Vaccine effectiveness and duration of protection against symptomatic infections and severe Covid-19 outcomes in adults aged 50 years and over, France, January to mid-December 2021.

Background: SARS-CoV-2 continues to spread despite fast vaccine rollout, which could be attributed to waning immunity or to a reduced protection against some variants. A thorough characterization of vaccine protection and its duration in time is needed to inform vaccination policies and enhance public trust. Methods: We linked three national databases with exhaustive information on screening, vaccination and hospitalizations in France from January 1st to December 12, 2021. We performed a two-step analysis to estimate vaccine effectiveness against severe outcomes of Covid-19 (requiring hospitalization) in people aged 50 years or over, combining: (i) a test-negative case-control design to assess vaccine effectiveness against symptomatic infections; and (ii) a survival analysis to assess the additional protection against severe outcomes (hospitalizations, ICU admissions and inpatient deaths) in infected individuals. Findings: We found a high vaccine effectiveness in people aged 50 years or more, reaching 82% against symptomatic infections and 94% against hospitalizations, after a full vaccination scheme with the Covid-19 vaccines used in France.Vaccine effectiveness against symptomatic infections decreased over time, dropping to 53% after six months, but remained high against severe outcomes (90% after six months). The booster dose allowed restoring protection levels above 90% against symptomatic infections. Vaccine protection and its evolution in time, showed little difference against the variants that circulated prior to December 2021 in France, including the Delta variant. Interpretation: Though vaccine immunity decreases over time, vaccination remains crucial to provide individual protection against severe outcomes requiring hospitalization. This decline can be reversed by the receipt of a booster dose.

Vaccine-induced and naturally-acquired protection against Omicron and Delta symptomatic infection and severe COVID-19 outcomes, France, December 2021 to January 2022.

We assessed the protection conferred by naturally-acquired, vaccine-induced and hybrid immunity during the concomitant Omicron and Delta epidemic waves in France on symptomatic infection and severe COVID-19. The greatest levels of protection against both variants were provided by hybrid immunity. Protection against Omicron symptomatic infections was systematically lower and waned at higher speed than against Delta in those vaccinated. In contrast, there were little differences in variant-specific protection against severe inpatient outcomes in symptomatic individuals.

Lockdown impact on age-specific contact patterns and behaviours, France, April 2020.

BackgroundMany countries implemented national lockdowns to contain the rapid spread of SARS-CoV-2 and avoid overburdening healthcare capacity.AimWe aimed to quantify how the French lockdown impacted population mixing, contact patterns and behaviours.MethodsWe conducted an online survey using convenience sampling and collected information from participants aged 18 years and older between 10 April and 28 April 2020.ResultAmong the 42,036 survey participants, 72% normally worked outside their home, and of these, 68% changed to telework during lockdown and 17% reported being unemployed during lockdown. A decrease in public transport use was reported from 37% to 2%. Participants reported increased frequency of hand washing and changes in greeting behaviour. Wearing masks in public was generally limited. A total of 138,934 contacts were reported, with an average of 3.3 contacts per individual per day; 1.7 in the participants aged 65 years and older compared with 3.6 for younger age groups. This represented a 70% reduction compared with previous surveys, consistent with SARS-CoV2 transmission reduction measured during the lockdown. For those who maintained a professional activity outside home, the frequency of contacts at work dropped by 79%.ConclusionThe lockdown affected the population's behaviour, work, risk perception and contact patterns. The frequency and heterogeneity of contacts, both of which are critical factors in determining how viruses spread, were affected. Such surveys are essential to evaluate the impact of lockdowns more accurately and anticipate epidemic dynamics in these conditions.

Evolution of outcomes for patients hospitalised during the first 9 months of the SARS-CoV-2 pandemic in France: A retrospective national surveillance data analysis.

BACKGROUND: As SARS-CoV-2 continues to spread, a thorough characterisation of healthcare needs and patient outcomes, and how they have changed over time, is essential to inform planning. METHODS: We developed a probabilistic framework to analyse detailed patient trajectories from 198,846 hospitalisations in France during the first nine months of the pandemic. Our model accounts for the varying age- and sex- distribution of patients, and explore changes in outcome probabilities as well as length of stay. FINDINGS: We found that there were marked changes in the age and sex of hospitalisations over the study period. In particular, the proportion of hospitalised individuals that were >80y varied between 27% and 48% over the course of the epidemic, and was lowest during the inter-peak period. The probability of hospitalised patients entering ICU dropped from 0·25 (0·24-0·26) to 0·13 (0·12-0·14) over the four first months as case numbers fell, before rising to 0·19 (0·19-0·20) during the second wave. The probability of death followed a similar trajectory, falling from 0·25 (0·24-0·26) to 0·10 (0·09-0·11) after the first wave before increasing again during the second wave to 0·19 (0·18-0·19). Overall, we find both the probability of death and the probability of entering ICU were significantly correlated with COVID-19 ICU occupancy. INTERPRETATION: There are large scale trends in patients outcomes by age, sex and over time. These need to be considered in ongoing healthcare planning efforts. FUNDING: INCEPTION.

Estimating the burden of SARS-CoV-2 in France.

France has been heavily affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and went into lockdown on 17 March 2020. Using models applied to hospital and death data, we estimate the impact of the lockdown and current population immunity. We find that 2.9% of infected individuals are hospitalized and 0.5% of those infected die (95% credible interval: 0.3 to 0.9%), ranging from 0.001% in those under 20 years of age to 8.3% in those 80 years of age or older. Across all ages, men are more likely to be hospitalized, enter intensive care, and die than women. The lockdown reduced the reproductive number from 2.90 to 0.67 (77% reduction). By 11 May 2020, when interventions are scheduled to be eased, we project that 3.5 million people (range: 2.1 million to 6.0 million), or 5.3% of the population (range: 3.3 to 9.3%), will have been infected. Population immunity appears to be insufficient to avoid a second wave if all control measures are released at the end of the lockdown.

A network-based approach to modelling bluetongue spread in France.

Bluetongue virus serotype 8 (BTV-8) was reported for the first time in Europe in 2006, causing the largest bluetongue outbreak ever recorded. France was mostly impacted in 2007/09. Trade restrictions were implemented all along. Vaccination became available from 2008: a limited number of doses was first administered in an emergency vaccination campaign, followed by two nationwide compulsory vaccination campaigns in 2009 and 2010. France regained a disease-free status in December 2012, but BTV may have kept circulating undetected as infected herds have been reported again since August 2015. We developed a stochastic dynamic compartmental model of BTV transmission in cattle and sheep to analyze the relative importance of vector active flight and host movements in disease spread, and assess the effectiveness of control measures. We represented BTV transmission both within and between French administrative subdivisions called cantons, during the 2007/09 outbreak and until the end of 2010, when compulsory vaccination was interrupted. Within-canton transmission was vector-borne, and between canton transmission could occur through three contact networks that accounted for movements of: (i) vectors between pastures located at close distance; (ii) cattle and sheep between pastures of the same farm; (iii) traded cattle. We estimated the model parameters by approximate Bayesian computation, using data from the 2007 French outbreak. With this framework, we were able to reproduce the BTV-8 epizootic wave. Host movements between distant pastures of the same farm were found to have a major contribution to BTV spread to disease-free areas, thus raising practical questions about herd management during outbreaks. We found that cattle trade restrictions had been well complied with; without them, the whole French territory would have been infected by winter 2007. The 2008 emergency vaccination campaign had little impact on disease spread as almost half vaccine doses had likely been administered to already immune cattle. Alternatively, establishing a vaccination buffer zone would have allowed a better control of BTV in 2008: limiting its spatial expansion and decreasing the number of infected cattle and sheep. We also showed a major role of compulsory vaccination in controlling the outbreak in 2009 and 2010, though we predicted a possible low-level circulation after the last detection.

Quantifying bluetongue vertical transmission in French cattle from surveillance data.

Bluetongue is a vector-borne disease of ruminants with economic consequences for the livestock industry. Bluetongue virus serotype 8 (BTV-8) caused a massive outbreak in Europe in 2006/2009 and re-emerged in France in 2015. Given the unprecedented epidemiological features of this serotype in cattle, the importance of secondary routes of transmission was reconsidered and transplacental transmission of BTV-8 was demonstrated in naturally and experimentally infected cattle. Here we used surveillance data from the on-going outbreak to quantify BTV-8 vertical transmission in French cattle. We used RT-PCR pre-export tests collected from June to December 2016 on the French territory and developed a catalytic model to disentangle vertical and vector-borne transmission. A series of in silico experiments validated the ability of our framework to quantify vertical transmission provided sufficient prevalence levels. By applying our model to an area selected accordingly, we estimated a probability of vertical transmission of 56% (55.8%, 95% credible interval 41.7-70.6) in unvaccinated heifers infected late in gestation. The influence of this high probability of vertical transmission on BTV-8 spread and persistence should be further investigated.

Bluetongue transmission and control in Europe: A systematic review of compartmental mathematical models.

The growing frequency of bluetongue virus (BTV) incursions in Europe in recent years led to the largest BTV outbreak ever recorded in 2006/09, with a dramatic impact on the cattle and sheep industries. The complex epidemiology of this vector-borne disease of ruminants and its recent emergence need to be better understood to identify and implement efficient control strategies. Mathematical models provide useful tools for that purpose; many of them have been developed in the light of the 2006/09 outbreak. We aimed to provide a systematic review of compartmental mathematical models dedicated to BTV occurrence or transmission in European countries, to assess robustness of findings to different modelling approaches and assumptions. We identified relevant papers from PubMed and Scopus databases, 21 of which were included in the review following the selection process laid out in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. We systematically extracted data from these papers to address the diversity and evolution of modelling approaches, and to identify important characteristics for future model development. Then, we summarized the main insights provided into bluetongue epidemiology, and discussed the relevance of these models as tools for risk mapping and for the design of surveillance and control systems. On the whole, the mechanistic models reviewed provided flexible frameworks, yielding mostly epidemiological insights specific to geographical areas and study periods. Despite the limitations of these models that sometimes relied on strong assumptions, we advocate their use to facilitate and inform evidence-based decision-making in animal health.

Using serological studies to reconstruct the history of bluetongue epidemic in French cattle under successive vaccination campaigns.

Bluetongue virus is a vector-borne pathogen affecting ruminants that has caused major epidemics in France. Reconstructing the history of bluetongue in French cattle under control strategies such as vaccination has been hampered by the high level of sub-clinical infection, incomplete case data and poor understanding of vaccine uptake over time and space. To tackle these challenges, we used three age-structured serological surveys carried out in cattle (N = 22,342) from ten administrative subdivisions called departments. We fitted catalytic models within a Bayesian MCMC framework to reconstruct the force of seroconversion from infection or vaccination, and the population-level susceptibility per semester between 2007 and 2016. In the departments of the study area, we estimated that 36% of cattle had been infected prior to vaccine rollout that became compulsory from July 2008. The last outbreak case was notified in December 2009, at which time 83% of the animals were seropositive, under the cumulative effect of vaccination and infection. The probability of seroconversion per semester dropped below 10% after 2010 when vaccination became optional. Vaccine uptake was smaller during the 2012 campaign than during the one in 2011, with strong regional contrasts. Eighty four percent of cattle were susceptible when bluetongue re-emerged in 2015. Thus, serological surveys can be used to estimate vaccine uptake and the magnitude of infection, the relative effect of which can sometimes be inferred using prior knowledge on reported incidence and vaccination dates.

Increased adaptive immune responses and proper feedback regulation protect against clinical dengue.

Clinical symptoms of dengue virus (DENV) infection, the most prevalent arthropod-borne viral disease, range from classical mild dengue fever to severe, life-threatening dengue shock syndrome. However, most DENV infections cause few or no symptoms. Asymptomatic DENV-infected patients provide a unique opportunity to decipher the host immune responses leading to virus elimination without negative impact on an individual's health. We used an integrated approach of transcriptional profiling and immunological analysis to compare a Cambodian population of strictly asymptomatic viremic individuals with clinical dengue patients. Whereas inflammatory pathways and innate immune response pathways were similar between asymptomatic individuals and clinical dengue patients, expression of proteins related to antigen presentation and subsequent T cell and B cell activation pathways was differentially regulated, independent of viral load and previous DENV infection history. Feedback mechanisms controlled the immune response in asymptomatic viremic individuals, as demonstrated by increased activation of T cell apoptosis-related pathways and FcγRIIB (Fcγ receptor IIB) signaling associated with decreased anti-DENV-specific antibody concentrations. Together, our data illustrate that symptom-free DENV infection in children is associated with increased activation of the adaptive immune compartment and proper control mechanisms, leading to elimination of viral infection without excessive immune activation, with implications for novel vaccine development strategies.