ABSTRACT
Background: Increased pediatric COVID-19 occurrence due to the SARS-CoV-2 Omicron variant has raised concerns about the effectiveness of existing vaccines. The protection provided by the SOBERANA-02-Plus vaccination scheme against this variant has not yet been studied. We aimed to evaluate the scheme's effectiveness against symptomatic Omicron infection and severe disease in children. Methods: In September 2021, Cuba implemented a mass pediatric immunization with the heterologous SOBERANA-02-Plus scheme: 2 doses of conjugated SOBERANA-02 followed by a heterologous SOBERANA-Plus dose. By December, before the Omicron outbreak, 95.4% of 2-18 years-old had been fully immunized. During the entire Omicron wave, we conducted a nationwide longitudinal post-vaccination case-population study to evaluate the real-world effectiveness of the SOBERANA-02-Plus scheme against symptomatic infection and severe disease in children without previous SARS-CoV-2 infection. The identification of COVID-19 cases relied on surveillance through first line services, which refer clinical suspects to pediatric hospitals where they are diagnosed based on a positive RT-PCR test. We defined the Incidence Rate ratio (IRR) as IRvaccinated age group/IRunvaccinated 1-year-old and calculated vaccine effectiveness as VE = (1-IRR)∗100%. 24 months of age being the 'eligible for vaccination' cut-off, we used a regression discontinuity approach to estimate effectiveness by contrasting incidence in all unvaccinated 1-year-old versus vaccinated 2-years-old. Estimates in the vaccinated 3-11 years-old are reported from a descriptive perspective. Findings: We included 1,098,817 fully vaccinated 2-11 years-old and 98,342 not vaccinated 1-year-old children. During the 24-week Omicron wave, there were 7003/26,241,176 person-weeks symptomatic COVID-19 infections in the vaccinated group (38.2 per 105 person-weeks in 2-years-old and 25.5 per 105 person-weeks in 3-11 years-old) against 3577/2,312,273 (154.7 per 105 person-weeks) in the unvaccinated group. The observed overall vaccine effectiveness against symptomatic infection was 75.3% (95% CI, 73.5-77.0%) in 2-years-old children, and 83.5% (95% CI, 82.8-84.2%) in 3-11 years-old. It was somewhat lower during Omicron BA.1 then during Omicron BA.2 variant circulation, which took place 1-3 and 4-6 months after the end of the vaccination campaign. The effectiveness against severe symptomatic disease was 100.0% (95% CI not estimated) and 94.6% (95% CI, 82.0-98.6%) in the respective age groups. No child death from COVID-19 was observed. Interpretation: Immunization of 2-11 years-old with the SOBERANA-02-Plus scheme provided strong protection against symptomatic and severe disease caused by the Omicron variant, which was sustained during the six months post-vaccination follow-up. Our results contrast with the observations in previous real-world vaccine effectiveness studies in children, which might be explained by the type of immunity a conjugated protein-based vaccine induces and the vaccination strategy used. Funding: National Fund for Science and Technology (FONCI-CITMA-Cuba).
ABSTRACT
Introducción: la hipertensión arterial constituye uno de los problemas médicos más importantes de la medicina contemporánea, siendo influida por múltiples factores de riesgo. Objetivo: determinar la presencia de factores de riesgo en pacientes hipertensos que asistieron a la consulta de medicina interna del Hospital Boliviano Español de Patacamaya, en la Paz, República de Bolivia durante el 2014. Material y método: es una investigación descriptiva y transversal. El universo estuvo conformado por los 7739 pacientes adultos (de 18 años y más) que asistieron a consulta de medicina interna por cualquier motivo de salud. La muestra la constituyeron los 270 pacientes con el diagnóstico de hipertensión arterial. Las variables estudiadas fueron: la edad, el sexo y los factores de riesgo. Se utilizaron medidas de resúmenes para datos cualitativos. Resultados: la prevalencia de hipertensión arterial del estudio fue de 3,4%, siendo los más afectados los mayores de 60 años del sexo masculino; los hábitos alimentarios inadecuados (70,0%) , los hábitos tóxicos (52,9%) y la eritrocitosis se presentaron con mayor frecuencia. El tener factores de riesgo resultó altamente significativo como predisponente para desarrollar hipertensión arterial, incrementando en 2,76 veces la presencia de esta. Conclusiones: existió una relación directamente proporcional entre la presencia de factores de riesgo y la hipertensión arterial en la serie estudiada.
Introduction: hypertension is one of the most important medical problems of contemporary medicine, being influenced by multiple risk factors. Objective: to determine the presence of risk factors en hypertensive patients attending the internal medicine office at Patacamaya Hospital, La Paz, Bolivia Republic during 2014. Material and method: this is a descriptive cross-sectional research. The universe was comprised of 7739 adult patients (18 years and older) attending internal medicine for any health reasons. The sample comprised 270 patients with a diagnosis of hypertension. The variables studied were: age, sex and risk factors. Summary measures for qualitative data were used. Results: the prevalence of hypertension in this study was 3.4%, those over 60 years and male were the most affected; inadequate eating habits (70.0%), toxic habits (52.9%) and erythrocytosis occurred more frequently. Having these risk factors was highly significant as a predisposing element to develop high blood pressure, increasing by 2.76 times its presence. Conclusions: there was a direct relationship between the presence of risk factors and hypertension in the studied series.
