COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study br

Background: From September 2021, Health Care Workers (HCWs) in Wales began eceiving a COVID-19 booster vaccination. This is the first dose beyond the primary vaccination schedule. Given the emergence o. new variants, vaccine waning vaccine, and increasing vaccination hesitancy, there is a need to understand booster vaccine uptake and subsequent breakthrough in this high-risk population. Methods: We conducted a prospective, national-scale, observational cohort study of HCWs in Wales using anonymised, linked data from the SAIL Databank. We analysed uptake of COVID-19 booster vaccinations from September 2021 to Februari 2022, with comparisons against uptake of the initial primary vaccination schedule. We also analysed booster breakthrough, in the form of PCR-confirmed SARS-Cov-2 infection, comparing to the second primarJ dose. Cox proportional hazard models were used to estimate associations for vaccination uptake and breakthrough regarding staff roles, socio-demographics, household composition, and other factors. Results: We derived a cohort of 73,030 HCWs living in Wales (78% female, 60% 18-49 years old). Uptake was quickest amongst HCWs aged 60 + years old (aHR 2.54, 95%Cl 2.45-2.63), compared with those aged 18-29. Asian HCWs had quicker uptake (aHR 1.18, 95%Cl 1.14-1.22), whilst Black HCWs had slower uptake (aHR 0.67, 95%Cl 0.61-0.74), compared to white HCWs. HCWs residing in the least deprived areas were slightly quicker to have received a booster dose (aHR 1.12, 95%Cl 1.09-1.15), compared with those in the most deprived areas. Strongest associations with breakthrough infections were found for those living with children (aHR 1.52, 95%Cl 1.41-1.63), compared to two-adult only households. HCWs aged 60+ years old were less likely to get breakthrough infections, compared to those aged 18-29 (aHR 0.42,<br />95%CI 0.38-0.47). Conclusion: Vaccination uptake was consistently lower among black HCWs, as well as those from deprived areas. Whilst breakthrough infections were highest in households with children. creativecommons.org/licenses/by/4.0/).<br />(c) 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license

Use of Tixagevimab and Cilgavimab (Evusheld) and Subsequent Outcomes of SARS-CoV-2 Infections in Lung Transplant Recipients

The protection of solid organ transplant recipients from infection has been challenging throughout the Coronavirus disease (COVID-19) pandemic. In 2022, tixagevimab and cilgavimab (Evusheld) was introduced as a means of providing passive antibodies and augmenting the vaccine immune response in immunocompromised patients. We aimed to assess the efficacy of Evusheld in reducing the incidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in lung transplant recipients. We conducted a single center, retrospective, observational cohort study examining SARS-CoV-2 incidence in 289 lung transplant recipients from January 2022 through July 2022. Manual chart extraction was utilized to collect dates of Evusheld administration, SARS-CoV-2 vaccination, and SARS-CoV-2 infection, as well as demographic and clinical data. Exact logistic regression models were used to compare incidence of SARS-CoV-2 infection and hospitalization rates between lung transplant recipients who received versus did not receive Evusheld. Of the 289 lung transplant recipients, 136 (47.1%) received Evusheld during the study period. The incidence of SARS-CoV-2 infection in transplant recipients who received Evusheld was 8.1% (or 11/136), compared to 34.0% (or 52/153) among those who did not receive Evusheld. Controlling for the number of SARS-CoV-2 vaccines received, the odds of a SARS-CoV-2 infection was approximately 83% lower for patients who received Evusheld (OR =0.18, 95% CI: 0.08 to 0.38, p<0.001). Further, the rate of hospitalization was available for 62 of 63 (98.4%) patients with a SARS-CoV-2 infection. Among these patients, no patient in the Evusheld group required hospitalization;conversely, 12 of 51 (23.5%) patients who did not receive Evusheld required hospitalization (OR =0.39, 95% CI: 0.00 to 2.38, p=0.21). Evusheld administration was associated with significant efficacy in the prevention of SARS-CoV-2 infection in lung transplant recipients. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Did the UK's public health shielding policy protect the clinically extremely vulnerable during the COVID-19 pandemic in Wales? Results of EVITE Immunity, a linked data retrospective study.

INTRODUCTION: The UK shielding policy intended to protect people at the highest risk of harm from COVID-19 infection. We aimed to describe intervention effects in Wales at 1 year. METHODS: Retrospective comparison of linked demographic and clinical data for cohorts comprising people identified for shielding from 23 March to 21 May 2020; and the rest of the population. Health records were extracted with event dates between 23 March 2020 and 22 March 2021 for the comparator cohort and from the date of inclusion until 1 year later for the shielded cohort. RESULTS: The shielded cohort included 117,415 people, with 3,086,385 in the comparator cohort. The largest clinical categories in the shielded cohort were severe respiratory condition (35.5%), immunosuppressive therapy (25.9%) and cancer (18.6%). People in the shielded cohort were more likely to be female, aged ≥50 years, living in relatively deprived areas, care home residents and frail. The proportion of people tested for COVID-19 was higher in the shielded cohort (odds ratio [OR] 1.616; 95% confidence interval [CI] 1.597-1.637), with lower positivity rate incident rate ratios 0.716 (95% CI 0.697-0.736). The known infection rate was higher in the shielded cohort (5.9% vs 5.7%). People in the shielded cohort were more likely to die (OR 3.683; 95% CI: 3.583-3.786), have a critical care admission (OR 3.339; 95% CI: 3.111-3.583), hospital emergency admission (OR 2.883; 95% CI: 2.837-2.930), emergency department attendance (OR 1.893; 95% CI: 1.867-1.919) and common mental disorder (OR 1.762; 95% CI: 1.735-1.789). CONCLUSION: Deaths and healthcare utilisation were higher amongst shielded people than the general population, as would be expected in the sicker population. Differences in testing rates, deprivation and pre-existing health are potential confounders; however, lack of clear impact on infection rates raises questions about the success of shielding and indicates that further research is required to fully evaluate this national policy intervention.

A tale of two epicentres: Lombardy and New York City at the outbreak of the Coronavirus pandemic

The paper explores the tale of two 'epicentres' - metropolitan New York and Lombardy - and seeks to depict the socio-demographic patterns that characterise the worst cases of infection, hospitalisation, and death during the first six months of the Covid-19 pandemic in 2020. By drawing upon secondary data concerning sub-territorial units within the two regions - ZIP-code level and counties in New York and municipalities in Italy - the paper compares the characteristics of the two areas in an effort to understand both how they became the original major epicentres and how their experiences of the pandemic differed. We suspected initially that the pandemic in Lombardy was a function of a complex constellation of variables, such as the age of the population, the unexpected emergence of the virus, and features of the local health system. In New York, the pattern seemed to fit a more familiar dynamic, the kind one would expect from the course that most pandemics take: the poor suffer the worst. The paper tries to extend the understanding of the complex and not univocal mix of social variables that can facilitate the spread of a pandemic and make its effects extreme.

Development of a Rapid Prototyping COVID-19 Geographic Information System and the Influence of Testing Centers on Data Visualization

Federal, state, and local governments have been tracking the spread of the COVID-19 pandemic, an infectious disease caused by a coronavirus. As a result of this pandemic, a consistent stream of health data has been produced that tracks the state of health for the seven billion plus people in the world each day, much of which has been publicly released. This open-source data can be used to analyze, visualize, and explain the spread of COVID-19. Here, a COVID-19 information system was created with the business intelligence software Tableau utilizing big data analysis techniques to contribute to general knowledge about the global pandemic. At a state level, data was collected from the big data initiative, the Covid Tracking Project. At the county level, if not provided in a downloadable format, the data was transcribed into a comma-separated values (CSV) file format and used for analysis. Data collection, cleaning, merging, and filtering was a time consuming and tedious task. The COVID-19 pandemic and increased amount of data collection has highlighted the need to perform rapid data analysis and visualizations. Tableau was used for the rapid prototyping of information system. The available data was decentralized and showed the lack of consistency and lack of nation-wide standardization in collecting COVID-19 data. Uncertainties in the data could be reduced through emphasizing how not all states release the same information, as well as efforts for transparency with how published statistics are calculated. The work aims to draw attention to the need for standardized data collection and the viability of using software such as Tableau for the creation of rapid visualizations. © 2021 ACM.

An update on the STRATIFY (staging by thoracoscopy in potentially radically treatable non-small cell lung cancer associated with minimal pleural effusion) study

IntroductionPleural effusion is common in lung cancer. Metastatic disease may be confirmed on imaging or fluid sampling. A minority of patients however with otherwise radically treatable disease have a small effusion not amenable to aspiration, or from which fluid cytology is negative;termed minimal pleural effusion (mini-PE). Previous retrospective studies associate significantly shorter survival in mini-PE than stage-matched cases without mini-PE and hypothesise this reflects occult pleural metastases (OPM) in up to 80% of patients. STRATIFY (Staging by Thoracoscopy in Potentially Radically Treatable Non-Small Cell Lung Cancer (NSCLC) Associated with Minimal Pleural Effusion) is a multicentre, prospective observational study, which will determine the true prevalence of OPM in this setting. An update on the study is provided here.MethodsSTRATIFY was funded by Chief Scientist Office and opened to recruitment in Jan-20. Target n=96 across 8 UK centres in 18 months. Key eligibility criteria include Mini-PE (defined by an ipsilateral effusion <1/3 hemithorax on chest radiograph), radically treatable NSCLC and LAT feasibility (defined by sufficient fluid ± lung sliding on screening ultrasound). Primary endpoint: Prevalence of OPM, defined as NSCLC cells in parietal pleural biopsies. Key secondary endpoints include LAT safety, the impact of LAT results on NSCLC treatment plans and non-invasive MRI-derived measures of cardiac function and altered body composition (as alternative explanations for mini-PE). Study progress, including the impact of COVID19 was reviewed and summarised.ResultsSTRATIFY was rapidly halted due to COVID19 after 1 patient was recruited. The study was allowed to reopen in July-20 but given a dramatic reduction in lung cancer referrals across the UK and delayed site set up processes, the study team took the decision to close recruitment from Oct-20 to Apr-21. This was supported by the funder who provided a costed 6-month extension. By June-21, 4/8 sites have opened. 4/6 six screened patients have been recruited, 2/4 have entered the MRI sub-study.ConclusionsSTRATIFY will determine the true prevalence of OPM in patients with radically treatable NSCLC and mini-PE. The study outcomes will be important in defining an extended role for LAT as a pleural staging tool.

Impact of the covid-19 pandemic on transplant pharmacist workforce

Purpose: Evaluate the impact of the COVID-19 pandemic on the transplant pharmacist workforce. Methods: A voluntary survey open from August 18, 2020 to September 15, 2020 was sent out to two prominent solid organ transplant pharmacy listservs. Respondents were asked to give background about their transplant institution, patient population and departmental staffing. Respondents were asked to comment on how the COVID-19 pandemic has impacted their ability to perform their transplant related activities for patient care. Results: A total of 67 transplant pharmacists from 57 centers responded to the survey. The majority (61.2%) of pharmacists surveyed practice primarily in abdominal transplant programs with 29.8% at small, 33.3% at moderate, and 36.8% at large volume centers (<100, 100-300, and >300 total transplants, respectively). Almost all institutions have a living donor kidney transplant program (96.5%) and in response to the COVID-19 pandemic, 55.2% of centers reported stopping non-life saving kidney and liver transplants, most (89.6%) stopped living donor transplants. A majority (73.1%) of pharmacists surveyed were funded by the pharmacy cost center. Due to the pandemic, 40% of centers surveyed stopped performing bedside medication education, and 46.3% no longer allowed caregivers on site for medication education (Figure 1). Consequently, 41.8% of the pharmacists surveyed felt that their confidence in their patients' understanding of medications decreased. Transplant pharmacists reported a perceived mean decrease in resources required for daily work responsibilities of 0.18% (IQR-0.35-0), 0.11% (IQR-0.3-0), and 0.26% (IQR-0.43-0) at low, moderate, and high volume transplant centers, respectively;however, there was no statistical difference. The perceived mean decrease in resources for pharmacists who are under the pharmacy cost center (0.18%, IQR-0.35-0) compared to those who are not (0.12%, IQR-0.3-0) was also not significantly different. Conclusions: There was a reported reduction in transplant pharmacist services due to the COVID-19 pandemic, particularly with patient education, and a perceived reduction in available resources, but no difference based on center volume. While life-saving transplant continued, the impact of patient education on outcomes remains uncertain.

Animal and translational models of SARS-CoV-2 infection and COVID-19.

COVID-19 is causing a major once-in-a-century global pandemic. The scientific and clinical community is in a race to define and develop effective preventions and treatments. The major features of disease are described but clinical trials have been hampered by competing interests, small scale, lack of defined patient cohorts and defined readouts. What is needed now is head-to-head comparison of existing drugs, testing of safety including in the background of predisposing chronic diseases, and the development of new and targeted preventions and treatments. This is most efficiently achieved using representative animal models of primary infection including in the background of chronic disease with validation of findings in primary human cells and tissues. We explore and discuss the diverse animal, cell and tissue models that are being used and developed and collectively recapitulate many critical aspects of disease manifestation in humans to develop and test new preventions and treatments.