Machine Learning and Laboratory Values in the Diagnosis, Prognosis and Vaccination Strategy of COVID-19

In March 2020, the World Health Organization (WHO) declared a pandemic status for COVID-19 disease caused by SARS-CoV-2 infection. Early diagnosis undoubtedly plays a fundamental role in the management of emergencies for the treatment of infected patients, whose prognosis may benefit from early treatment and containment of contagions in asymptomatic or pauci-symptomatic subjects. To date, the gold-standard technique for diagnosing SARS-CoV-2 infection is the identification of viral genomic material (RNA) by molecular diagnosis. To improve the pandemic management, the need for enhanced diagnostic capacity for SARS-CoV-2 infections soon emerged, with rapid, accurate, and easily accessible methods. Machine learning (ML) models could help define the diagnosis and, in some cases, even the prognosis of COVID-19 patients. This chapter describes ML models based on laboratory tests combined with other biometric parameters;the applications aimed at optimizing diagnosis and prognosis were mainly described. Finally, the vaccination campaign against SARS-CoV-2. The fields most considered were the heterogeneity in patient selection, laboratory parameters used, the machine learning models and their validation and implementation. Furthermore, we briefly describe artificial intelligence's potentialities in planning different strategies for the vaccination campaigns against SARS-COV-2 through laboratory tests. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Viktor Mikhailovich Zhdanov and the eradication of smallpox

Considering current epidemiological and social phenomena such as CoVid-19 pandemic, re-occurrence of monkeypox and vaccine hesitancy, the authors chose to delineate an historical, human, and scientific profile of Dr. Viktor Mikhailovich Zhdanov, as a key figure related not only to smallpox eradication, but also to the building up of worldwide vaccination strategies. The authors present some of Zhdanov main life and scientific experiences and awards in virology, epidemiology, and public health. The authors highlight the need for international commitment to cooperate in the fields of vaccine research and vaccine hesitancy. © Mattioli 1885

Genetic and epidemiological description of an outbreak of circulating vaccine-derived polio-virus type 2 (cVDPV2) in Angola, 2019-2020.

After six years without any detection of poliomyelitis cases, Angola reported a case of circulating vaccine-derived poliovirus type 2 (cVDPV2) with paralysis onset date of 27 March 2019. Ultimately, 141 cVDPV2 polio cases were reported in all 18 provinces in 2019-2020, with particularly large hotspots in the south-central provinces of Luanda, Cuanza Sul, and Huambo. Most cases were reported from August to December 2019, with a peak of 15 cases in October 2019. These cases were classified into five distinct genetic emergences (emergence groups) and have ties with cases identified in 2017-2018 in the Democratic Republic of Congo. From June 2019 to July 2020, the Angola Ministry of Health and partners conducted 30 supplementary immunization activity (SIA) rounds as part of 10 campaign groups, using monovalent OPV type 2 (mOPV2). There were Sabin 2 vaccine strain detections in the environmental (sewage) samples taken after mOPV2 SIAs in each province. Following the initial response, additional cVDPV2 polio cases occurred in other provinces. However, the national surveillance system did not detect any new cVDPV2 polio cases after 9 February 2020. While reporting subpar indicator performance in epidemiological surveillance, the laboratory and environmental data as of May 2021 strongly suggest that Angola successfully interrupted transmission of cVDPV2 early in 2020. Additionally, the COVID-19 pandemic did not allow a formal Outbreak Response Assessment (OBRA). Improving the sensitivity of the surveillance system and the completeness of AFP case investigations will be vital to promptly detect and interrupt viral transmission if a new case or sewage isolate are identified in Angola or central Africa.

Incremental Net Benefit and Incremental Cost-Effectiveness Ratio of COVID-19 Vaccination Campaigns: Systematic Review of Cost-Effectiveness Evidence.

SARS-CoV-2 vaccination has been the most effective tool to prevent COVID-19, significantly reducing deaths and hospitalizations worldwide. Vaccination has played a huge role in bringing the COVID-19 pandemic under control, even as the inequitable distribution of vaccines still leaves several countries vulnerable. Therefore, organizing a mass vaccination campaign on a global scale is a priority to contain the virus spread. The aim of this systematic review was to assess whether COVID-19 vaccination campaigns are cost-effective with respect to no vaccination. A systematic literature search was conducted in the WHO COVID-19 Global literature database, PubMed, Web of Science, Embase, and Scopus from 2020 to 2022. Studies assessing the COVID-19 vaccination campaign cost-effectiveness over no vaccination were deemed eligible. The "Drummond's checklist" was adopted for quality assessment. A synthesis of the studies was performed through the "dominance ranking matrix tool". Overall, 10 studies were considered. COVID-19 vaccination was deemed cost-effective in each of them, and vaccination campaigns were found to be sustainable public health approaches to fight the health emergency. Providing economic evaluation data for mass vaccination is needed to support decision makers to make value-based and evidence-based decisions to ensure equitable access to vaccination and reduce the COVID-19 burden worldwide.

ChAdOx1 nCoV-19 Vaccine Side Effects among Healthcare Workers in Trinidad and Tobago.

Vaccine hesitancy due to safety concerns is a hindrance to the success of vaccination campaigns. In February 2021, Trinidad and Tobago commenced its National COVID-19 Vaccination Program. Healthcare workers were among the first group to receive the ChAdOx1 nCoV-19 (Oxford-AstraZeneca (Covishield, Serum Institute of India, Pune, India), the first COVID-19 vaccine available nationally. This study examined the safety of this vaccine in terms of the systemic and local adverse events following immunization reported by healthcare worker recipients. A cross-sectional study was conducted via a telephone questionnaire. Data concerning demographics, medical and COVID-19-related anamneses, and local and systemic side effects experienced within the first 48 h after receiving the first and second dose of this vaccine, respectively, were gathered. Among the 687 participants (male = 275; female = 412), prevalence of fever, body pain, chills, nausea, myalgia, headache, malaise, fatigue, and other systemic symptoms declined significantly 48 h after administration of the second dose compared to the first dose. Chi-square test and multiple logistic regression demonstrated the greater likelihood of younger recipients to report systemic symptoms compared to older recipients. Multiple logistic regression indicated that females were more likely to report headache, fatigue, and discomfort, and were less likely to report no symptoms, compared to males, after both doses. On average, recipients reported less local and systemic side effects 48 h after receiving the second dose compared to the first dose. The reported rate of occurrence of side effects was <50% for most adverse events, which is consistent with the manufacturer's claims that the vaccine is safe. This study adds data on the safety of this vaccine in a population that has not been previously studied. The findings can inform public health policy efforts to lower vaccine hesitancy based on safety concerns surrounding the ChAdOx1 nCoV-19 vaccine across various groups in society, including healthcare workers.

The environmental impact of mass coronavirus vaccinations: A point of view on huge COVID-19 vaccine waste across the globe during ongoing vaccine campaigns.

The vaccine innovation is a ubiquitous preventive measure to the transmission of highly infectious SARS-COV-2. The ongoing mass coronavirus vaccination programmes have inadvertently become the bulk producers of biomedical and plastic waste triggering severe impact on the environment. The sustainable management of bio hazardous vaccine waste in particular; syringes, needles, used/un-used vials and single-use plastic equipment is of utmost importance. This perspective presents a critical point of view in terms of the generated vaccine waste and the subsequent knock-on effect on all aspects of ecosystem. The discussion includes dire consequences due to the release of huge amount of plastic-based personal protective equipment into marine environment. The pivotal crisis of CO2 emission during the manufacture and storage of different vaccines has contributed to global warming. The unavoidable generation of microfibers upon incineration, autoclaving, pyrolysis and open dumping of vaccine waste has further jeopardized the environment. In this vein, exploration of biodegradable materials for vaccine inoculation and development of green technologies for sound waste management is suggested to mitigate the environment pollution.

The Role of Attitudes, Norms, and Efficacy on Shifting COVID-19 Vaccine Intentions: A Longitudinal Study of COVID-19 Vaccination Intentions in New Zealand.

While public intentions to get a COVID-19 vaccine have been shifting around the world, few studies track factors that help us understand and improve COVID-19 vaccine uptake. This study focuses on identifying changing public intentions to get a COVID-19 vaccine in New Zealand, a country that has been largely successful in containing the pandemic but risks new outbreaks as less than 20% of the population is fully vaccinated by August 2021. Data on COVID-19 intentions were collected just after the vaccine approval and rollout targeting old-age groups in February 2021 and then before the general public rollout in May 2021 (n = 650, 60% reinterview response rate). Results show that intention to get a COVID-19 vaccine increased in three months and was the highest in the last one year. Consistent with the Theory of Planned Behaviour, attitudes and efficacy beliefs were significantly associated with COVID-19 vaccine intentions, in the cross-sectional as well as longitudinal analyses. Findings highlight the persisting influence of attitudes, efficacy beliefs, and past intentions on future decision-making process to get a COVID-19 vaccine. Future research opportunities to understand vaccine intentions and improve public vaccine uptake are highlighted.

Evaluation of Flu Vaccination Coverage among Healthcare Workers during a 3 Years' Study Period and Attitude towards Influenza and Potential COVID-19 Vaccination in the Context of the Pandemic.

(1) Background: vaccination of healthcare workers (HCWs) against seasonal influenza is considered the most effective way to protect HCWs, ensure patient's safety and to maintain essential health care services during influenza epidemics. With the present study we aimed to evaluate the efficacy of incremental bundles of measures implemented during the last three flu campaigns and to assess the attitudes towards influenza vaccination and a potential vaccine against COVID-19 among HCWs, in a large university hospital in Pisa, Italy. (2) Methods: We described measures implemented during 2018/2019, 2019/2020 and 2020/2021 and assessed their impact on flu vaccine coverage (VC) among employees and residents in Pisa university hospital. We considered sex, profession and ward to investigate differences in uptake. In addition, in 2020 a survey was developed and distributed to all employees to evaluate flu and COVID-19 vaccines attitudes. (3) Results: during the 2018/19 and 2019/20 flu campaigns the overall VC rate among HCWs was, respectively, 10.2% and 11.9%. In 2020/21 the overall VC rate jumped to 39.3% (+ 230.6%). Results from the survey indicated a more positive attitude towards flu vaccine as compared to COVID-19 vaccines among the 10.6% of the staff members who responded to the survey. In addition, 70.97% of HCWs totally agreed that being vaccinated against influenza would be more important than the previous years because of COVID-19 emergency. (4) Conclusions: a significant increase in VC was observed in 2020/21, especially among those sub-groups with consistently lower uptake in previous years. The COVID-19 pandemic positively influenced flu vaccination uptake during the 2020/21 season.

COVID-19 pandemics Stage II - Energy and environmental impacts of vaccination.

The COVID-19 pandemic developed the severest public health event in recent history. The first stage for defence has already been documented. This paper moves forward to contribute to the second stage for offensive by assessing the energy and environmental impacts related to vaccination. The vaccination campaign is a multidisciplinary topic incorporating policies, population behaviour, planning, manufacturing, materials supporting, cold-chain logistics and waste treatment. The vaccination for pandemic control in the current phase is prioritised over other decisions, including energy and environmental issues. This study documents that vaccination should be implemented in maximum sustainable ways. The energy and related emissions of a single vaccination are not massive; however, the vast numbers related to the worldwide production, logistics, disinfection, implementation and waste treatment are reaching significant figures. The preliminary assessment indicates that the energy is at the scale of ~1.08 × 1010 kWh and related emissions of ~5.13 × 1012 gCO2eq when embedding for the envisaged 1.56 × 1010 vaccine doses. The cold supply chain is estimated to constitute 69.8% of energy consumption of the vaccination life cycle, with an interval of 26-99% depending on haul distance. A sustainable supply chain model that responds to an emergency arrangement, considering equality as well, should be emphasised to mitigate vaccination's environmental footprint. This effort plays a critical role in preparing for future pandemics, both environmentally and socially. Research in exploring sustainable single-use or reusable materials is also suggested to be a part of the plans. Diversified options could offer higher flexibility in mitigating environmental footprint even during the emergency and minimise the potential impact of material disruption or dependency.

Covid-19 vaccine acceptance, hesitancy, and refusal among Canadian healthcare workers: A multicenter survey.

BACKGROUND: Determinants of COVID-19 vaccine acceptance among healthcare workers (HCW) remains poorly understood. We assessed HCWs' willingness to be vaccinated and reasons underlying hesitancy. METHODS: Cross-sectional survey across 17 healthcare institutions. HCWs eligible for vaccination (Pfizer-BioNTech mRNA) in December 2020 were invited to receive immunization. Multivariate logistic regression was performed to identify predictors of acceptance. Reasons for refusal among those who never intended to be vaccinated (ie, firm refusers) and those who preferred delaying vaccination (ie, vaccine hesitants) were assessed. RESULTS: Among 2,761 respondents (72% female, average age, 44), 2,233 (80.9%) accepted the vaccine. Physicians, environmental services workers and healthcare managers were more likely to accept vaccination compared to nurses. Male sex, age over 50, rehabilitation center workers, and occupational COVID-19 exposure were independently associated with vaccine acceptance by multivariate analysis. Factors for refusal included vaccine novelty, wanting others to receive it first, and insufficient time for decision-making. Among those who declined, 74% reported they may accept future vaccination. Vaccine firm refusers were more likely than vaccine hesitants to distrust pharmaceutical companies and to prefer developing a natural immunity by getting COVID-19. CONCLUSIONS: Vaccine hesitancy exists among HCWs. Our findings provide useful information to plan future interventions and improve acceptance.

Attitudes of healthcare workers towards COVID-19 vaccination: a survey in France and French-speaking parts of Belgium and Canada, 2020.

In October and November 2020, we conducted a survey of 2,678 healthcare workers (HCWs) involved in general population immunisation in France, French-speaking Belgium and Quebec, Canada to assess acceptance of future COVID-19 vaccines (i.e. willingness to receive or recommend these) and its determinants. Of the HCWs, 48.6% (n = 1,302) showed high acceptance, 23.0% (n = 616) moderate acceptance and 28.4% (n = 760) hesitancy/reluctance. Hesitancy was mostly driven by vaccine safety concerns. These must be addressed before/during upcoming vaccination campaigns.