messenger RNA: A Targeted Review
Researchers conducted a targeted review of the reactogenicity of authorized/approved messenger RNA (mRNA) and protein-based vaccines demonstrated by clinical trials and real-world evidence. It was found that mRNA-based boosters show a higher incidence and an increased severity of reactogenicity compared with the Novavax protein-based COVID-19 vaccine (NVX-CoV2373). In a recent study from the National Institute of Allergy and Infectious Diseases, the incidence of pain/tenderness, swelling, erythema, fatigue/malaise, headache, muscle pain, or fever was higher in individuals boosted with BNT162b2 (0.4% to 41.6% absolute increase) or mRNA-1273 (5.5% to 55.0% absolute increase) compared with NVX-CoV2373. Evidence suggests that NVX-CoV2373, when utilized as a heterologous booster, demonstrates less reactogenicity compared with mRNA vaccines, which, if communicated to hesitant individuals, may strengthen booster uptake rates worldwide.

COVID: The Late Phase/PASC/Long COVID

Characterizing Long COVID in Children and Adolescents
Here the objective was to identify the most common prolonged symptoms experienced by children (aged 6 to 17 years) after SARS-CoV-2 infection, how these symptoms differ by age (school-age [6-11 years] vs adolescents [12-17 years]), how they cluster into distinct phenotypes, and what symptoms in combination could be used as an empirically derived index to assist researchers to study the likely presence of PASC. These are the results of a multicenter longitudinal observational cohort study, the RECOVER Pediatric Observational Cohort Study (RECOVER-Pediatrics) with participants recruited from more than 60 U.S. health care and community settings between March 2022 and December 2023, including school-age children and adolescents with and without SARS-CoV-2 infection history. Ultimately 898 school-age children (751 with previous SARS-CoV-2 infection [referred to as infected] and 147 without [referred to as uninfected]; mean age, 8.6 years; 49% female; 11% were Black or African American, 34% were Hispanic, Latino, or Spanish, and 60% were White) and 4469 adolescents (3109 infected and 1360 uninfected; mean age, 14.8 years; 48% female; 13% were Black or African American, 21% were Hispanic, Latino, or Spanish, and 73% were White) were included. Median time between first infection and symptom survey was 506 days for school-age children and 556 days for adolescents. In models adjusted for sex and race and ethnicity, 14 symptoms in both school-age children and adolescents were more common in those with SARS-CoV-2 infection history compared with those without infection history, with 4 additional symptoms in school-age children only and 3 in adolescents only. These symptoms affected almost every organ system. Combinations of symptoms most associated with infection history were identified to form a PASC research index for each age group; these indices correlated with poorer overall health and quality of life. The index emphasizes neurocognitive, pain, and gastrointestinal symptoms in school-age children but change or loss in smell or taste, pain, and fatigue/malaise–related symptoms in adolescents. Clustering analyses identified four PASC symptom phenotypes in school-age children and three in adolescents.