scholarly journals Does a lack of vaccine side effects correlate with reduced BNT162b2 mRNA vaccine response among healthcare workers and nursing home residents?

2021 ◽  
Author(s):  
Oladayo A. Oyebanji ◽  
Brigid Wilson ◽  
Debbie Keresztesy ◽  
Lenore Carias ◽  
Dennis Wilk ◽  
...  
Keyword(s):  
Nursing Home ◽  
Side Effects ◽  
Healthcare Workers ◽  
Nursing Home Residents ◽  
Community Dwelling ◽  
Vaccine Response ◽  
Term Care ◽  
Post Vaccination ◽  
Dichotomous Variable ◽  
Antibody Levels

Abstract Background The BNT162b2 SARS-CoV-2 mRNA vaccination has mitigated the burden of COVID-19 among residents of long-term care facilities considerably, despite being excluded from the vaccine trials. Data on reactogenicity (vaccine side effects) in this population are limited. Aims To assess reactogenicity among nursing home (NH) residents. To provide a plausible proxy for predicting vaccine response among this population. Methods We enrolled and sampled NH residents and community-dwelling healthcare workers who received the BNT162b2 mRNA vaccine, to assess local or systemic reactogenicity and antibody levels (immunogenicity). Results NH residents reported reactions at a much lower frequency and lesser severity than the community-dwelling healthcare workers. These reactions were mild and transient with all subjects experiencing more local than systemic reactions. Based on our reactogenicity and immunogenicity data, we developed a linear regression model predicting log-transformed anti-spike, anti-receptor-binding domain (RBD), and neutralizing titers, with a dichotomous variable indicating the presence or absence of reported reactions which revealed a statistically significant effect, with estimated shifts in log-transformed titers ranging from 0.32 to 0.37 (all p < 0.01) indicating greater immunogenicity in subjects with one or more reported reactions of varying severity. Discussion With a significantly lower incidence of post-vaccination reactions among NH residents as reported in this study, the BNT162b2 mRNA vaccine appears to be well-tolerated among this vulnerable population. If validated in larger populations, absence of reactogenicity could help guide clinicians in prioritizing vaccine boosters. Conclusions Reactogenicity is significantly mild among nursing home residents and overall, subjects who reported post-vaccination reactions developed higher antibody titers.

scholarly journals Significant reduction in humoral immunity among healthcare workers and nursing home residents 6 months after COVID-19 BNT162b2 mRNA vaccination

2021 ◽  
Author(s):  
David H. Canaday ◽  
Oladayo A. Oyebanji ◽  
Debbie Keresztesy ◽  
Michael Payne ◽  
Dennis Wilk ◽  
...  
Keyword(s):  
Nursing Home ◽  
Humoral Immunity ◽  
Healthcare Workers ◽  
Limit Of Detection ◽  
Nursing Home Residents ◽  
Good Health ◽  
Neutralization Assay ◽  
Vaccine Response ◽  
Post Vaccination ◽  
Antibody Levels

AbstractHigh COVID-19 mortality among nursing home (NH) residents led to their prioritization for SARS-CoV-2 vaccination; most NH residents received BNT162b2 mRNA vaccination under the Emergency Use Authorization due to first to market and its availability. With NH residents’ poor initial vaccine response, the rise of NH breakthrough infections and outbreaks, characterization of the durability of immunity to inform public health policy on the need for boosting is needed. We report on humoral immunity from 2 weeks to 6-months post-vaccination in 120 NH residents and 92 ambulatory healthcare worker controls with and without pre-vaccination SARS-CoV-2 infection. Anti-spike and anti-receptor binding domain (RBD) IgG, and serum neutralization titers, were assessed using a bead-based ELISA method and pseudovirus neutralization assay. Anti-spike, anti-RBD and neutralization levels dropped more than 84% over 6 months’ time in all groups irrespective of prior SARS-CoV-2 infection. At 6 months post-vaccine, 70% of the infection-naive NH residents had neutralization titers at or below the lower limit of detection compared to 16% at 2 weeks after full vaccination. These data demonstrate a significant reduction in levels of antibody in all groups. In particular, those infection-naive NH residents had lower initial post-vaccination humoral immunity immediately and exhibited the greatest declines 6 months later. Healthcare workers, given their younger age and relative good-health, achieved higher initial antibody levels and better maintained them, yet also experienced significant declines in humoral immunity. Based on the rapid spread of the delta variant and reports of vaccine breakthrough in NH and among younger community populations, boosting NH residents may be warranted.

scholarly journals Reduced BNT162b2 mRNA vaccine response in SARS-CoV-2-naive nursing home residents

2021 ◽  
Author(s):  
David H. Canaday ◽  
Lenore Carias ◽  
Oladayo A. Oyebanji ◽  
Debbie Keresztesy ◽  
Dennis Wilk ◽  
...  
Keyword(s):  
Nursing Home ◽  
Healthcare Workers ◽  
Nursing Home Residents ◽  
Antibody Responses ◽  
Control Measures ◽  
Vaccine Response ◽  
Infection Control Measures ◽  
Data Gap ◽  
Antibody Levels ◽  
Care Worker

AbstractThe SARS-CoV-2 pandemic impact on nursing home (NH) residents prompted their prioritization for early vaccination. To fill the data gap for vaccine immunogenicity in NH residents, we examined antibody levels after BNT162b2 mRNA vaccine to spike, receptor binding domain (RBD) and for virus neutralization in 149 NH residents and 111 health care worker controls. SARS-CoV-2-naive NH residents mount antibody responses with nearly 4-fold lower median neutralization titers and half the anti-spike level compared to SARS-CoV-2-naive healthcare workers. By contrast, SARS-CoV-2-recovered vaccinated NH residents had neutralization, anti-spike and anti-RBD titers similar to SARS-CoV-2-recovered vaccinated healthcare workers. NH residents’ blunted antibody responses have important implications regarding the quality and durability of protection afforded by neoantigen vaccines. We urgently need better longitudinal evidence on vaccine effectiveness specific to NH resident populations to inform best practices for NH infection control measures, outbreak prevention and potential indication for a vaccine boost.

scholarly journals Needs-based provision of medical care to nursing home residents: protocol for a mixed-methods study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e025614 ◽  
Author(s):  
Jonas Czwikla ◽  
Maike Schulz ◽  
Franziska Heinze ◽  
Thomas Kalwitzki ◽  
Daniel Gand ◽  
...  
Keyword(s):  
Nursing Home ◽  
Mixed Methods ◽  
Nursing Homes ◽  
Medical Care ◽  
Delphi Study ◽  
Nursing Home Residents ◽  
Community Dwelling ◽  
Mixed Methods Study ◽  
Care Needs ◽  
Term Care

IntroductionNursing home residents typically have greater needs for medical care than community-dwelling elderly. However, restricted cognitive abilities and limited mobility may impede their access to general practitioners and medical specialists. The provision of medical care in nursing homes may therefore be inappropriate in some areas of medical care. The purpose of this mixed-methods study is to systematically assess, evaluate and explain met and unmet medical care needs in German nursing homes and to develop solutions where medical care is found to be inappropriate.Methods and analysisFirst, statutory health insurance claims data are analysed to identify differences in the utilisation of medical care between nursing home residents and community-dwelling elderly with and without need for long-term care. Second, the health status and medical care of 500 nursing home residents are assessed and evaluated to quantify met and unmet medical care needs. Third, qualitative expert interviews and case conferences and, fourth, quantitative analyses of linked data are used to provide structural, case-specific and generalisable explanations of inappropriate medical care among nursing home residents. Fifth, a modified Delphi study is employed to develop pilot projects aiming to improve medical care in nursing homes.Ethics and disseminationThis study was approved by the Ethics Committee of the University of Bremen on 23 November 2017. Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals.Trial registration numberDRKS00012383.

scholarly journals Comparative analysis of post-vaccination anti-spike IgG antibodies in old Nursing Home Residents and in middle-aged Healthcare workers

2021 ◽  
Author(s):  
Helene Jeulin ◽  
Denis Craus ◽  
Carlos Labat ◽  
Athanase Benetos
Keyword(s):  
Nursing Home ◽  
Health Care Workers ◽  
Healthcare Workers ◽  
Nursing Home Residents ◽  
Igg Antibodies ◽  
Middle Aged ◽  
Post Vaccination ◽  
Care Workers ◽  
History Of ◽  
Few Data

The current consensus is that 2 doses of mRNA vaccines against SARS-CoV-2 are needed for people without COVID-19 history, while for those who had suffered COVID-19, a single dose may be enough to achieve high levels of immunization. This consensus has been based on results obtained in middle-aged populations, whereas only few data exist for the oldest and most frail adults such as nursing home residents (NH-Res) that is, the population most vulnerable to develop severe forms of COVID-19. In this study, we studied the anti-SARS-CoV-2 IgG(S) level of NH-Res and healthcare workers (HCWs) with or without a history of COVID-19 infection taking into account the time since immunization (COVID-19 and/or vaccination). 654 subjects were analyzed: 397 NH-Res (median age 88, IQR 82-93 years, 75% women) and 257 Health Care Workers (HCWs, median 46, IQR 38-54 years, 81% women). NH-Res and HCWs were classified in one of the following 3 groups: No-COVID history and 2 vaccine shots (COV-NO/2VACC); Yes-COVID history and 1 (COV-YES/1VACC) or 2 (COV-YES/2VACC) vaccine injections. The time-related decrease in IgG (S) in subjects without COVID-19 history, SARS-COV-2 serology would be negative in HCWs approximately 220 days and in residents 180 days after vaccination. This time-related decrease was much slower in those with history of COVID. NH-Res belonging into the COV-NO/2VACC and the COV-YES/1VACC groups showed lower IgG (S) levels than the same groups of HCWs (for both groups, p<0.0001), whereas in the group COV-YES/2VACC, IgG (S) levels were similar in NH-Res and HCWs (p=0.88). These results remained unchanged after adjustment for age and duration since immunization. Thus, in NH-Res, 2 vaccine shots were associated with a more pronounced immune response, whereas in HCWs, 1 or 2 vaccine shots in patients with COVID-19 history did make any difference. These results indicate significant differences in mRNA vaccination between NH-Res and middle-aged controls, and could contribute to the specification of vaccine policy in this very old, frail population.

scholarly journals Between Social Inclusion and Exclusion: Integration of Daycare Guests in the Nursing Home Setting

2020 ◽  
Author(s):  
Kerstin Hämel ◽  
Gundula Röhnsch
Keyword(s):  
Nursing Home ◽  
Social Inclusion ◽  
Nursing Home Residents ◽  
Community Dwelling ◽  
Cognitive Capacity ◽  
Home Setting ◽  
Residential Care Facilities ◽  
Care Approach ◽  
Nursing Home Setting ◽  
Close Relatives

Abstract Background and Objectives In integrated daycare, community-dwelling older people in need of care join existing groups in residential care facilities during the day. This study focuses on how nursing home residents experience the integrative care approach, exploring opportunities for social inclusion and mechanisms of exclusion. Research Design and Methods A purposive sample of residents differing in cognitive capacity and level of (non)conflictual interaction with daycare guests was selected. Episodic interviews with residents (N = 10) and close relatives (N = 2) were conducted in 3 pilot facilities in Germany and analyzed using thematic coding. Results The analysis revealed different orientation patterns towards the presence of daycare guests: respondents (a) demonstrated indifference to the daycare guests, (b) saw bonding with guests as a means to connect to the outside world, and (c) perceived incompatibility between in-group and out-group. Criticisms included disruption of daily routines and loss of privacy. Most interviewees came to terms with the care situation using rational and moral arguments. Discussion and Implications The study reveals the importance of residents’ participation when integrating daycare guests. Institutional procedures are required to prevent exclusion of daycare guests and avoid overtaxing residents.

scholarly journals Advance care planning preferences in Chinese nursing home residents: results from two cross-sectional studies in Hong Kong and Taiwan

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Xinyi Xu ◽  
Shu-Wen Tu ◽  
Chia-Chin Lin
Keyword(s):  
Hong Kong ◽  
Nursing Home ◽  
End Of Life ◽  
Advance Directive ◽  
End Of Life Care ◽  
Nursing Home Residents ◽  
Completion Rate ◽  
Life Care ◽  
Term Care

Abstract Background The proportion of hospital deaths has declined in the past few decades, while the proportions of nursing home deaths have increased. This trend of increasing deaths in long-term care facilities underlines the importance of improving end-of-life care provisions in these settings to meet individual preferences and needs. Under these circumstances, a comprehensive understanding of end-of-life care preferences in local nursing home residents can help healthcare professionals and policymakers develop strategies to increase the advance directive completion rate and quality of care. This study aimed to explore and compare advance directive and end-of-life care preferences of nursing home residents in Hong Kong and Taiwan. Methods A structured questionnaire was developed by the research team to investigate advance directive and end-of-life care preferences in older Chinese nursing home residents. Nursing home residents with frail or pre-frail status and over the age of 64 were invited to participate in the study, and information on demographics, functional status, advance directive experiences, and end-of-life care expectations was collected through questionnaire interviews. Results A total of 325 eligible participants from 32 facilities completed the survey, including 238 older residents in Hong Kong and 87 in Taiwan. A significantly lower proportion of the Hong Kong residents had completed an advance directive compared with the Taiwanese (3 vs. 13%, p = 0.001). Among participants who did not have an advance directive, 46% of the Taiwanese participants said they would consider completing one in the future, compared with 20% of the Hong Kong participants (p < 0.001). A total of 79% of the Hong Kong participants and 80% of the Taiwanese participants responded that prolonging life in the given hypothetical dying scenario was “not important” (p = 0.76). Only 14% of participants in Hong Kong and 18% of participants in Taiwan reported prior occurrence of end-of-life care discussions with family members or health professionals (p = 0.37). Conclusions This paper adds evidence in support of improving end-of-life communication and the advance directive completion rate in nursing homes in Hong Kong and Taiwan. Further research is necessary to explore cross-cultural differences in end-of-life preferences and its applications in predicting decision-making and the quality of end-of-life care.

scholarly journals Prevalence of mobility disabilities in nursing home residents and the association with age, BMI, fall risk and social participation

2017 ◽  
Vol 7 (12) ◽  
pp. 105
Author(s):  
Patrick Fehling ◽  
Theo Dassen
Keyword(s):  
Nursing Home ◽  
Social Participation ◽  
Fall Risk ◽  
Nursing Home Residents ◽  
Prevalence Study ◽  
Mobility Disability ◽  
Nursing Assessment ◽  
Term Care ◽  
Medical Diagnoses ◽  
Care Facilities

Background and aim: Physical mobility is often described as a basic prerequisite for independence, self-determination, and social participation. Older people, particularly those in long-term care facilities, are more often affected by the loss of their mobility. However, the prevalence of the mobility disabilities of nursing home residents and their association with demographic and care-specific/medical factors have so far been studied less. This prevalence study should investigate a possible association of mobility disability with age, BMI, multimorbidity, fall risk, and social participation.Methods: The prevalence study covered the data of residents in 30 German residential care facilities (RCFs). Trained staff nurses used a standardised instrument to collect data about the age, obesity, medical diagnoses, the fall risk, the level of mobility disability, and the need for supporting the social participation of the residents.Results: The representative sample included 2,066 nursing home residents, of whom 81.5% required support in their mobility. The level of a mobility disability or the need for a support in matters of mobility by others was not associated either with age, with the BMI, or with the fall risk of the participants. The groups with higher mobility disability included the more multimorbid participants with more difficult medical diagnoses, and these had a higher need for support in their social participation.Conclusions: It may be that professional care must reflect the premature link between older and obese patients with mobility disability. In addition to nursing diagnoses, medical diagnoses should necessarily be integrated into the nursing assessment. The association between the level of mobility disability and the fall risk, which is often mentioned in the literature, should be critically reflected. Nursing home residents should be informed that there is a possible association between their mobility disability and their social participation. 

scholarly journals Side Effects of mRNA-Based COVID-19 Vaccine: Nationwide Phase IV Study among Healthcare Workers in Slovakia

2021 ◽  
Vol 14 (9) ◽  
pp. 873
Author(s):  
Abanoub Riad ◽  
Barbora Hocková ◽  
Lucia Kantorová ◽  
Rastislav Slávik ◽  
Lucia Spurná ◽  
...  
Keyword(s):  
Side Effects ◽  
Side Effect ◽  
Healthcare Workers ◽  
Large Scale ◽  
Large Population ◽  
Medical Attention ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Post Vaccination ◽  
Phase Iv

mRNA-based COVID-19 vaccines such as BNT162b2 have recently been a target of anti-vaccination campaigns due to their novelty in the healthcare industry; nevertheless, these vaccines have exhibited excellent results in terms of efficacy and safety. As a consequence, they acquired the first approvals from drug regulators and were deployed at a large scale among priority groups, including healthcare workers. This phase IV study was designed as a nationwide cross-sectional survey to evaluate the post-vaccination side effects among healthcare workers in Slovakia. The study used a validated self-administered questionnaire that inquired about participants’ demographic information, medical anamneses, COVID-19-related anamnesis, and local, systemic, oral, and skin-related side effects following receiving the BNT162b2 vaccine. A total of 522 participants were included in this study, of whom 77% were females, 55.7% were aged between 31 and 54 years, and 41.6% were from Banska Bystrica. Most of the participants (91.6%) reported at least one side effect. Injection site pain (85.2%) was the most common local side effect, while fatigue (54.2%), headache (34.3%), muscle pain (28.4%), and chills (26.4%) were the most common systemic side effects. The reported side effects were of a mild nature (99.6%) that did not require medical attention and a short duration, as most of them (90.4%) were resolved within three days. Females and young adults were more likely to report post-vaccination side effects; such a finding is also consistent with what was previously reported by other phase IV studies worldwide. The role of chronic illnesses and medical treatments in post-vaccination side effect incidence and intensity requires further robust investigation among large population groups.

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