ABSTRACT
Background. In February 2021 Kazakhstan began offering COVID-19 vaccines to adults. Breakthrough SARS-CoV-2 infections raised concerns about real-world vaccine effectiveness. We aimed to evaluate effectiveness of four vaccines against SARS-CoV-2 infection. Methods. We conducted a retrospective cohort analysis among adults in Almaty using aggregated vaccination data and individual-level breakthrough COVID-19 cases (>=14 days from 2nd dose) using national surveillance data. We ran time-adjusted Cox-proportional-hazards model with sensitivity analysis accounting for varying entry into vaccinated cohort to assess vaccine effectiveness for each vaccine (measured as 1-adjusted hazard ratios) using the unvaccinated population as reference (N=565,390). We separately calculated daily cumulative hazards for COVID-19 breakthrough among vaccinated persons by age and vaccine month. Results. From February 22 to Sept 1, 2021 in Almaty, 747,558 (57%) adults were fully vaccinated (received 2 doses) and 108,324 COVID-19 cases (11,472 breakthrough) were registered. Vaccine effectiveness against infection was 78% (sensitivity estimates: 74-82%) for QazVac, 77% (72-81%) for Sputnik V, 71% (69-72%) for Hayat-Vax, and 69% (64-72%) for CoronaVac. Among vaccinated persons, the 90-day follow-up cumulative hazard for breakthrough infection was 2.2%. Cumulative hazard was 2.9% among people aged >=60 years versus 1.9% among persons aged 18-39 years (p< 0.001), and 1.2% for people vaccinated in February-May versus 3.3% in June-August (p< 0.001). Conclusion. Our analysis demonstrates high effectiveness of COVID-19 vaccines against infection in Almaty similar to other observational studies. Higher cumulative hazard of breakthrough among people >60 years of age and during variant surges warrants targeted booster vaccination campaigns. (Figure Presented).
ABSTRACT
Background. Vaccines against COVID-19 are critical to controlling COVID-19. A successful vaccination campaign requires high vaccine uptake. Knowledge of people's perceptions towards vaccines and their readiness to be vaccinated helps inform messaging around vaccine confidence. Our study aimed to assess the level of vaccine confidence and identify associated factors in two cities in Kyrgyz Republic. Methods. In August 2021, we conducted a convenient sample study of adults (>=18 years old) at public service centers and malls in Bishkek and Naryn. A participant had high vaccine confidence if they (1) believed that the COVID-19 vaccine is important to protect oneself or to protect others in their community, and (2) had been vaccinated or planned to get vaccinated. We used logistic regression to assess associations with high vaccine confidence. Results. Of 1595 respondents, 29% had high COVID-19 vaccine confidence, 37% believed getting a vaccine was important to protect oneself, and 39% believed it was important to protect others in their community. Moreover, 63% of respondents were not vaccinated and did not plan on getting vaccinated,61% reported concerns about safety and side effects, and 44% believed (incorrectly) that vaccines would not effectively prevent COVID-19. Vaccine confidence increased with age (42% aged >=50 years vs 21% aged 18-29 years) and education level (38% among those with higher education vs 22% lower education). Higher age (adjusted odds ratio [AOR]: 1.8, 95% confidence interval [CI] 1.4-2.3), higher education (AOR 1.5, CI 1.2-1.8), high COVID-19 knowledge (AOR 2.5, CI 1.6-4.1), prior COVID-19 testing (AOR 1.5, CI 1.3-1.8), and reporting healthcare workers as a primary source of COVID-19 information (AOR 1.3, CI 1.1-1.6) were associated with high vaccine confidence. Conclusion. Results demonstrate that building vaccine confidence is likely needed, especially among younger people and people with lower education. Healthcare providers can work with populations to address safety concerns and promote vaccine effectiveness.
ABSTRACT
Background. The COVID-19 pandemic's global disruptions resulted in food insecurity and negative consequences beyond direct health impact. Increased understanding of these consequences can protect critical infrastructure workers, including teachers, in future pandemics and COVID-19 waves. Methods. We conducted a descriptive cross-sectional study from September through October 2021 in Kulyab, Tajikistan. Teachers, systematically recruited from 54 secondary schools, responded to an online structured questionnaire on food security and negative consequences. We defined food insecurity as (1) being very worried about not having food, (2) having run out of food a lot more than before the pandemic, or (3) having to skip meals often because of insufficient money, and high food insecurity if all applied. Multivariable logistic regressions were conducted to identify variables associated with high food insecurity. Results. Of 1,575 teachers surveyed, 44% had food insecurity, and 14% had high food insecurity. Negative consequences experienced included, 40% income loss, 7% having to move households, 67% depression/anxiety, and 44% fear of leaving home due to violence. Food insecurity was independently greater among teachers with school age children (15% vs. 9%), that had to quarantine or isolate (18% vs. 9%), and who had COVID-19 (21% vs. 13%). Odds of high food insecurity were higher among teachers with significant income loss (Adjusted odds ratio (AOR): 3.3, 95% CI: 1.9-5.7), depression/anxiety (AOR 1.8, 95% CI: 1.2-3.0), fear of leaving home due to violence (AOR 2.6, 95% CI: 1.7-4.1), and tele working vs in-person (AOR 1.6, 95% CI: 1.1-2.3). Odds were lower among teachers who practiced physical distancing (AOR 0.5, 95% CI: 0.3-0.7) and with household members > 60 years old (AOR 0.4, 95% CI: 0.1-0.8). Conclusion. During the COVID-19 pandemic teachers in our study experienced high food insecurity, income loss, and anxiety or depression. Safety nets could be strengthened and focused for health threats affecting populations access to food.
ABSTRACT
Background. Despite infection control and mitigation measures against corona virus disease (COVID-19) in Kyrgyzstan hospitals, 3173 healthcare workers (HCW) had been diagnosed with COVID-19 by September 2020 (22 COVID-19 cases/100 HCW). We aimed to identify risks for COVID-19 among HCW exposed to COVID-19 patients in Bishkek. Methods. We conducted a case-control study in six hospitals with high COVID-19 incidence using incidence-density sampling. Cases were HCW with positive SARS-CoV-2 PCR and negative SARS-CoV-2 IgG results June 2020-May 2021 exposed to COVID-19 patients < 14 days prior to PCR positive test. Controls were randomly selected HCW working with COVID-19 patients at the same time with negative SARS-CoV-2 PCR and IgG results. HCW with COVID-19 contacts outside of the work setting were excluded. We used logistic regression to identify factors associated with COVID-19. Results. We included 132 cases and 406 controls;479 (89%) were women, and 256 (48%) were ages < 40 years. HCW wore different types of masks;among these medical respirators (FFP3) were used by 49% of cases vs 28% of controls. Comorbidities were reported in 34% of cases vs 14% of controls;90% of cases vs 91% of controls stayed in shift-dormitories. Odds of COVID-19 were greater for HCW who used FFP3 vs other types of respirators including N95 (adjusted odds ratio=2.9, 95% confidence interval [CI]: 1.1-3.9), shared a shiftwork dormitory with another HCW diagnosed with COVID-19 vs not (2.9, CI: 1.5-5.5), and had a comorbidity vs not (2.3, CI:1.4 -5.0). Conclusion. HCW can become infected from exposures in a variety of settings. Ourfindings showed an association of COVID-19 with shared dormitory, comorbidity and FFP3 use. Results are not causal, but they point to the need for increased infection control and mitigation in communal spaces, including dormitories. Additionally, hospitals should ensure quality of respirators and correct training on respirator use.
ABSTRACT
Background. People living with HIV (PLHIV) with viral hepatitis C (HCV) coinfection have higher risk of liver failure and mortality. Globally, >2 million people globally have HIV/HCV co-infections. Central Asia is one of the regions most affected by HCV. Since 2018, Kyrgystan has provided HCV treatment free of charge to 427 PLHIV. We analyzed factors associated with HCV treatment success among PLHIV in Kyrgystan. Methods. We conducted retrospective cohort survey among PLHIV > 18 years old on HIV antiretroviral treatment that completed viral hepatitis C treatment before September 2021. We defined treatment success as having RNA PCR < 15 IU/mL posttreatment and negative DNA PCR 12 and 24 weeks post-treatment. We ed demographic, clinical, and laboratory data from the national registry and interviewed consenting participants using structured questionnaires. We used logistic regression to identify factors associated with treatment success. Results. Of 302 participants, 81% were >= 40 years old, 79% were male, 72% had ever injected drugs, 53% had ever been incarcerated, and 15% were on methadone. Treatment outcomes were classified as success among 86%. Reluctance to seek healthcare services due to fear of HIV status disclosure was reported by 39% of participants and was associated with reduced odds of treatment success (adjusted odds ratio [AOR]: 0.4, 95% CI: 0.2-1.0). Participants receiving SMS counseling (64%) had increased odds of treatment success (AOR: 2.4, 95% CI: 1.2-5.4) as did those who followed an HCV diet (AOR: 31, 95% CI: 1.4-6.8). Participants with an opportunistic infection (32%) and or HIV stage 3 or 4 (49%) also had decreased odds of treatment success (AOR: 0.3, 95% CI: 0.1-1.3;and AOR: 0.1, 95% CI: 0.01-0.5, respectively). Initiation of care in 2020 (COVID-19 pandemic beginning) was also associated with reduced odds (AOR: 0.3, 95% CI: 0.1-1.0). Conclusion. Our study found high HCV treatment success in a difficult-to-treat population including during the COVID-19 pandemic. Programs that reduce stigma towards people living with HIV, promote early engagement in care, and provide SMS-based counseling could help increase treatment success for PLHIV in groups at higher risk for non-retention in care.