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EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-332999


Background: A major goal of COVID-19 vaccination is to prevent severe outcomes (hospitalizations and deaths). We estimated the effectiveness of mRNA and ChAdOx1 COVID-19 vaccines against severe outcomes in four Canadian provinces between December 2020 and September 2021. Methods: We conducted this multiprovincial retrospective test-negative study among community-dwelling adults aged ≥18 years in Ontario, Quebec, British Columbia, and Manitoba using linked provincial databases and a common study protocol. Multivariable logistic regression was used to estimate province-specific vaccine effectiveness against COVID-19 hospitalization and/or death. Estimates were pooled using random effects models. Results: We included 2,508,296 tested subjects, with 31,776 COVID-19 hospitalizations and 5,842 deaths. Vaccine effectiveness was 83% after a first dose, and 98% after a second dose, against both hospitalization and death (separately). Against severe outcomes (hospitalization or death), effectiveness was 87% (95%CI: 71%-94%) ≥84 days after a first dose of mRNA vaccine, increasing to 98% (95%CI: 96%-99%) ≥112 days after a second dose. Vaccine effectiveness against severe outcomes for ChAdOx1 was 88% (95%CI: 75%-94%) ≥56 days after a first dose, increasing to 97% (95%CI: 91%-99%) ≥56 days after a second dose. Lower one-dose effectiveness was observed for adults aged ≥80 years and those with comorbidities, but effectiveness became comparable after a second dose. Two doses of vaccines provided very high protection for both homologous and heterologous schedules, and against Alpha, Gamma, and Delta variants. Conclusions: Two doses of mRNA or ChAdOx1 vaccines provide excellent protection against severe outcomes of hospitalization and death.

Preprint in English | EuropePMC | ID: ppcovidwho-328537


Background: The unprecedented COVID-19 pandemic has been spreading for more than one and a half years. However, it is unclear whether the pandemic influenced admission in pediatric intensive care units (PICUs) that never received COVID-19 patients during the early major outbreak in China . Methods: A retrospective study was conducted in a PICU in a tertiary hospital in Chengdu, southwestern China. We sought to describe the trend of admission number from pre-epidemic years (2018 and 2019) to 2021. We explored the impact of the COVID-19 outbreak on PICU admission characteristics by including all patients younger than 18 years admitted to the PICU between January 23 and April 8 in 2020 and those admitted in the same time periods in pre-epidemic years and in 2021. Results: The percentage of patients admitted to the PICU from the Chengdu region increased from 34.2 percent in 2019 to 40.4 percent in 2020, whereas that from other provinces decreased from 11.7 percent in 2019 to 5.8 percent in 2020 ( P = 0.012). The median length of stay (LOS) in the PICU was significantly longer in the 2020 cohort (4.0 days) than in the 2019 cohort (2.0 days) ( P <0.001);the median hospital LOS was also significantly longer in the former (12.0 days) than in the latter (8.0 days) ( P < 0.001). Both hospital outcomes ( P = 0.005) and primary diagnosis distributions ( P = 0.025) between the 2020 and 2019 cohorts were significant. Conclusions: In a PICU that never received COVID-19 patients, the onset of the 2020 major outbreak was accompanied by changes in the composition of regions of patients, longer PICU and hospital stays, an increased proportion of unauthorized discharge and death, and a larger proportion of neoplasms, nervous system diseases and injury.

Lancet Reg Health Am ; 2: 100038, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1461650


BACKGROUND: We studied lab-confirmed COVID-19 infection (LCCI) testing, incidence, and severity. METHODS: We included all Manitoba residents and limited our severity analysis to LCCI patients. We calculated testing, incidence and vaccination rates between March 8, 2020 and June 1, 2021. We estimated the association between patient characteristics and testing (rate ratio [RR]; Poisson regression), including the reason for testing (screening, symptomatic, contact/outbreak asymptomatic), incidence (hazard ratio [HR]; Cox regression), and severity (prevalence ratio [PR], Cox regression). FINDINGS: The overall testing rate during the second/third wave was 570/1,000 person-years, with an LCCI rate of 50/1,000 person-years. The secondary attack rate during the second/third wave was 16%. Across regions, young children (<10) had the lowest positivity for symptomatic testing, the highest positivity for asymptomatic testing, and the highest risk of LCCI as asymptomatic contact. People in the lowest income quintile had the highest risk of LCCI, 1.3-6x the hazard of those in the highest income quintile. Long-term care (LTC) residents were particularly affected in the second wave with HRs>10 for asymptomatic residents. INTERPRETATION: Although the severity of LCCI in children was low, they have a high risk of asymptomatic positivity. The groups most vulnerable to LCCI, who should remain a focus of public health, were residents of Manitoba's North, LTC facilities, and low-income neighbourhoods. FUNDING: Canada Research Chair Program.