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1.
The Lancet. Infectious diseases ; 2022.
Article in English | EuropePMC | ID: covidwho-1877191

ABSTRACT

Background The omicron (B.1.1.529) variant of SARS-CoV-2 has increased capacity to elude immunity and cause breakthrough infections. The aim of this study was to estimate the effectiveness of mRNA-based vaccine boosters (third dose) against infection with the omicron variant by age, sex, time since complete vaccination, type of primary vaccine, and type of booster. Methods In this nationwide cohort study, we linked data from three nationwide population registries in Spain (Vaccination Registry, Laboratory Results Registry, and National Health System registry) to select community-dwelling individuals aged 40 years or older, who completed their primary vaccine schedule at least 3 months before the start of follow-up, and had not tested positive for SARS-CoV-2 since the start of the pandemic. On each day between Jan 3, and Feb 6, 2022, we matched individuals who received a booster mRNA vaccine and controls of the same sex, age group, postal code, type of vaccine, time since primary vaccination, and number of previous tests. We estimated risk of laboratory-confirmed SARS-CoV-2 infection using the Kaplan-Meier method and compared groups using risk ratios (RR) and risk differences. Vaccine effectiveness was calculated as one minus RR. Findings Between Jan 3, and Feb 6, 2022, 3 111 159 matched pairs were included in our study. Overall, the estimated effectiveness from day 7 to 34 after a booster was 51·3% (95% CI 50·2–52·4). Estimated effectiveness was 52·5% (51·3–53·7) for an mRNA-1273 booster and 46·2% (43·5–48·7) for a BNT162b2 booster. Effectiveness was 58·6% (55·5–61·6) if primary vaccination had been with ChAdOx1 nCoV-19 (Oxford–AstraZeneca), 55·3% (52·3–58·2) with mRNA-1273 (Moderna), 49·7% (48·3–51·1) with BNT162b2 (Pfizer–BioNTech), and 48·0% (42·5–53·7) with Ad26.COV2.S (Janssen). Estimated effectiveness was 43·6% (40·0–47·1) when the booster was administered between 151 days and 180 days after complete vaccination and 52·2% (51·0–53·3) if administered more than 180 days after primary scheduled completion. Interpretation Booster mRNA vaccine-doses were moderately effective in preventing infection with the omicron variant of SARS-CoV-2 for over a month after administration, which indicates their suitability as a strategy to limit the health effects of COVID-19 in periods of omicron variant domination. Estimated effectiveness was higher for mRNA-1273 compared with BNT162b2 and increased with time between completed primary vaccination and booster. Funding None.

2.
Euro Surveill ; 27(21)2022 May.
Article in English | MEDLINE | ID: covidwho-1875327

ABSTRACT

IntroductionIn July and August 2021, the SARS-CoV-2 Delta variant dominated in Europe.AimUsing a multicentre test-negative study, we measured COVID-19 vaccine effectiveness (VE) against symptomatic infection.MethodsIndividuals with COVID-19 or acute respiratory symptoms at primary care/community level in 10 European countries were tested for SARS-CoV-2. We measured complete primary course overall VE by vaccine brand and by time since vaccination.ResultsOverall VE was 74% (95% CI: 69-79), 76% (95% CI: 71-80), 63% (95% CI: 48-75) and 63% (95% CI: 16-83) among those aged 30-44, 45-59, 60-74 and ≥ 75 years, respectively. VE among those aged 30-59 years was 78% (95% CI: 75-81), 66% (95% CI: 58-73), 91% (95% CI: 87-94) and 52% (95% CI: 40-61), for Comirnaty, Vaxzevria, Spikevax and COVID-19 Vaccine Janssen, respectively. VE among people 60 years and older was 67% (95% CI: 52-77), 65% (95% CI: 48-76) and 83% (95% CI: 64-92) for Comirnaty, Vaxzevria and Spikevax, respectively. Comirnaty VE among those aged 30-59 years was 87% (95% CI: 83-89) at 14-29 days and 65% (95% CI: 56-71%) at ≥ 90 days between vaccination and onset of symptoms.ConclusionsVE against symptomatic infection with the SARS-CoV-2 Delta variant varied among brands, ranging from 52% to 91%. While some waning of the vaccine effect may be present (sample size limited this analysis to only Comirnaty), protection was 65% at 90 days or more between vaccination and onset.


Subject(s)
COVID-19 , Influenza Vaccines , Influenza, Human , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Europe/epidemiology , Humans , Influenza, Human/prevention & control , Primary Health Care , SARS-CoV-2 , Vaccination
3.
Euro Surveill ; 27(19)2022 05.
Article in English | MEDLINE | ID: covidwho-1847114

ABSTRACT

BackgroundAfter a national lockdown during the first wave of the COVID-19 pandemic in Spain, regional governments implemented different non-pharmaceutical interventions (NPIs) during the second wave.AimTo analyse which implemented NPIs significantly impacted effective reproduction number (Rt) in seven Spanish provinces during 30 August 2020-31 January 2021.MethodsWe coded each NPI and levels of stringency with a 'severity index' (SI) and computed a global SI (mean of SIs per six included interventions). We performed a Bayesian change point analysis on the Rt curve of each province to identify possible associations with global SI variations. We fitted and compared several generalised additive models using multimodel inference, to quantify the statistical effect on Rt of the global SI (stringency) and the individual SIs (separate effect of NPIs).ResultsThe global SI had a significant lowering effect on the Rt (mean: 0.16 ± 0.05 units for full stringency). Mandatory closing times for non-essential businesses, limited gatherings, and restricted outdoors seating capacities (negative) as well as curfews (positive) were the only NPIs with a significant effect. Regional mobility restrictions and limited indoors seating capacity showed no effect. Our results were consistent with a 1- to 3-week-delayed Rt as a response variable.ConclusionWhile response measures implemented during the second COVID-19 wave contributed substantially to a decreased reproduction number, the effectiveness of measures varied considerably. Our findings should be considered for future interventions, as social and economic consequences could be minimised by considering only measures proven effective.


Subject(s)
COVID-19 , Bayes Theorem , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Humans , Pandemics/prevention & control , SARS-CoV-2 , Spain/epidemiology
4.
PLoS Comput Biol ; 18(3): e1009964, 2022 03.
Article in English | MEDLINE | ID: covidwho-1770638

ABSTRACT

When responding to infectious disease outbreaks, rapid and accurate estimation of the epidemic trajectory is critical. However, two common data collection problems affect the reliability of the epidemiological data in real time: missing information on the time of first symptoms, and retrospective revision of historical information, including right censoring. Here, we propose an approach to construct epidemic curves in near real time that addresses these two challenges by 1) imputation of dates of symptom onset for reported cases using a dynamically-estimated "backward" reporting delay conditional distribution, and 2) adjustment for right censoring using the NobBS software package to nowcast cases by date of symptom onset. This process allows us to obtain an approximation of the time-varying reproduction number (Rt) in real time. We apply this approach to characterize the early SARS-CoV-2 outbreak in two Spanish regions between March and April 2020. We evaluate how these real-time estimates compare with more complete epidemiological data that became available later. We explore the impact of the different assumptions on the estimates, and compare our estimates with those obtained from commonly used surveillance approaches. Our framework can help improve accuracy, quantify uncertainty, and evaluate frequently unstated assumptions when recovering the epidemic curves from limited data obtained from public health systems in other locations.


Subject(s)
COVID-19 , Epidemics , COVID-19/epidemiology , Humans , Reproducibility of Results , Retrospective Studies , SARS-CoV-2
5.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-329132

ABSTRACT

Background: With the emergence of SARS-CoV-2, influenza surveillance systems in Spain were transformed into a new syndromic sentinel surveillance system. The Acute Respiratory Infection Surveillance System (SiVIRA in Spanish) is based on a sentinel network for Acute Respiratory Infection (ARI) surveillance in Primary care, and a network of sentinel hospitals for Severe ARI (SARI) surveillance in hospitals. Methods: Using a test-negative design and data from SARI admissions notified to SiVIRA between January 1 and October 3, 2021, we estimated COVID-19 VE against hospitalization, by age group, vaccine type, time since vaccination and SARS-CoV-2 variant. Results: VE was 89% (95% CI: 83-93) against COVID-19 hospitalization overall in persons aged 20 years and older. VE was higher for mRNA vaccines, and lower for those aged 80 years and older, with a decrease in protection beyond 3 months of completing vaccination, and a further decrease after 5 months. We found no differences between periods with circulation of Alpha or Delta SARS-CoV-2 variants, although variant-specific VE was slightly higher against Alpha. Conclusions: The SiVIRA surveillance system, with a network of sentinel hospitals in Spain was able to describe clinical and epidemiological characteristics of SARI hospitalizations, monitor the circulation of SARS-CoV-2 and other respiratory viruses, and provide data to measure the effectiveness of COVID-19 vaccination in the population under surveillance. Our results add to evidence of high VE of mRNA vaccines against severe COVID-19 and waning protection with time since vaccination.

6.
SSRN;
Preprint in English | SSRN | ID: ppcovidwho-326222

ABSTRACT

Background: The effectiveness of mRNA-based boosters against COVID-19 during the Omicron era has not been studied in follow-up studies by age, sex, time since complete vaccination, type of primary vaccine, and type of booster. Methods: We linked data from nationwide population registries in Spain to select community-dwelling individuals ≥40 years, fully vaccinated ≥3 months ago and without prior SARS-CoV-2 positive tests. On each day between 3 January and 6 February 2022 we matched individuals receiving a booster mRNA vaccine and controls of the same sex, age group, postal code, type of vaccine, time since primary vaccination and number of previous tests. We estimated risk of laboratory-confirmed SARS-CoV-2 infection using the Kaplan-Meier method and compared groups using ratios and differences. Results: The estimated effectiveness (95% confidence interval) during days 7 to 34 after a booster was 51.3% (50.2, 52.4) overall, higher for females and people aged 60-79. Estimated effectiveness was 52.5% (51.3, 53.7) for an mRNA-1273 booster and 46.2% (43.5, 48.7) for a BNT162b2 booster. Effectiveness was 58.6% (55.5, 61.6) if primary vaccination had been with or ChAdOx1-S, 55.3% (52.3, 58.2) with mRNA-1273, 49.7% (48.3, 51.1) with BNT162b2 and 48.0% (42.5, 53.7) with Ad26.cov2.S. Estimated effectiveness was 43.6% (40.0, 47.1) when the booster was administered 6 months after complete vaccination, and 52.2% (51.0, 53.3) at longer intervals. Conclusions: Booster mRNA vaccine-doses were moderately effective in preventing SARS-CoV-2 Omicron infection for over a month after administration. Estimated effectiveness was higher for mRNA-1273 compared with BNT162b2 and increased with time since complete vaccination. Funding Information: None. Declaration of Interests: Authors declare no support from any organisation for the submitted work;no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: This study was approved by the research ethics committee at the Instituto de Salud Carlos III (approval no. CEI PI 98_2020). Keywords: Covid-19, SARS-CoV-2, Omicron, vaccines, effectiveness, Pfizer, Moderna

7.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-310410

ABSTRACT

Background: The analysis of the evolution of the COVID-19 epidemic can provide evidence of the impact of measures implemented to reduce its progression. Our aim was to describe the evolution of the pandemic in the different Spanish regions and to examine the effect of the non-pharmaceutical public health interventions during the first epidemic wave on these trends. Methods: Daily incidence rates of cases were calculated at national and regional level between 31th of January and 10th of May 2020. Epidemic curves, important dates of interventions and effective reproduction number (Rt) were plotted and transmissibility parameters were calculated. To summarize the geographical heterogeneity in the evolution, regional epidemic curves have been classified into homogeneous groups using a clustering procedure. Findings: The incidence rate reached 5 cases per 100,000 on March 1 and peaked at March 20. The Rt gradually decreased after the national lockdown falling below 1 on March 24. Two homogeneous groups of epidemic curves were identified among regions, mainly differentiated by the magnitude of the daily incidence rate and the evolution of the Rt in the period prior to lockdown. However, irrespectively of the previous trend, the lockdown was followed by a steep decrease in the number of cases starting 6 days after its implementation. Interpretation: Our results confirm that the restrictive national lockdown efficiently reduced the progression of the epidemic in Spain during the first wave. This effect was similar in the two regional clusters, independent of the previous dynamics of the epidemic.Funding Statement: The study was supported by Instituto de Salud Carlos III, Spain (ISCIII) grant number COV20-008Declaration of Interests: All authors declare no competing interests.

8.
Nat Commun ; 13(1): 482, 2022 01 25.
Article in English | MEDLINE | ID: covidwho-1655580

ABSTRACT

The impact of the COVID-19 pandemic on excess mortality from all causes in 2020 varied across and within European countries. Using data for 2015-2019, we applied Bayesian spatio-temporal models to quantify the expected weekly deaths at the regional level had the pandemic not occurred in England, Greece, Italy, Spain, and Switzerland. With around 30%, Madrid, Castile-La Mancha, Castile-Leon (Spain) and Lombardia (Italy) were the regions with the highest excess mortality. In England, Greece and Switzerland, the regions most affected were Outer London and the West Midlands (England), Eastern, Western and Central Macedonia (Greece), and Ticino (Switzerland), with 15-20% excess mortality in 2020. Our study highlights the importance of the large transportation hubs for establishing community transmission in the first stages of the pandemic. Here, we show that acting promptly to limit transmission around these hubs is essential to prevent spread to other regions and countries.


Subject(s)
Bayes Theorem , COVID-19/mortality , Pandemics/statistics & numerical data , SARS-CoV-2/isolation & purification , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/virology , Cause of Death , England/epidemiology , Female , Geography , Greece/epidemiology , Humans , Italy/epidemiology , Male , Middle Aged , Pandemics/prevention & control , SARS-CoV-2/physiology , Spain/epidemiology , Survival Rate , Switzerland/epidemiology
9.
Viruses ; 13(12)2021 12 03.
Article in English | MEDLINE | ID: covidwho-1554893

ABSTRACT

Measuring mortality has been a challenge during the COVID-19 pandemic. Here, we compared the results from the Spanish daily mortality surveillance system (MoMo) of excess mortality estimates, using a time series analysis, with those obtained for the confirmed COVID-19 deaths reported to the National Epidemiological Surveillance Network (RENAVE). The excess mortality estimated at the beginning of March 2020 was much greater than what has been observed in previous years, and clustered in a very short time. The cumulated excess mortality increased with age. In the first epidemic wave, the excess mortality estimated by MoMo was 1.5 times higher than the confirmed COVID-19 deaths reported to RENAVE, but both estimates were similar in the following pandemic waves. Estimated excess mortality and confirmed COVID-19 mortality rates were geographically distributed in a very heterogeneous way. The greatest increase in mortality that has taken place in Spain in recent years was detected early by MoMo, coinciding with the spread of the COVID-19 pandemic. MoMo is able to identify risk situations for public health in a timely manner, relying on mortality in general as an indirect indicator of various important public health problems.


Subject(s)
COVID-19/mortality , Pandemics , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Epidemiological Monitoring , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Public Health , SARS-CoV-2 , Spain/epidemiology , Young Adult
11.
Euro Surveill ; 26(29)2021 07.
Article in English | MEDLINE | ID: covidwho-1323061

ABSTRACT

We measured COVID-19 vaccine effectiveness (VE) against symptomatic SARS-CoV-2 infection at primary care/outpatient level among adults ≥ 65 years old using a multicentre test-negative design in eight European countries. We included 592 SARS-CoV-2 cases and 4,372 test-negative controls in the main analysis. The VE was 62% (95% CI: 45-74) for one dose only and 89% (95% CI: 79-94) for complete vaccination. COVID-19 vaccines provide good protection against COVID-19 presentation at primary care/outpatient level, particularly among fully vaccinated individuals.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Aged , COVID-19 Vaccines , Europe , Humans , Primary Health Care
12.
Euro Surveill ; 26(24)2021 Jun.
Article in English | MEDLINE | ID: covidwho-1278342

ABSTRACT

Residents in long-term care facilities (LTCF) experienced a large morbidity and mortality during the COVID-19 pandemic in Spain and were prioritised for early COVID-19 vaccination. We used the screening method and population-based data sources to obtain estimates of mRNA COVID-19 vaccine effectiveness for elderly LTCF residents. The estimates were 71% (95% CI: 56-82%), 88% (95% CI: 75-95%), and 97% (95% CI: 92-99%), against SARS-CoV-2 infections (symptomatic and asymptomatic), and COVID-19 hospitalisations and deaths, respectively.


Subject(s)
COVID-19 Vaccines , COVID-19 , Aged , Hospitalization , Humans , Long-Term Care , Pandemics , RNA, Messenger , SARS-CoV-2 , Spain/epidemiology
13.
Euro Surveill ; 26(2)2021 01.
Article in English | MEDLINE | ID: covidwho-1067623

ABSTRACT

The European monitoring of excess mortality for public health action (EuroMOMO) network monitors weekly excess all-cause mortality in 27 European countries or subnational areas. During the first wave of the coronavirus disease (COVID-19) pandemic in Europe in spring 2020, several countries experienced extraordinarily high levels of excess mortality. Europe is currently seeing another upsurge in COVID-19 cases, and EuroMOMO is again witnessing a substantial excess all-cause mortality attributable to COVID-19.


Subject(s)
COVID-19/mortality , Mortality/trends , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Cause of Death , Child , Child, Preschool , Computer Systems , Epidemiological Monitoring , Europe/epidemiology , Humans , Infant , Infant, Newborn , Middle Aged , SARS-CoV-2 , Young Adult
14.
BMJ ; 371: m4509, 2020 11 27.
Article in English | MEDLINE | ID: covidwho-947819

ABSTRACT

OBJECTIVE: To estimate the infection fatality risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), based on deaths with confirmed coronavirus disease 2019 (covid-19) and excess deaths from all causes. DESIGN: Nationwide seroepidemiological study. SETTING: First wave of covid-19 pandemic in Spain. PARTICIPANTS: Community dwelling individuals of all ages. MAIN OUTCOME MEASURES: The main outcome measure was overall, and age and sex specific, infection fatality risk for SARS-CoV-2 (the number of covid-19 deaths and excess deaths divided by the estimated number of SARS-CoV-2 infections) in the community dwelling Spanish population. Deaths with laboratory confirmed covid-19 were obtained from the National Epidemiological Surveillance Network (RENAVE) and excess all cause deaths from the Monitoring Mortality System (MoMo), up to 15 July 2020. SARS-CoV-2 infections in Spain were derived from the estimated seroprevalence by a chemiluminescent microparticle immunoassay for IgG antibodies in 61 098 participants in the ENE-COVID nationwide seroepidemiological survey between 27 April and 22 June 2020. RESULTS: The overall infection fatality risk was 0.8% (19 228 of 2.3 million infected individuals, 95% confidence interval 0.8% to 0.9%) for confirmed covid-19 deaths and 1.1% (24 778 of 2.3 million infected individuals, 1.0% to 1.2%) for excess deaths. The infection fatality risk was 1.1% (95% confidence interval 1.0% to 1.2%) to 1.4% (1.3% to 1.5%) in men and 0.6% (0.5% to 0.6%) to 0.8% (0.7% to 0.8%) in women. The infection fatality risk increased sharply after age 50, ranging from 11.6% (8.1% to 16.5%) to 16.4% (11.4% to 23.2%) in men aged 80 or more and from 4.6% (3.4% to 6.3%) to 6.5% (4.7% to 8.8%) in women aged 80 or more. CONCLUSION: The increase in SARS-CoV-2 infection fatality risk after age 50 appeared to be more noticeable in men than in women. Based on the results of this study, fatality from covid-19 was greater than that reported for other common respiratory diseases, such as seasonal influenza.


Subject(s)
COVID-19/mortality , Seroepidemiologic Studies , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Antibodies, Viral/blood , Child , Child, Preschool , Female , Humans , Immunoglobulin G/blood , Infant , Infant, Newborn , Male , Middle Aged , Risk , Sex Factors , Spain/epidemiology , Young Adult
15.
Euro Surveill ; 25(26)2020 07.
Article in English | MEDLINE | ID: covidwho-639161

ABSTRACT

A remarkable excess mortality has coincided with the COVID-19 pandemic in Europe. We present preliminary pooled estimates of all-cause mortality for 24 European countries/federal states participating in the European monitoring of excess mortality for public health action (EuroMOMO) network, for the period March-April 2020. Excess mortality particularly affected ≥ 65 year olds (91% of all excess deaths), but also 45-64 (8%) and 15-44 year olds (1%). No excess mortality was observed in 0-14 year olds.


Subject(s)
Cause of Death/trends , Coronavirus Infections/mortality , Coronavirus/isolation & purification , Influenza, Human/mortality , Pneumonia, Viral/mortality , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Child , Child, Preschool , Coronavirus Infections/diagnosis , Disease Outbreaks , Europe/epidemiology , Female , Humans , Infant , Infant, Newborn , Influenza, Human/diagnosis , Male , Middle Aged , Mortality/trends , Pandemics , Pneumonia, Viral/diagnosis , Population Surveillance , Preliminary Data , SARS-CoV-2 , Young Adult
16.
Eurosurveillance ; 25(9):2000178, 2020.
Article | WHO COVID | ID: covidwho-4442

ABSTRACT

A cluster of pneumonia of unknown origin was identified in Wuhan, China, in December 2019 [1]. On 12 January 2020, Chinese authorities shared the sequence of a novel coronavirus termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) isolated from some clustered cases [2]. Since then, the disease caused by SARS-CoV-2 has been named coronavirus disease 2019 (COVID-19). As at 21 February 2020, the virus had spread rapidly mostly within China but also to 28 other countries, including in the World Health Organization (WHO) European Region [3-5]. Here we describe the epidemiology of the first cases of COVID-19 in this region, excluding cases reported in the United Kingdom (UK), as at 21 February 2020. The study includes a comparison between cases detected among travellers from China and cases whose infection was acquired due to subsequent local transmission.%R doi:https://doi.org/10.2807/1560-7917.ES.2020.25.9.2000178

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