Effectiveness of ChAdOx1 vaccine in older adults during SARS-CoV-2 Gamma variant circulation in São Paulo

AbstractA two-dose regimen of the Oxford-AstraZeneca (ChAdOx1) Covid-19 vaccine with an inter-dose interval of three months has been implemented in many countries with restricted vaccine supply. However, there is limited evidence for the effectiveness of ChAdOx1 by dose in elderly populations in countries with high prevalence of the Gamma variant of SARS-CoV-2. Here, we estimate ChAdOx1 effectiveness by dose against the primary endpoint of RT-PCR-confirmed Covid-19, and secondary endpoints of Covid-19 hospitalization and Covid-19-related death, in adults aged ≥60 years during an epidemic with high Gamma variant prevalence in São Paulo state, Brazil using a matched, test-negative case-control study. Starting 28 days after the first dose, effectiveness of a single dose of ChAdOx1 is 33.4% (95% CI, 26.4–39.7) against Covid-19, 55.1% (95% CI, 46.6–62.2) against hospitalization, and 61.8% (95% CI, 48.9–71.4) against death. Starting 14 days after the second dose, effectiveness of the two-dose schedule is 77.9% (95% CI, 69.2–84.2) against Covid-19, 87.6% (95% CI, 78.2–92.9) against hospitalization, and 93.6% (95% CI, 81.9–97.7) against death. Completion of the ChAdOx1 vaccine schedule affords significantly increased protection over a single dose against mild and severe Covid-19 outcomes in elderly individuals during widespread Gamma variant circulation.

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Effectiveness of the ChAdOx1 vaccine in the elderly during SARS-CoV-2 Gamma variant transmission in Brazil

10.1101/2021.07.19.21260802 ◽

2021 ◽

Author(s):

Matt Hitchings ◽

Otavio T Ranzani ◽

Murilo Dorion ◽

Tatiana Lang D'Agostini ◽

Regiane Cardoso de Paula ◽

...

Keyword(s):

Single Dose ◽

Conditional Logistic Regression ◽

Dose Interval ◽

Respiratory Illness ◽

Dose Schedule ◽

The Elderly ◽

Case Control ◽

Rt Pcr ◽

Vaccine Schedule ◽

Negative Case

Background A two-dose regimen of ChAdOx1 coronavirus disease 19 (Covid-19) vaccine with an inter-dose interval of three months has been implemented in many countries with restricted vaccine supply. However, there is limited evidence for the effectiveness of ChAdOx1 by dose in elderly populations in countries with high prevalence of the Gamma variant of severe acute respiratory syndrome 2 (SARS-CoV-2). Methods We conducted a test-negative case-control study to estimate the effectiveness of ChAdOx1 vaccine in adults aged 60 years or older during a Gamma-variant-associated epidemic in São Paulo state, Brazil, between 17 January and 2 July 2021. Cases and matched test-negative controls were individuals, identified from surveillance databases, who experienced an acute respiratory illness and underwent SARS-CoV-2 RT-PCR testing. We used conditional logistic regression to estimate the effectiveness by dose against RT-PCR-confirmed Covid-19, Covid-19 hospitalization, and Covid-19-related death. Results 61,164 individuals were selected into matched case-control pairs. Starting ≥28 days after the first dose, adjusted effectiveness of a single dose of ChAdOx1 was 33.4% (95% CI, 26.4 to 39.7) against Covid-19, 55.1% (95% CI, 46.6 to 62.2) against hospitalization, and 61.8% (95% CI, 48.9 to 71.4) against death. Starting ≥14 days after the second dose, the adjusted effectiveness of the two-dose schedule was 77.9% (95% CI, 69.2 to 84.2) against Covid-19, 87.6% (95% CI, 78.2 to 92.9) against hospitalization, and 93.6% (95% CI, 81.9 to 97.7) against death. Conclusions Completion of the ChAdOx1 vaccine schedule afforded significantly increased protection over a single dose against mild and severe Covid-19 outcomes in elderly individuals during widespread Gamma variant transmission.

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STANDARDIZED CLINICAL PATHWAYS FOR ESOPHAGECTOMY ARE NOT A REALITY IN BRAZIL, EVEN WITH A HIGH PREVALENCE OF ESOPHAGEAL CANCER AND ACHALASIA

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202015000300011 ◽

2015 ◽

Vol 28 (3) ◽

pp. 190-192 ◽

Cited By ~ 1

Author(s):

Marina ZAMUNER ◽

Fernando A. M. HERBELLA ◽

José L. B. AQUINO

Keyword(s):

Clinical Pathways ◽

Early Mobilization ◽

Sao Paulo ◽

Work Team ◽

Multidisciplinary Teams ◽

São Paulo ◽

Clinical Practices ◽

Paulo State ◽

High Prevalence ◽

São Paulo State

Background: The adoption of standardized protocols and specialized multidisciplinary teams for esophagectomy involve changes in routines with the implantation of expensive clinical practices and deviations from ingrained treatment philosophies. Aim: To evaluate the prevalence of standardized protocols and specialized multidisciplinary teams in São Paulo state, Brazil. Methods: Institutions that routinely perform esophagectomies in São Paulo were contacted and questioned about the work team involved in the procedure and the presence of standardized routines in the preoperatory care. Results: Fifteen centers answered the questionnaire: 10 (67%) public institutions and five (33%) private. There were seven (47%) medical schools, six (40%) with a residency program and two (13%) nonacademic institutions. The mean number of esophagectomies per year was 23. There was a multidisciplinary pre-operative team in nine (60%). There was a multidisciplinary postoperative team in 11 (73%). Early mobilization protocol was adopted in 12 (80%) institutions, early feeding in 13 (87%), routinely epidural in seven (47%), analgesia protocol in seven (47%), hydric restriction in six (40%), early extubation in six (40%), standardized hospitalization time in four (27%) and standardized intensive care time in two (13%). Conclusion: The prevalence of standardized protocols and specialized teams is very low in Sao Paulo state, Brazil. The presence of specialized surgeons is a reality and standardized protocols related directly to surgeons have higher frequency than those related to other professionals in the multidisciplinary team.

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High prevalence of clindamycin resistance in Staphylococcus aureus blood culture isolates in São Paulo, Brazil

Journal of Laboratory Physicians ◽

10.4103/jlp.jlp_161_16 ◽

2017 ◽

Vol 9 (04) ◽

pp. 314-316 ◽

Cited By ~ 1

Author(s):

Felipe S. Lupinacci ◽

Daniel Bussius ◽

Felipe Acquesta ◽

Gustavo Fam ◽

Raphael Rossi ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Blood Culture ◽

Susceptibility Testing ◽

Sao Paulo ◽

Resistance Rate ◽

Blood Cultures ◽

São Paulo ◽

Inducible Clindamycin Resistance ◽

Total Prevalence ◽

High Prevalence

Abstract BACKGROUND: Clindamycin has become an important antimicrobial option for the treatment of Staphylococcus aureus. However, little is known about the current patterns of clindamycin-susceptibility in S. aureus invasive isolates, both in our country and in other developing countries in the world. AIMS: The aim of this study was to determine the prevalence of constitutive and inducible clindamycin resistance in methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) blood culture isolates in São Paulo, Brazil. MATERIALS AND METHODS: From July 2011 to June 2012, all S. aureus isolates from blood cultures collected at our hospital were included in the study. Antimicrobial susceptibility testing was performed according to recommendations of the Clinical and Laboratory Standards Institute. RESULTS: Total prevalence of clindamycin resistance was 68%, including 7.2% with inducible resistance. In MRSA resistance rate was 90.8% whereas in MSSA the rate was 32.7%. CONCLUSIONS: Our high prevalence of clindamycin resistance highlights the importance of performing D-test in a routine base, as well of maintaining continued surveillance for the prevalence of clindamycin resistance.

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Prevalence of self-reported chronic diseases in individuals over the age of 40 in São Paulo, Brazil: the Platino study

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2012000500009 ◽

2012 ◽

Vol 28 (5) ◽

pp. 905-912 ◽

Cited By ~ 5

Author(s):

Andréa K. Carvalho ◽

Ana Maria B. Menezes ◽

Aquiles Camelier ◽

Fernanda Warken Rosa ◽

Oliver A. Nascimento ◽

...

Keyword(s):

Chronic Diseases ◽

Sao Paulo ◽

São Paulo ◽

High Prevalence ◽

Over 40 Years

Few studies have been conducted to determine the prevalence of chronic diseases and its impact in individuals aged 40 years or over in Brazil. The objective of this study is to evaluate the prevalence of some common chronic diseases in the Brazilian subgroup assessed by the PLATINO study using a self-reported survey. A total of 918 individuals (55% women) with a mean age of 54.6 ± 10.9 years were evaluated. The most prevalent diseases were obesity (62.5%), hypertension (39.2%) and gastritis (30.9%). We conclude from this study that there is a high prevalence of chronic diseases in the population over 40 years of age: 88% of the population suffers from a minimum of one disease and 26% of the sample suffers from at least three diseases. We also observed that the number of comorbidities increases with age.

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High prevalence of dementia among older adults from poor socioeconomic backgrounds in São Paulo, Brazil

International Psychogeriatrics ◽

10.1017/s1041610207005625 ◽

2007 ◽

Vol 20 (02) ◽

Cited By ~ 80

Author(s):

Marcia Scazufca ◽

Paulo R. Menezes ◽

Homero P. Vallada ◽

André L. Crepaldi ◽

Maria Pastor-Valero ◽

...

Keyword(s):

Older Adults ◽

Sao Paulo ◽

São Paulo ◽

High Prevalence ◽

Prevalence Of Dementia

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Prevalence of Syphilis and associated factors in homeless people of Sao Paulo, Brazil, using a Rapid Test

Revista Brasileira de Epidemiologia ◽

10.1590/1809-4503201400020005eng ◽

2014 ◽

Vol 17 (2) ◽

pp. 341-354 ◽

Cited By ~ 7

Author(s):

Valdir Monteiro Pinto ◽

Mariza Vono Tancredi ◽

Herculano Duarte Ramos De Alencar ◽

Elisabeth Camolesi ◽

Márcia Moreira Holcman ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Homeless People ◽

Rapid Test ◽

Sao Paulo ◽

Screening Tests ◽

Prior History ◽

São Paulo ◽

Syphilis Infection ◽

Convenience Sample ◽

High Prevalence

Introduction: Homeless people are a vulnerable group to sexually transmitted diseases (STD) with high prevalence of syphilis and hepatitis. Objectives: To estimate the prevalence of syphilis infection and its association with risky behaviors for STDs in a sample of homeless people, and to assess the feasibility of the use of rapid syphilis test (RST) in this population. Methods: Cross-sectional study, in a convenience sample of homeless people assisted in social support services of São Paulo, between 2006 and 2007. A structured questionnaire was applied and RST was performed. In addition, a blood sample for syphilis detection was also collected. The sensitivity and specificity of the RST was estimated using conventional laboratory diagnosis (VDRL + TPHA) as reference. Results: 1,405 volunteers were included in the study. The prevalence rate of syphilis was 7.0%, and was associated with homosexual practices (ORadj 4.9; 95%CI 2.6 - 9.4), prior history of STD (ORadj 2.6; 95%CI 1.7 - 4.0) and with self-referred non-white race (ORadj 1.9; 95%CI 1.1 - 3.4). The sensitivity and specificity of the RST for syphilis were, respectively, 81.4 and 92.1%. Conclusion: The high prevalence of syphilis infection among homeless people shows the need for actions for its control and the utilization of RST that can be considered an efficient strategy due to its sensitivity and specificity. Public Health policymakers must strengthen actions for syphilis control, with screening tests for syphilis and early treatment, decreasing morbidity with the improvement of sexual and reproductive health of the population in general and especially the most vulnerable.

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Caracterização do perfil de pacientes hipertensos atendidos pela enfermagem no ambulatório de um hospital público

Revista Recien - Revista Científica de Enfermagem ◽

10.24276/rrecien2177-157x.2012.2.5.26-30 ◽

2012 ◽

Vol 2 (5) ◽

pp. 26

Author(s):

Maria Áurea Cordeiro ◽

Lucia Helena Presoto

Keyword(s):

Public Health ◽

Blood Pressure ◽

Pressure Measurement ◽

Blood Pressure Measurement ◽

Sao Paulo ◽

Measurement Information ◽

São Paulo ◽

Treatment Frequency ◽

Hypertensive Patients ◽

High Prevalence

A Hipertensão Arterial Sistêmica é uma doença com alta prevalência na população geral e que constitui um dos principais problemas de saúde pública. Este trabalho objetivou traçar o perfil dos pacientes hipertensos atendidos no ambulatório público, localizado na Cidade de São Paulo, no período de 20 de agosto a 25 de setembro de 2009, por meio da análise de 60 usuários escolhidos aleatoriamente, segundo as variáveis: gênero; faixa etária; etnia; estado civil; sobre a patologia; frequência de consulta; tipo de tratamento; periodicidade do tratamento; frequência de aferição da pressão arterial; informações recebidas. Os resultados obtidos demonstraram a predominância do sexo feminino, faixa etária entre sessenta e seis a setenta e quatro anos, estado civil predominou os casados, com a etnia negra, frequência da aferição da pressão arterial de uma a duas vezes por semana.Descritores: Hipertensão Arterial, Pacientes, Saúde Pública. Characterization of the profile of hypertensive patients seen by nurses at the ambulatory of a public hospitalAbstract: The Hypertension is a disease with high prevalence in the general population and is a major public health problems. This study aimed to determine the profile of hypertensive patients seen in outpatient public, located in São Paulo, from august 20 to september 25, 2009, through the analysis of 60 randomly selected users, according to the variables: gender; age, ethnicity, marital status, on the condition, frequency of consultation, type of treatment, frequency of treatment, frequency of blood pressure measurement, information received. The results showed a predominance of females, aged sixty-six to seventy-four years, the married state civil predominated, with black ethnicity, frequency of blood pressure measurement from one to two times a week.Descriptors: Hypertension, Patients, Public Health. Caracterización del perfil de los pacientes atendidos por la enfermería en la clínica de uno hospital públicoResumen: La hipertensión arterial es una enfermedad con una alta prevalencia en la población general y es uno problema de salud pública importantes. Este estudio tuvo como objetivo determinar el perfil de los pacientes hipertensos atendidos en consulta externa pública, que se encuentra en São Paulo, a partir de agosto 20 a septiembre 25, 2009, a través del análisis de 60 usuarios seleccionados al azar, de acuerdo a las variables: género; edad, origen étnico, estado civil, sobre la condición, frecuencia de consulta, el tipo de tratamiento, la frecuencia del tratamiento, la frecuencia de la tensión arterial medida, la información recibida. Los resultados mostraron uno predominio del sexo femenino, con edades entre sesenta y seis-setenta y cuatro años, el estado civil casado predominó, con el origen étnico negro, la frecuencia de la medición de la presión de una o dos veces a la semana.Descriptores: Hipertensión, Pacientes, Salud Pública.

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Single-Dose Universal Hepatitis A Immunization in 1-Year-Old Infants in Argentina: High Prevalence of Protective Antibodies up to 11 Years Following Vaccination

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.753 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S320-S320 ◽

Cited By ~ 1

Author(s):

Analia Urueña ◽

Jorge González ◽

Maria Eugenia Perez Carrega ◽

Analía Rearte ◽

Andrea Uboldi ◽

...

Keyword(s):

Single Dose ◽

Urban Areas ◽

Hepatitis A ◽

Hepatitis A Virus ◽

Geometric Mean ◽

Dose Schedule ◽

Global Rate ◽

High Prevalence ◽

Protective Antibodies ◽

Socio Economic Variables

Abstract Background Single-dose Hepatitis A Virus (HAV) vaccination was implemented for all Argentinean children aged 12 months in 2005, instead of the standard two-dose schedule. Previous studies demonstrated a dramatic decline in HAV infection rates, fulminant hepatitis, and liver transplantation along with low viral circulation and high prevalence of protective antibody response 8 years following the intervention. This study assessed long-term seroprotection against HAV after vaccination with this novel scheme. Methods Children who received one dose of HAV vaccine at 1 year of age, at least nine years before enrollment, were included at three centers in Argentina between May 2015 and April 2016. Demographic and socio-economic characteristics of the child, mother and house were collected through a questionnaire after informed consent signature. Blood samples were tested for anti-HAV antibodies. Antibody titers ≥10 mIU/mL were considered seroprotective. Logistic regression analysis was done to evaluate associations between different variables and seroprotection. Results Of 1119 children included, 97.0% lived in urban areas, 92.7% had safe water access and 57.8% had sewers at home. Mean age was 10.7 years, and the mean post-vaccination interval was 9.7 years (Range: 9.0–11.3 years). Of the total, 87.6% had protective antibodies against HAV. Higher seroprotection rates were observed in Santa Fe compared with the global rate (91.9% vs. 87.6%; OR 1.94 (95% CI: 1.27–2.95); P = 0.002). In contrast, lowest rates resulted in San Justo, Buenos Aires (81.4% vs. 87.6% OR 0.45 (95% CI: 0.32–0.65); P <0.001). No association between socio-economic variables and seroprotection was found. Geometric mean concentration (GMC) of HAV Ab titers was 28.0 mIU/mL (95% CI: 26.8–29.3 mIU/mL). Conclusion Single-dose universal hepatitis A immunization in infants resulted in sustained immunologic protection up to 11 years in Argentina. Lower seroprevalence rates in San Justo have no clear reason and were not associated with an increase in HAV cases in that area. These findings, along with the low current disease burden confirm the success of the intervention. Disclosures All authors: No reported disclosures.

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