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1.
N Engl J Med ; 385(16): 1474-1484, 2021 10 14.
Article in English | MEDLINE | ID: covidwho-1612234

ABSTRACT

BACKGROUND: Despite the high efficacy of the BNT162b2 messenger RNA vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rare breakthrough infections have been reported, including infections among health care workers. Data are needed to characterize these infections and define correlates of breakthrough and infectivity. METHODS: At the largest medical center in Israel, we identified breakthrough infections by performing extensive evaluations of health care workers who were symptomatic (including mild symptoms) or had known infection exposure. These evaluations included epidemiologic investigations, repeat reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays, antigen-detecting rapid diagnostic testing (Ag-RDT), serologic assays, and genomic sequencing. Correlates of breakthrough infection were assessed in a case-control analysis. We matched patients with breakthrough infection who had antibody titers obtained within a week before SARS-CoV-2 detection (peri-infection period) with four to five uninfected controls and used generalized estimating equations to predict the geometric mean titers among cases and controls and the ratio between the titers in the two groups. We also assessed the correlation between neutralizing antibody titers and N gene cycle threshold (Ct) values with respect to infectivity. RESULTS: Among 1497 fully vaccinated health care workers for whom RT-PCR data were available, 39 SARS-CoV-2 breakthrough infections were documented. Neutralizing antibody titers in case patients during the peri-infection period were lower than those in matched uninfected controls (case-to-control ratio, 0.361; 95% confidence interval, 0.165 to 0.787). Higher peri-infection neutralizing antibody titers were associated with lower infectivity (higher Ct values). Most breakthrough cases were mild or asymptomatic, although 19% had persistent symptoms (>6 weeks). The B.1.1.7 (alpha) variant was found in 85% of samples tested. A total of 74% of case patients had a high viral load (Ct value, <30) at some point during their infection; however, of these patients, only 17 (59%) had a positive result on concurrent Ag-RDT. No secondary infections were documented. CONCLUSIONS: Among fully vaccinated health care workers, the occurrence of breakthrough infections with SARS-CoV-2 was correlated with neutralizing antibody titers during the peri-infection period. Most breakthrough infections were mild or asymptomatic, although persistent symptoms did occur.


Subject(s)
COVID-19 Vaccines , COVID-19/epidemiology , Health Personnel/statistics & numerical data , Adult , Asymptomatic Diseases , COVID-19/diagnosis , COVID-19/prevention & control , COVID-19 Nucleic Acid Testing , Case-Control Studies , Female , Humans , Israel/epidemiology , Male , Middle Aged , Reverse Transcriptase Polymerase Chain Reaction , Treatment Failure
2.
Int J Environ Res Public Health ; 18(24)2021 12 15.
Article in English | MEDLINE | ID: covidwho-1613816

ABSTRACT

Governments worldwide have imposed harsh restrictions for decreasing the Covid-19 pandemic and maintaining public health. Yet such limitations have impacted people's physical activity. This study examined relationships between changes in physical activity and resilience, emotions, and depression during two lockdowns in Israel. An online survey was completed twice by 135 participants during two consecutive lockdowns. The results indicate that resilience and positive emotions were higher, and negative emotions and depression were lower during the second lockdown compared to the first one-even though people spent less time performing physical activity in the later lockdown. Moreover, negative emotions significantly decreased among people who reported increased physical activity during the second lockdown [M = 2.2 (SD = 0.9) compared to M = 1.9 (SD = 0.8) on a scale of 1-5] and increased among those who reported a reduction in activity [M = 1.8 (SD = 0.7) compared to M = 2.2 (SD = 0.7)]. It could therefore be concluded that while the Israeli population's resilience is higher compared to other populations (who do not regularly deal with crisis situations), their increased physical activity was associated with better resilience and emotions and lower depression scores. Since lockdowns are an extreme yet often repeated phenomenon, it is important to understand the psychological implications of engaging in physical activity.


Subject(s)
COVID-19 , Pandemics , Communicable Disease Control , Emotions , Exercise , Humans , Israel/epidemiology , SARS-CoV-2
3.
PLoS One ; 16(12): e0261772, 2021.
Article in English | MEDLINE | ID: covidwho-1591204

ABSTRACT

OBJECTIVE: To identify predicators of patients with fibromyalgia (FM) that are associated with a severe COVID-19 disease course. METHODS: We utilized the data base of the Clalit Health Services (CHS); the largest public organization in Israel, and extracted data concerning patients with FM. We matched two subjects without FM to each subject with FM by sex and age and geographic location. Baseline characteristics were evaluated by t-test for continuous variables and chi-square for categorical variables. Predictors of COVID-19 associated hospitalization were identified using univariable logistic regression model, significant variables were selected and analyzed by a multivariable logistic regression model. RESULTS: The initial cohort comprised 18,598 patients with FM and 36,985 matched controls. The mean age was 57.5± 14.5(SD), with a female dominance of 91%. Out of this cohort we extracted the study population, which included all patients contracted with COVID-19, and consisted of 571 patients with FM and 1008 controls. By multivariable analysis, the following variables were found to predict COVID-19 associated hospitalization in patients with FM: older age (OR, 1.25; CI, 1.13-1.39; p<0.001), male sex (OR, 2.63; CI, 1.18-5.88; p<0.05) and hypertension (OR, 1.75; CI, 1.04-2.95; p<0.05). CONCLUSION: The current population-based study revealed that FM per se was not directly associated with COVID-19 hospitalization or related mortality. Yet classical risk factors endangering the general population were also relevant among patients with FM.


Subject(s)
COVID-19/epidemiology , Fibromyalgia/epidemiology , Adult , Aged , Female , Hospitalization , Humans , Israel/epidemiology , Male , Middle Aged , Retrospective Studies , Risk Factors , Severity of Illness Index
4.
Euro Surveill ; 26(45)2021 Nov.
Article in English | MEDLINE | ID: covidwho-1581442

ABSTRACT

The SARS-CoV-2 Lambda (Pango lineage designation C.37) variant of interest, initially identified in Peru, has spread to additional countries. First detected in Israel in April 2021 following importations from Argentina and several European countries, the Lambda variant infected 18 individuals belonging to two main transmission chains without further spread. Micro-neutralisation assays following Comirnaty (BNT162b2 mRNA, BioNTech-Pfizer) vaccination demonstrated a significant 1.6-fold reduction in neutralising titres compared with the wild type virus, suggesting increased susceptibility of vaccinated individuals to infection.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19 Vaccines , Humans , Israel/epidemiology , Vaccination
5.
Sci Rep ; 11(1): 24449, 2021 12 27.
Article in English | MEDLINE | ID: covidwho-1585776

ABSTRACT

Syndromic surveillance systems monitor disease indicators to detect emergence of diseases and track their progression. Here, we report on a rapidly deployed active syndromic surveillance system for tracking COVID-19 in Israel. The system was a novel combination of active and passive components: Ads were shown to people searching for COVID-19 symptoms on the Google search engine. Those who clicked on the ads were referred to a chat bot which helped them decide whether they needed urgent medical care. Through its conversion optimization mechanism, the ad system was guided to focus on those people who required such care. Over 6 months, the ads were shown approximately 214,000 times and clicked on 12,000 times, and 722 people were informed they needed urgent care. Click rates on ads and the fraction of people deemed to require urgent care were correlated with the hospitalization rate ([Formula: see text] and [Formula: see text], respectively) with a lead time of 9 days. Males and younger people were more likely to use the system, and younger people were more likely to be determined to require urgent care (slope: [Formula: see text], [Formula: see text]). Thus, the system can assist in predicting case numbers and hospital load at a significant lead time and, simultaneously, help people determine if they need medical care.


Subject(s)
COVID-19/epidemiology , Sentinel Surveillance , Ambulatory Care/statistics & numerical data , COVID-19/pathology , COVID-19/virology , Hospitalization/statistics & numerical data , Humans , Israel/epidemiology , Linear Models , SARS-CoV-2/isolation & purification , Search Engine
6.
Int J Environ Res Public Health ; 19(1)2021 Dec 23.
Article in English | MEDLINE | ID: covidwho-1580843

ABSTRACT

Based on Pearlin's stress process model and the social inequality approach to health, this study used a social lens to explore the role of socioeconomic inequities in mental distress during the COVID-19 pandemic in Israel. Specifically, we examined people's pre-pandemic sociodemographic characteristics and economic situation, and the economic effects of the pandemic itself on mental distress. A real-time survey was conducted in May 2020 among 273 adults (ages 20-68), and hierarchical linear models were employed. Findings indicated that groups vulnerable to mental distress in routine times (e.g., women, people with economic difficulties) showed the same pattern during the pandemic. Not only was unemployment related to mental distress, so too was a reduction in work hours. The pandemic's economic effects (e.g., needing to take out loans, having a worsening financial situation) were also associated with increased mental distress. This study is one of very few studies to explore a wide range of socioeconomic factors and their association with mental distress during the current crisis. The findings call for broader interventions to alleviate the economic distress caused by the pandemic to promote mental health, especially for groups that were vulnerable before the crisis and those most affected economically following the pandemic.


Subject(s)
COVID-19 , Pandemics , Adult , Aged , Female , Humans , Israel/epidemiology , Mental Health , Middle Aged , SARS-CoV-2 , Young Adult
7.
PLoS One ; 16(3): e0243265, 2021.
Article in English | MEDLINE | ID: covidwho-1576038

ABSTRACT

Severe acute respiratory disease coronavirus 2 (SARS-CoV-2) which causes corona virus disease (COVID-19) was first identified in Wuhan, China in December 2019 and has since led to a global pandemic. Importations of SARS-CoV-2 to Israel in late February from multiple countries initiated a rapid outbreak across the country. In this study, SARS-CoV-2 whole genomes were sequenced from 59 imported samples with a recorded country of importation and 101 early circulating samples in February to mid-March 2020 and analyzed to infer clades and mutational patterns with additional sequences identified Israel available in public databases. Recorded importations in February to mid-March, mostly from Europe, led to multiple transmissions in all districts in Israel. Although all SARS-CoV-2 defined clades were imported, clade 20C became the dominating clade in the circulating samples. Identification of novel, frequently altered mutated positions correlating with clade-defining positions provide data for surveillance of this evolving pandemic and spread of specific clades of this virus. SARS-CoV-2 continues to spread and mutate in Israel and across the globe. With economy and travel resuming, surveillance of clades and accumulating mutations is crucial for understanding its evolution and spread patterns and may aid in decision making concerning public health issues.


Subject(s)
COVID-19/pathology , Genetic Variation , Genome, Viral/genetics , SARS-CoV-2/genetics , COVID-19/epidemiology , COVID-19/virology , High-Throughput Nucleotide Sequencing , Humans , Israel/epidemiology , Mutation , SARS-CoV-2/isolation & purification
8.
Lancet Respir Med ; 9(9): 999-1009, 2021 09.
Article in English | MEDLINE | ID: covidwho-1545508

ABSTRACT

BACKGROUND: Concurrent with the Pfizer-BioNTech BNT162b2 COVID-19 vaccine roll-out in Israel initiated on Dec 19, 2020, we assessed the early antibody responses and antibody kinetics after each vaccine dose in health-care workers of different ages and sexes, and with different comorbidities. METHODS: We did a prospective, single-centre, longitudinal cohort study at the Sheba Medical Centre (Tel-Hashomer, Israel). Eligible participants were health-care workers at the centre who had a negative anti-SARS-CoV-2 IgG assay before receiving the first dose of the intramuscular vaccine, and at least one serological antibody test after the first dose of the vaccine. Health-care workers with a positive SARS-CoV-2 PCR test before vaccination, a positive anti-SARS-CoV-2 IgG serology test before vaccination, or infection with COVID-19 after vaccination were excluded from the study. Participants were followed up weekly for 5 weeks after the first vaccine dose; a second dose was given at week 3. Serum samples were obtained at baseline and at each weekly follow-up, and antibodies were tested at 1-2 weeks after the first vaccine dose, at week 3 with the administration of the second vaccine dose, and at weeks 4-5 (ie, 1-2 weeks after the second vaccine dose). Participants with comorbidities were approached to participate in an enriched comorbidities subgroup, and at least two neutralising assays were done during the 5 weeks of follow-up in those individuals. IgG assays were done for the entire study population, whereas IgM, IgA, and neutralising antibody assays were done only in the enriched comorbidities subgroup. Concentrations of IgG greater than 0·62 sample-to-cutoff (s/co) ratio and of IgA greater than 1·1 s/co, and titres of neutralising antibodies greater than 10 were considered positive. Scatter plot and correlation analyses, logistic and linear regression analyses, and linear mixed models were used to investigate the longitudinal antibody responses. FINDINGS: Between Dec 19, 2020, and Jan 30, 2021, we obtained 4026 serum samples from 2607 eligible, vaccinated participants. 342 individuals were included in the enriched comorbidities subgroup. The first vaccine dose elicited positive IgG and neutralising antibody responses at week 3 in 707 (88·0%) of 803 individuals, and 264 (71·0%) of 372 individuals, respectively, which were rapidly increased at week 4 (ie, 1 week after the second vaccine dose) in 1011 (98·4%) of 1027 and 357 (96·5%) of 370 individuals, respectively. Over 4 weeks of follow-up after vaccination, a high correlation (r=0·92) was detected between IgG against the receptor-binding domain and neutralising antibody titres. First-dose induced IgG response was significantly lower in individuals aged 66 years and older (ratio of means 0·25, 95% CI 0·19-0·31) and immunosuppressed individuals (0·21, 0·14-0·31) compared with individuals aged 18·00-45·99 years and individuals with no immunosuppression, respectively. This disparity was partly abrogated following the second dose. Overall, endpoint regression analysis showed that lower antibody concentrations were consistently associated with male sex (ratio of means 0·84, 95% CI 0·80-0·89), older age (ie, ≥66 years; 0·64, 0·58-0·71), immunosuppression (0·44, 0·33-0·58), and other specific comorbidities: diabetes (0·88, 0·79-0·98), hypertension (0·90, 0·82-0·98), heart disease (0·86, 0·75-1·00), and autoimmune diseases (0·82, 0·73-0·92). INTERPRETATION: BNT162b2 vaccine induces a robust and rapid antibody response. The significant correlation between receptor-binding domain IgG antibodies and neutralisation titres suggests that IgG antibodies might serve as a correlate of neutralisation. The second vaccine dose is particularly important for older and immunosuppressed individuals, highlighting the need for timely second vaccinations and potentially a revaluation of the long gap between doses in some countries. Antibody responses were reduced in susceptible populations and therefore they might be more prone to breakthrough infections. FUNDING: Sheba Medical Center, Israel Ministry of Health.


Subject(s)
Antibodies, Neutralizing/blood , Antibodies, Viral/blood , COVID-19 Vaccines/immunology , COVID-19/prevention & control , Health Personnel/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Antibodies, Neutralizing/immunology , Antibodies, Viral/immunology , Antibodies, Viral/isolation & purification , COVID-19/epidemiology , COVID-19/immunology , COVID-19/virology , COVID-19 Vaccines/administration & dosage , Female , Follow-Up Studies , Humans , Immunity, Humoral , Immunogenicity, Vaccine , Israel/epidemiology , Longitudinal Studies , Male , Middle Aged , Pandemics/prevention & control , Prospective Studies , SARS-CoV-2/immunology , Vaccination/methods , Vaccination/statistics & numerical data , Young Adult
10.
Pediatr Infect Dis J ; 40(8): e310-e311, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1541587

ABSTRACT

The dynamics of intrafamilial spread of SARS-CoV-2 during January-February 2021 when variant B.1.1.7 predominated were compared with data from April to May 2020, when other circulating variants prevailed. Much higher intrafamilial transmission rates among all age groups, in particular in young children, and lower rates of sensory impairment were demonstrated during January-February 2021.


Subject(s)
COVID-19/epidemiology , COVID-19/virology , SARS-CoV-2/classification , Adolescent , COVID-19/transmission , Child , Child, Preschool , Female , Humans , Hypesthesia/epidemiology , Hypesthesia/virology , Infant , Infant, Newborn , Israel/epidemiology , Male , SARS-CoV-2/genetics , Young Adult
11.
Isr J Health Policy Res ; 10(1): 40, 2021 07 15.
Article in English | MEDLINE | ID: covidwho-1533279

ABSTRACT

BACKGROUND AND PURPOSE: Marked reductions in imaging exams have been documented during the COVID-19 pandemic. The study aimed to examine the effect of the two waves of COVID-19 on magnetic resonance imaging (MRI) utilization at the national and regional level. MATERIALS AND METHODS: A retrospective-archive study was conducted in Israel, comparing March-December 2020 with March-December 2018 and 2019. Data on MRI utilization were obtained from the national MRI registry, while data on confirmed COVID-19 cases, by place of residence, were obtained from the Israeli Ministry of Health open COVID-19 database. RESULTS: The number and rate of MRI examinations decreased during the first COVID-19 wave, with the steepest drop in April 2020: 47.5% relative decrease compared to April 2019, and 42.2% compared to 2018. This was followed by a compensatory increase between the waves and a return to almost pre-pandemic levels of use, with just a modest decrease, during the second, more intense COVID wave, compared with the previous year. Existing differences between regions increased during the pandemic. The rate ratio of MRI exams between Tel-Aviv and the Northern periphery increased from 2.89 in April 2019 to 3.94 in April 2020. Jerusalem metropolitan region, with the largest burden of COVID disease, demonstrated only a modest decrease (1%) in MRI utilization during the first 10 months of the pandemic. CONCLUSIONS: At the national level, time trends in reduced MRI utilization followed the first wave of COVID-19, and were accompanied by increased regional disparities. These changes were not explained by differences in the burden of COVID-19 disease but might be explained by unequal distribution of MRI scanners among regions. Reduced utilization was not evident during the second wave, nor at the beginning of the third wave, despite higher COVID-19 case load, demonstrating adaptation to the new normal. Patterns of MRI utilization might help policy-makers and healthcare managers predict the behavior of imaging as well as other sectors, such as elective surgical procedures, during an ongoing pandemic. This forecast might help to manage the lasting effects of the pandemic, including extended waiting times, in the months and years following its remission. In preparation for future national emergencies, timely and detailed data on MRI utilization can serve as a "sensor" for a wide array of diagnostic and interventional medical activities, providing policy-makers with an updated snapshot to guide their response at the regional and national levels.


Subject(s)
COVID-19/epidemiology , Magnetic Resonance Imaging/statistics & numerical data , Pandemics , Procedures and Techniques Utilization/trends , Humans , Israel/epidemiology , Retrospective Studies
12.
Sci Rep ; 11(1): 22120, 2021 11 11.
Article in English | MEDLINE | ID: covidwho-1510614

ABSTRACT

The outbreak of the Coronavirus disease 2019 (COVID-19), and the drastic measures taken to mitigate its spread through imposed social distancing, have brought forward the need to better understand the underlying factors controlling spatial distribution of human activities promoting disease transmission. Focusing on results from 17,250 epidemiological investigations performed during early stages of the pandemic outbreak in Israel, we show that the distribution of carriers of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), which causes COVID-19, is spatially correlated with two satellite-derived surface metrics: night light intensity and landscape patchiness, the latter being a measure to the urban landscape's scale-dependent spatial heterogeneity. We find that exposure to SARS-CoV-2 carriers was significantly more likely to occur in "patchy" parts of the city, where the urban landscape is characterized by high levels of spatial heterogeneity at relatively small, tens of meters scales. We suggest that this spatial association reflects a scale-dependent constraint imposed by the city's morphology on the cumulative behavior of the people inhabiting it. The presented results shed light on the complex interrelationships between humans and the urban landscape in which they live and interact, and open new avenues for implementation of multi-satellite data in large scale modeling of phenomena centered in urban environments.


Subject(s)
COVID-19/epidemiology , Cities/epidemiology , Human Activities , Humans , Israel/epidemiology , SARS-CoV-2/isolation & purification , Satellite Imagery , Urban Population
13.
Isr J Health Policy Res ; 10(1): 62, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1496220

ABSTRACT

BACKGROUND: The Covid-19 pandemic began in Israel on February 2020. Between February and October 2020, 2 periods of lockdown were imposed on Israeli population. OBJECTIVE: To assess the effect of the Covid-19 pandemic on visits to the emergency department (ED) and on hospitalizations in medical wards in Israel's Chaim Sheba Medical Center, and to compare the effect during the first and second lockdowns. METHODS: Data regarding the number of visits of non-Covid-19 patients to the ED and the number of admissions to the medical wards, were extracted from the computerized system of the hospital. Data were analyzed for patients' characteristics, length of stay in the medical wards, in hospital mortality and the rate of 7 and 30 days re-hospitalization, and compared to the same period during 2019. RESULTS: Total visits to the Sheba ED during March-October decreased by 18.5%. The most dramatic decrease occurred during the first lockdown. The number of patients admitted to the Sheba medical wards decreased by 28% (P < 0.05). The length of stay decreased from 3.69 days during 2019 to 3.42 days during 2020 (P < 0.01). The most pronounced decrease in the length of stay was observed during the second month of the first lockdown. During the pandemic, hospitalized patients at Sheba were older and were less likely to be males. The in-hospital absolute non-COVID mortality decreased from 913 to 858 respectively. CONCLUSIONS: The Covid-19 crisis emphasizes the role of medical wards in the care of complex patients. Medical wards in Israel were at the frontline of Israel's battle against this pandemic, while continuing to treat very complex non-Covid patients. To avoid burnout of the medical staff who treat very intensively complex patients, we believe these wards should be strengthen with specialists having expertise in treating these patients. Due to our insights, the Sheba medical Center is now redesigning the concept of how intensive care beds should be managed in a big tertiary center.


Subject(s)
COVID-19 , Pandemics , Communicable Disease Control , Emergency Service, Hospital , Hospitalization , Hospitals , Humans , Israel/epidemiology , Male , SARS-CoV-2
14.
Sci Rep ; 11(1): 21002, 2021 10 25.
Article in English | MEDLINE | ID: covidwho-1483148

ABSTRACT

COVID19 infection was associated with possible psychiatric manifestations, including psychosis and mania. In addition, psychiatric disorders might be triggered by severe psychological reactions to the pandemic or the measures taken to contain it. This study aimed to assess the trends of new-onset psychosis/mania during the pandemic timeline. Psychiatric emergency department records during January-July 2019 and 2020 of two regional mental health centers were manually examined. Cases of new-onset psychosis or mania were found in 326 out of 5161 records examined. The ratio of these cases increased by 45.5% in 2020 compared to 2019 (189 out of 2367, 137 out of 2479, respectively, p = 0.001). The peak increase was in April 2020 (9.4% vs. 4.7%, p = 0.015). There was no association between the rise of new-onset psychotic or manic episodes and national incidence of COVID19 cases, as observed during Israel 2nd wave. PCR tests were negative, except a single case. In this study, an increase in new-onset psychosis/mania was identified during the initial phase of the pandemic. Though causality could not be directly inferred, lack of infection symptoms, negative PCR testing and temporal distribution incongruent with COVID19 caseload did not support a direct effect of SARS-CoV-2. Alternative explanations are discussed, such as psychological reaction to stress and preventive measures, as well as case-shifting between different mental health settings.


Subject(s)
Bipolar Disorder/epidemiology , COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Hospitals, Psychiatric/statistics & numerical data , Psychotic Disorders/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Bipolar Disorder/psychology , COVID-19 Nucleic Acid Testing , Electronic Health Records , Emergency Service, Hospital/trends , Female , Hospitals, Psychiatric/trends , Humans , Israel/epidemiology , Longitudinal Studies , Male , Middle Aged , Pandemics , Psychotic Disorders/psychology , Stress, Psychological , Young Adult
15.
BMC Public Health ; 21(1): 1521, 2021 08 06.
Article in English | MEDLINE | ID: covidwho-1477368

ABSTRACT

BACKGROUND: The COVID-19 outbreak holds public health concerns. The stay-at-home increases sedentary behavior, with unintended adverse outcomes. Since organized recreation and sports facilities were closed, we aimed to study how the crisis of closure affected exercise habits and weight gain among the trainee population in Israel. We examined differences in weight gain among individuals with different PA activities and assessed their ability to adapt to digital media as an alternative training structure. METHODS: A cross-sectional survey consisted of a multiple-choice questionnaire obtained using a web-based survey application. Trainees (1202) who exercised steadily anonymously answered the questionnaire sent by their coaches regarding their activity and weight gain during lockdown times. RESULTS: Results confirmed that 70% of Israelis trained less than their usual routine, 60% used digital media for training, 55% gained weight. Half of the respondents gained more than 2 kg, with an average increase of 1.2 kg. However, those who exhibited a higher physical activity level gained less weight. Using digital media for training was associated with higher physical activity levels. The aged population was less likely to use digital media. CONCLUSIONS: Since increased sedentary behavior could increase the risk for potential worsening of health conditions, health agencies should look for strategies, including digital remote media training to promote physical activity and subsequently, preventing the increased burden of future comorbidities worsening by a sedentary lifestyle. Approval: by the Helsinki ethics committee of Sheba Medical Center (6504-19-SMC).


Subject(s)
COVID-19 , Adult , Aged , Communicable Disease Control , Cross-Sectional Studies , Exercise , Humans , Internet , Israel/epidemiology , SARS-CoV-2 , Weight Gain
16.
Microbiol Spectr ; 9(2): e0087021, 2021 10 31.
Article in English | MEDLINE | ID: covidwho-1455682

ABSTRACT

The first case of SARS-CoV-2 was discovered in Israel in late February 2020. Three major outbreaks followed, resulting in over 800,000 cases and over 6,000 deaths by April 2021. Our aim was characterization of a serological snapshot of Israeli patients and healthy adults in the early months of the COVID-19 pandemic. Sera from 55 symptomatic COVID-19 patients and 146 healthy subjects (early-pandemic, reverse transcription-quantitative PCR [qRT-PCR]-negative), collected in Israel between March and April 2020, were screened for SARS-CoV-2-specific IgG, IgM, and IgA antibodies, using a 6-plex antigen microarray presenting the whole inactivated virus and five viral antigens: a stabilized version of the spike ectodomain (S2P), spike subunit 1 (S1), receptor-binding-domain (RBD), N-terminal-domain (NTD), and nucleocapsid (NC). COVID-19 patients, 4 to 40 days post symptom onset, presented specific IgG to all of the viral antigens (6/6) in 54 of the 55 samples (98% sensitivity). Specific IgM and IgA antibodies for all six antigens were detected in only 10% (5/55) and 4% (2/55) of the patients, respectively, suggesting that specific IgG is a superior serological marker for COVID-19. None of the qRT-PCR-negative sera reacted with all six viral antigens (100% specificity), and 48% (70/146) were negative throughout the panel. Our findings confirm a low seroprevalence of anti-SARS-CoV-2 antibodies in the Israeli adult population prior to the COVID-19 outbreak. We further suggest that the presence of low-level cross-reacting antibodies in naive individuals calls for a combined, multiantigen analysis for accurate discrimination between naive and exposed individuals. IMPORTANCE A 6-plex protein array presenting the whole inactivated virus and five nucleocapsid and spike-derived SARS-CoV-2 antigens was used to generate a serological snapshot of SARS-CoV-2 seroprevalence and seroconversion in Israel in the early months of the pandemic. Our findings confirm a very low seroprevalence of anti-SARS-CoV-2 antibodies in the Israeli adult population. We further propose that the presence of low-level nonspecific antibodies in naive individuals calls for a combined, multiantigen analysis for accurate discrimination between naive and exposed individuals enabling accurate determination of seroconversion. The developed assay is currently applied to evaluate immune responses to the Israeli vaccine during human phase I/II trials.


Subject(s)
Antibodies, Viral/blood , COVID-19 Serological Testing/methods , COVID-19/epidemiology , Microarray Analysis/methods , SARS-CoV-2/immunology , Adult , Aged , Antigens, Viral/immunology , Coronavirus Nucleocapsid Proteins/immunology , Female , Humans , Immunoassay/methods , Immunoglobulin A/blood , Immunoglobulin G/blood , Immunoglobulin M/blood , Israel/epidemiology , Male , Middle Aged , Phosphoproteins/immunology , Sensitivity and Specificity , Seroepidemiologic Studies , Spike Glycoprotein, Coronavirus/immunology , Young Adult
17.
Microbiol Spectr ; 9(2): e0050621, 2021 10 31.
Article in English | MEDLINE | ID: covidwho-1455679

ABSTRACT

Emerging SARS-CoV-2 (SC-2) variants with increased infectivity and vaccine resistance are of major concern. Rapid identification of such variants is important for the public health decision making and to provide valuable data for epidemiological and policy decision making. We developed a multiplex reverse transcriptase quantitative PCR (RT-qPCR) assay that can specifically identify and differentiate between the emerging B.1.1.7 and B.1.351 SC-2 variants. In a single assay, we combined four reactions-one that detects SC-2 RNA independently of the strain, one that detects the D3L mutation, which is specific to variant B.1.1.7, one that detects the 242 to 244 deletion, which is specific to variant B.1.351, and the fourth reaction, which identifies the human RNAseP gene, serving as an endogenous control for RNA extraction integrity. We show that the strain-specific reactions target mutations that are strongly associated with the target variants and not with other major known variants. The assay's specificity was tested against a panel of respiratory pathogens (n = 16), showing high specificity toward SC-2 RNA. The assay's sensitivity was assessed using both in vitro transcribed RNA and clinical samples and was determined to be between 20 and 40 viral RNA copies per reaction. The assay performance was corroborated with Sanger and whole-genome sequencing, showing complete agreement with the sequencing results. The new assay is currently implemented in the routine diagnostic work at the Central Virology Laboratory, and may be used in other laboratories to facilitate the diagnosis of these major worldwide-circulating SC-2 variants. IMPORTANCE This study describes the design and utilization of a multiplex reverse transcriptase quantitative PCR (RT-qPCR) to identify SARS-COV-2 (SC2) RNA in general and, specifically, to detect whether it is of lineage B.1.1.7 or B.1.351. Implementation of this method in diagnostic and research laboratories worldwide may help the efforts to contain the COVID-19 pandemic. The method can be easily scaled up and be used in high-throughput laboratories, as well as small ones. In addition to immediate help in diagnostic efforts, this method may also help in epidemiological studies focused on the spread of emerging SC-2 lineages.


Subject(s)
COVID-19/diagnosis , High-Throughput Nucleotide Sequencing/methods , High-Throughput Screening Assays/methods , SARS-CoV-2/classification , SARS-CoV-2/genetics , COVID-19/epidemiology , COVID-19/virology , Genome, Viral/genetics , Humans , Israel/epidemiology , RNA, Viral/genetics , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2/immunology , SARS-CoV-2/isolation & purification , Sensitivity and Specificity , Whole Genome Sequencing
18.
J Hepatol ; 75(2): 435-438, 2021 08.
Article in English | MEDLINE | ID: covidwho-1454287

ABSTRACT

BACKGROUND & AIMS: Two SARS-CoV-2 mRNA vaccines were approved to prevent COVID-19 infection, with reported vaccine efficacy of 95%. Liver transplant (LT) recipients are at risk of lower vaccine immunogenicity and were not included in the registration trials. We assessed vaccine immunogenicity and safety in this special population. METHODS: LT recipients followed at the Tel-Aviv Sourasky Medical Center and healthy volunteers were tested for SARS-CoV-2 IgG antibodies directed against the Spike-protein (S) and Nucleocapsid-protein (N) 10-20 days after receiving the second Pfizer-BioNTech BNT162b2 SARS-CoV-2 vaccine dose. Information regarding vaccine side effects and clinical data was collected from patients and medical records. RESULTS: Eighty LT recipients were enrolled. Mean age was 60 years and 30% were female. Twenty-five healthy volunteer controls were younger (mean age 52.7 years, p = 0.013) and mostly female (68%, p = 0.002). All participants were negative for IgG N-protein serology, indicating immunity did not result from prior COVID-19 infection. All controls were positive for IgG S-protein serology. Immunogenicity among LT recipients was significantly lower with positive serology in only 47.5% (p <0.001). Antibody titer was also significantly lower in this group (mean 95.41 AU/ml vs. 200.5 AU/ml in controls, p <0.001). Predictors for negative response among LT recipients were older age, lower estimated glomerular filtration rate, and treatment with high dose steroids and mycophenolate mofetil. No serious adverse events were reported in either group. CONCLUSION: LT recipients developed substantially lower immunological response to the Pfizer-BioNTech SARS-CoV-2 mRNA-based vaccine. Factors influencing serological antibody responses include age, renal function and immunosuppressive medications. The findings require re-evaluation of vaccine regimens in this population. LAY SUMMARY: The Pfizer-BioNTech BNT162b2 SARS-CoV-2 vaccine elicited substantially inferior immunity in liver transplant recipients. Less than half of the patients developed sufficient levels of antibodies against the virus, and in those who were positive, average antibody levels were 2x less compared to healthy controls. Factors predicting non-response were older age, renal function and immunosuppressive medications.


Subject(s)
Antibodies, Viral/blood , COVID-19 Vaccines , COVID-19 , Immunogenicity, Vaccine/immunology , Immunoglobulin G/blood , Immunosuppressive Agents/therapeutic use , Liver Transplantation/methods , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/adverse effects , COVID-19 Vaccines/immunology , Female , Humans , Israel/epidemiology , Kidney Function Tests , Male , Middle Aged , Risk Factors , SARS-CoV-2/immunology , Serologic Tests/methods , Serologic Tests/statistics & numerical data , Vaccination/adverse effects , Vaccination/methods
19.
BMC Public Health ; 21(1): 1543, 2021 08 12.
Article in English | MEDLINE | ID: covidwho-1351119

ABSTRACT

BACKGROUND: Influenza is a substantial cause of morbidity and mortality for Israel and the Palestinian territory. Given the extensive interaction between the two populations, vaccination in one population may indirectly benefit the other via reduced transmission. Due to the mobility and extensive contacts, Palestinians employed in Israel could be a prime target for vaccination. METHODS: To evaluate the epidemiological and the economic benefits conferred by vaccinating Palestinians employed in Israel, we developed a model of influenza transmission within and between Israel and the West Bank. We parameterized the contact patterns underlying transmission by conducting a survey among Palestinians employed in Israel, and integrating survey results with traffic patterns and socio-demographic data. RESULTS: Vaccinating 50% of Palestinian workers is predicted to reduce the annual influenza burden by 28,745 cases (95% CI: 15,031-50,717) and 37.7 deaths (95% CI: 19·9-65·5) for the Israeli population, and by 32,9900 cases (95% CI: 14,379-51,531) and 20.2 deaths (CI 95%: 9·8-31·5) for the Palestinian population. Further, we found that as the indirect protection was so substantial, funding such a vaccination campaign would be cost-saving from the Israeli Ministry of Health perspective. CONCLUSIONS: Offering influenza vaccination to Palestinians employed in Israel could efficiently reduce morbidity and mortality within both Israel and the Palestinian territory.


Subject(s)
Influenza Vaccines , Influenza, Human , Cost-Benefit Analysis , Humans , Immunization Programs , Influenza, Human/epidemiology , Influenza, Human/prevention & control , Israel/epidemiology , Surveys and Questionnaires , Vaccination
20.
Emerg Infect Dis ; 27(11): 2919-2922, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1441081

ABSTRACT

In Israel, the BNT162b2 vaccine against severe acute respiratory syndrome coronavirus 2 was approved for use in adolescents in June 2021, shortly before an outbreak of B.1.617.2 (Delta) variant-dominant infection. We evaluated short-term vaccine effectiveness and found the vaccine to be highly effective among this population in this setting.


Subject(s)
COVID-19 , Vaccines , Adolescent , COVID-19 Vaccines , Disease Outbreaks , Humans , Israel/epidemiology , SARS-CoV-2
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