Coronavirus COVID-19 Update for April 23, 2022

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Clinical Reports

COVID-19 Mortality and Vaccine Coverage — Hong Kong Special Administrative Region, China,
January 6, 2022–March 21, 2022

This article gives insight into what happens when an omicron outbreak occurs along a largely unvaccinated and not previously infected population that practices a zero COVID approach. In this population, where it is estimated that less than 50% of those >65 had received > 2 vaccine doses, there were a total of > 1 million cases and the mortality rate in Hong Kong was among the highest reported worldwide since the COVID-19 pandemic began at almost 4%. This outbreak highlights the necessity to identify and address gaps in age-specific vaccination coverage. This can help prevent mortality from COVID19, especially in older adults.
Hospitalizations of Children Aged 5–11 Years with Laboratory-Confirmed COVID-19 — COVID-NET, 14 States,
March 2020–February 2022

Among 400 children aged 5-11 years hospitalized with COVID-19 during the first few months of omicron, 3 in 10 had no underlying conditions, 9 in 10 were unvaccinated, and 2 in 10 required ICU care. COVID-19-associated hospitalization rates in children aged 5-11 years were approximately twice as high among unvaccinated as among vaccinated children. Non-Hispanic Black children represented the largest group of unvaccinated children. Children with diabetes and obesity were more likely to experience severe COVID-19. Increasing vaccination among children aged 5-11 can prevent hospitalization and severe outcomes.
SARS-CoV-2 co-infection with influenza viruses, respiratory syncytial virus, or adenovirusesS
tudy authors examined clinical outcomes of co-infection with influenza viruses, respiratory syncytial virus, or adenoviruses in 212 466 adults with SARS-CoV-2 infection who were admitted to hospital in the UK between Feb 6, 2020, and Dec 8, 2021. Viral co-infection was detected in (8·4%) of the patients. Co-infection with influenza viruses was associated with increased odds of receiving invasive mechanical ventilation. SARS-CoV-2 co-infections with influenza viruses and adenoviruses were each significantly associated with increased odds of death.

Antiviral Therapeutics and Vaccines

Pfizer and BioNTech Announce Data Demonstrating High Immune Response Following a Booster Dose of their COVID-19 Vaccine in Children 5 Through 11 Years of Age
Data from a subanalysis of 30 sera from a Phase 2/3 clinical trial of children 5 through 11 years of age show a 36-fold increase in SARS-CoV-2 Omicron neutralizing titers following a booster (third) dose of the Pfizer-BioNTech COVID-19 Vaccine.In the Phase 2/3 clinical trial with 140 children a booster (third) dose of the Pfizer-BioNTech COVID-19 Vaccine increased neutralizing antibodies by 6-fold against the SARS-CoV-2 wild-type strain in this age group. Companies plan to submit these data to U.S. Food and Drug Administration in the coming days with additional submissions to other regulatory agencies worldwide to follow.

Safety, Immunogenicity and Antibody Persistence of a Bivalent Beta-Containing Booster Vaccine
The results of this phase 2/3 study evaluate the safety and immunogenicity of the bivalent vaccine candidate mRNA-1273.211 (equal mRNA amounts of ancestral SARS-CoV-2 and Beta variant spike proteins) as 50-μg (n=300) and 100-μg (n=595) first booster doses approximately 8.8-9.8 months after the mRNA-1273 primary series. These results indicate that bivalent booster vaccines can induce potent and durable antibody responses providing a new tool in response to emerging variants.
Low-dose bivalent mRNA vaccine is highly effective against different SARS-CoV-2 variants in a transgenic mouse model
In this study, the low-dose bivalent mRNA vaccine contained half the mRNA of each respective monovalent vaccine, induced comparable neutralizing antibody titres, enrichment of lung-resident memory CD8⁺T cells, specific CD4⁺ and CD8⁺ responses, and fully protected transgenic mice from SARS-CoV-2 lethality. The bivalent mRNA vaccine significantly reduced viral replication in both Beta- and Delta-challenged mice. Sera from bivalent mRNA vaccine immunized Wistar rats also contained neutralizing antibodies against the B.1.1.529 (Omicron BA.1) variant. This data suggests that low-dose and fit-for-purpose multivalent mRNA vaccines encoding distinct S-proteins is a feasible approach for increasing the potency of vaccines against emerging and co-circulating SARS-CoV-2 variants.

Intramuscular AZD7442 (Tixagevimab–Cilgavimab) for Prevention of Covid-19
Eligible participants were adults (≥18 years of age) who had an increased risk of an inadequate response to Covid-19 vaccination. Antibody levels were not checked post vaccine. These are the results of an ongoing, multicenter, double-blind, parallel-group, randomized, placebo-controlled trial, researchers assessed the safety and efficacy of a single dose of AZD7442 (two consecutive intramuscular injections; one each of tixagevimab and cilgavimab) for preexposure prophylaxis against Covid-19.A total of 5197 participants underwent randomization and received one dose of AZD7442 or placebo (3460 in the AZD7442 group and 1737 in the placebo group). Symptomatic Covid-19 occurred in (0.2%) of participants in the AZD7442 group and in (1.0%) participants in the placebo group (relative risk reduction, 76.7%; 95% confidence interval [CI], 46.0 to 90.0; P<0.001); extended follow-up at a median of 6 months showed a relative risk reduction of 82.8% (95% CI, 65.8 to 91.4). Five cases of severe or critical Covid-19 and two Covid-19–related deaths occurred, all in the placebo group.

Diagnostics

FDA Authorizes First COVID-19 Diagnostic Test Using Breath Samples
The performance of the InspectIR COVID-19 Breathalyzer was validated in a large study of 2,409 individuals, including those with and without symptoms. In the study, the test was shown to have 91.2% sensitivity (the percent of positive samples the test correctly identified) and 99.3% specificity (the percent of negative samples the test correctly identified). The study also showed that, in a population with only 4.2% of individuals who are positive for the virus, the test had a negative predictive value of 99.6%, meaning that people who receive a negative test result are likely truly negative in areas of low disease prevalence. The test performed with similar sensitivity in a follow-up clinical study focused on the omicron variant. The InspectIR COVID-19 Breathalyzer uses a technique called gas chromatography gas mass-spectrometry (GC-MS) to separate and identify chemical mixtures and rapidly detect five Volatile Organic Compounds (VOCs) associated with SARS-CoV-2 infection in exhaled breath. When the InspectIR COVID-19 Breathalyzer detects the presence of VOC markers of SARS-CoV-2, a presumptive (unconfirmed) positive test result is returned and should be confirmed with a molecular test.

Epidemiology

Global Prevalence of Post COVID-19 Condition or Long COVID: A Meta-Analysis and Systematic Review
This purpose of this study was to examine the worldwide prevalence of post COVID-19 condition otherwise known as Long COVID. 50 studies were included, and 41 were meta-analyzed. Global estimated pooled prevalence of post COVID-19 condition was 0.43 (95% CI: 0.44, 0.63) and 0.34 (95% CI: 0.25, 0.46), respectively. Regional prevalence estimates were Asia – 0.51 (95% CI: 0.37, 0.65), Europe – 0.44 (95% CI: 0.32, 0.56), and North America – 0.31 (95% CI: 0.21, 0.43). Global prevalence for 30, 60, 90, and 120 days after infection were estimated to be 0.37 (95% CI: 0.26, 0.49), 0.25 (95% CI: 0.15, 0.38), 0.32 (95% CI: 0.14,0.57) and 0.49 (95% CI: 0.40, 0.59), respectively. Fatigue was the common symptom reported with a prevalence of 0.23, followed by memory problems, with a prevalence of 0.14. The study found the prevalence of Long COVID to be substantial, and highlighted the health effects of COVID-19 and the stress it can cause on healthcare systems.