Equation-Based Modeling vs. Agent-Based Modeling with Applications to the Spread of COVID-19 Outbreak

In this paper, we explore two modeling approaches to understanding the dynamics of infectious diseases in the population: equation-based modeling (EBM) and agent-based modeling (ABM). To achieve this, a comparative study of these approaches was conducted and we highlighted their advantages and disadvantages. Two case studies on the spread of the COVID-19 pandemic were carried out using both approaches. The results obtained show that differential equation-based models are faster but still simplistic, while agent-based models require more machine capabilities but are more realistic and very close to biology. Based on these outputs, it seems that the coupling of both approaches could be an interesting compromise.

Sudden hearing loss and COVID-19 vaccine: A potential signal?

Introduction: Vaccination against COVID-19 appears to be a promising approach to mitigate this pandemic. The French agency of medicinal products (ANSM) issued a signal concerning cases of sudden hearing loss (SHL) following vaccination with elasomeran (Spikevax® Moderna) [1] and AZD1222 (Vaxzevria® AstraZeneca) [2]. SHL is defined as a sensorineural hearing loss ≥30 dB within 72 hours [3]. We aimed to investigate the potential signal of SHL associated with COVID-19 vaccines. Material and methods: We queried VigiBase® (World Health Organization pharmacovigilance database), for all reports of "Sudden Hearing Loss" (MedDRA Preferred Term) related to "COVID-19 vaccine" (Active Ingredient), from 1967 to December 30, 2021 [4]. Disproportionality analysis was based on the Reporting Odds Ratio (ROR) with its 95% Confidence Interval (CI) and the Information Component (IC). A positive IC025 is statistically needed to confirm the detection of a signal [5]. Results: In VigiBase®, 1,602 cases of COVID-19 vaccine-associated SHL were collected. Tozinameran (Pfizer-BioNTech) was mostly notified with 1,053 (65.7%) reports, followed by elasomeran (Moderna, 281, 17.5%), AZD1222 (AstraZeneca, 217, 13.5%), and JNJ 78436735 (Janssen, 43, 2.7%). Most cases concerned women (885, 55.2%), with a median age of 51 years, and 827 (51.6%) were considered serious. The association of COVID-19 vaccines and SHL showed significant disproportionality, with a ROR of 7.4 (95% CI 6.9-7.9) and an IC025>0. Tozinameran reached the strongest ROR (8.2;95% CI 7.6-8.8), followed by elasomeran (4.6;95% CI 4.0-5.2), JNJ-78436735 (3.0;95% CI 2.2-4.0), and AZD1222 (2.7;95% CI 2.3-3.1), all with IC025>0. Discussion/Conclusion: Significant disproportionality was identified for COVID-19 vaccines and SHL. Even though this adverse drug event may rely on an inflammatory mechanism, causality cannot be established by this pharmacovigilance study. However, this finding may strengthen the signals issued by ANSM, concerning elasomeran and AZD1222. SHL following COVID-19 vaccination might be evoked and treated as soon as possible.

COVID-19 vaccine-associated trigeminal neuralgia: Analysis of the WHO safety database

Introduction: To contain the COVID-19 pandemic, vaccination is deemed as a promising approach. A French pharmacovigilance survey identified five cases of trigeminal neuralgia (TN) following vaccination with AZD1222 (Vaxzevria®, AstraZeneca) [1]. Furthermore, a case report mentioned such an adverse reaction with tozinameran (Comirnaty®, Pfizer-BioNTech) [2]. TN is characterized by recurrent, unilateral, and brief electric shock-like pain in one or more trigeminal divisions [3]. TN is triggered by innocuous stimuli. We aimed to investigate the potential signal of TN related to COVID-19 vaccines. Material and methods: We queried VigiBase® (World Health Organization pharmacovigilance database) for all reports of "Trigeminal Neuralgia" (MedDRA Preferred Term) associated with "COVID-19 vaccine" (Active Ingredient), from 1967 to December 29, 2021 [4]. Disproportionality analysis relied on the Reporting Odds Ratio (ROR) with its 95% Confidence Interval (CI), and the Information Component (IC). A positive IC025 is statistically needed to confirm the detection of a signal [5]. Results: In VigiBase®, we gathered 1,283 cases of COVID-19 vaccine-related TN. Most reports involved women (998, 77.8%), with a median age of 52 years, and 510 (39.8%) were deemed serious. Tozinameran was mostly reported with 782 (61.0%) cases, followed by AZD1222 (264, 20.6%), elasomeran (Spikevax® Moderna, 185, 14.4%), and JNJ-78436735 (Janssen® Johnson & Johnson, 37, 2.9%). The association of COVID-19 vaccines and TN revealed significant disproportionality, with an IC025>0 and a ROR of 3.1 (95% CI 2.9-3.3). Tozinameran showed the strongest ROR (3.6;95% CI 3.3-3.8), followed by AZD1222 (2.3;95% CI 2.0-2.6), elasomeran (2.0;95% CI 1.7-2.3), and JNJ-78436735 (1.8 95% CI 1.3-2.5), each with IC025>0. Discussion/Conclusion: COVID-19 vaccines and TN showed relevant disproportionality. Albeit this reaction may rely on an immune-mediated inflammation, causality can only remain hypothetical in this pharmacovigilance study. Nonetheless, this finding may suggest a signal, strengthening reports mentioned by literature and French pharmacovigilance. A TN occurring after COVID-19 vaccination should alert the clinician.

Is transient global amnesia an adverse event associated with COVID-19 vaccines?

Introduction: Vaccination against COVID-19 appears to be a promising approach to mitigate this pandemic. The French agency of medicinal products (ANSM) issued a signal concerning cases of transient global amnesia (TGA) following vaccination with elasomeran (Spikevax® Moderna) [1]. TGA is characterized by the sudden onset of anterograde amnesia with preservation of other cognitive functions and a spontaneous resolution within 24 h [2]. We aimed to investigate the potential link of TGA with COVID-19 vaccines. Material and methods: We queried the WHO VigiBase® for all reports of "Transient global amnesia" (MedDRA Preferred Term) related to "Covid-19 vaccine"(Active Ingredient), from 1967 to December 6, 2021 [3]. Disproportionality analysis was based on the Reporting Odds Ratio (ROR) with its 95% Confidence Interval [CI] and the Information Component (IC) [4]. A positive IC025 statistically detects a signal [5]. Results: The search yielded 289 COVID-19 vaccine-associated TGAs, 178 of which (61.6%) were deemed serious. Most cases concerned women (187, 64.7%), with a median age of 66 years. Tozinameran (T: Comirnarty® Pfizer-BioNTech) was the most represented with 147 reports (50.8%), followed by AZD1222 (A: Vaxzevria® AstraZeneca) with 69 reports (23,8%), elasomeran (E: Spikevax®, Moderna) with 60 reports (20.8%), and JNJ-78436735 (J: Janssen® Johnson & Johnson) with 12 reports (4.2%). With a IC025 > 0, COVID-19 vaccines proved a significant disproportionality (global ROR 5.1 [4.4-6.0]), with respective RORs at 4.6 [3.9-5.0] for T, E at 4.4 [3.4-6.0], A at 3.8 [3.0-5.0], and J at 3.7 [2.1-6.0]. Discussion/Conclusion: Our analysis of COVID-19 vaccines and TGA shows significant disproportionality. Various mechanisms, such as cerebrovascular, inflammatory, or migrainous, may underlie this association. Yet causality cannot be ascertained solely with this approach, although it strengthens the signal issued by the ANSM. Further studies may help to identify the causality of COVID-19 vaccines in triggering TGAs.

SUCCESSFUL STRATEGIES FOR TREATING TRAUMATIZED CHILDREN IN CHALLENGING CIRCUMSTANCES

Objectives: The COVID-19 pandemic highlights behavioral health disparities that impact low-resource communities and make it challenging to provide evidence-based treatments to children in these settings. This Symposium presents successful strategies and data for implementing an evidence-based trauma treatment, trauma-focused CBT (TF-CBT) for children in low-resource and otherwise challenging settings. Methods: Rosaura Orengo-Aguayo, PhD, describes partnership and adaptation strategies for implementing TF-CBT in postdisaster Puerto Rico. Regan Stewart, PhD, describes strategies for implementing TF-CBT via telehealth in schools or homes. Aubrey R. Dueweke, PhD, describes strategies for implementing TF-CBT in El Salvador, and Shannon Dorsey, PhD, describes treatment outcomes and acceptability among traumatized bereaved children in Africa randomized to receive TF-CBT or usual care (UC) when training, supervision, and treatment were provided by experienced local lay counselors. All studies used the Child PTSD Symptom Scale for DSM-5 (CPSS) to evaluate improvement in PTSD symptoms from before to after TF-CBT treatment. Results: A total of 31 children in postdisaster Puerto Rico experienced large improvement in their PTSD symptoms (d = 1.94), and 70 children receiving TF-CBT via telehealth experienced significant improvement in their PTSD (d = 2.23), with low dropout rates (11.4%). A total of 121 Salvadoran children experienced significant improvement in their PTSD (d = 2.04). At posttreatment in 3 of 4 African settings, children receiving TF-CBT experienced significantly greater improvement in PTSD than those receiving UC with high acceptability;at 1-year follow-up, children in the 2 settings with greater adversities who had received TF-CBT continued to experience significantly greater improvement than those who had received UC. Marilyn B. Benoit, MD, discusses the clinical, public health, and research implications of these findings. Conclusions: Successful implementation strategies can lead to positive outcomes for trauma-impacted children receiving TF-CBT in a variety of low-resource settings. PTSD, EBP, R