Evaluating the effects of vaccine rollout policies in European countries: A simulation study

The results of a simulation-based evaluation of several policies for vaccine rollout are reported. In the presence of limited vaccine supply, this policy choice is a pressing issue for several countries worldwide, and the adopted course of action will affect the extension or easing of non-pharmaceutical interventions in the next months. We employ a suitably generalised, age-structure, stochastic SEIR (Susceptible -> Exposed -> Infectious -> Removed) epidemic model that can accommodate quantitative descriptions of the major effects resulting from distinct vaccination strategies. The different rates of social contacts among distinct age-groups are informed by a recent survey conducted in Greece. The results are summarised and evaluated in terms of the total number of deaths and infections as well as life years lost. The optimal strategy is found to be one based on fully vaccinating the elderly/at risk as quickly as possible, while extending the time-interval between the two vaccine doses to 12 weeks for all individuals below 75 years old, in agreement with epidemic theory which suggests targeting a combination of susceptibility and infectivity. This policy, which is similar to the approaches adopted in the UK and in Canada, is found to be effective in reducing deaths and life years lost in the period while vaccination is still being carried out.

Download Full-text

Assessing Age-Specific Vaccination Strategies and Post-Vaccination Reopening Policies for COVID-19 Control Using SEIR Modeling Approach

10.1101/2021.02.18.21251981 ◽

2021 ◽

Author(s):

Xia Wang ◽

Hulin Wu ◽

Sanyi Tang

Keyword(s):

Age Structure ◽

Age Groups ◽

Social Contact ◽

The Elderly ◽

Vaccination Rate ◽

Social Contacts ◽

Post Vaccination ◽

Vaccination Strategies ◽

Contact Patterns ◽

Effect Of Age

AbstractBackgroundAs the availability of COVID-19 vaccines, it is badly needed to develop vaccination guidelines to prioritize the vaccination delivery in order to effectively stop COVID-19 epidemic and minimize the loss.MethodsWe evaluated the effect of age-specific vaccination strategies on the number of infections and deaths using an SEIR model, considering the age structure and social contact patterns for different age groups for each of different countries.ResultsIn general, the vaccination priority should be given to those younger people who are active in social contacts to minimize the number of infections; while the vaccination priority should be given to the elderly to minimize the number of deaths. But this principle may not always apply when the interaction of age structure and age-specific social contact patterns is complicated. Partially reopening schools, workplaces or households, the vaccination priority may need to be adjusted accordingly.ConclusionsPrematurely reopening social contacts could initiate a new outbreak or even a new pandemic out of control if the vaccination rate and the detection rate are not high enough. Our result suggests that it requires at least nine months of vaccination before fully reopening social contacts in order to avoid a new pandemic.

Download Full-text

Excess mortality from COVID and non-COVID causes in minority populations

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.2101386118 ◽

2021 ◽

Vol 118 (39) ◽

pp. e2101386118 ◽

Cited By ~ 1

Author(s):

Christopher J. Cronin ◽

William N. Evans

Keyword(s):

Excess Mortality ◽

Time Interval ◽

Hispanic Males ◽

Excess Death ◽

Life Years ◽

Life Years Lost ◽

Race Ethnicity ◽

And Gender ◽

Death Count ◽

Excess Deaths

The 2020 US mortality totaled 2.8 million after early March, which is 17.3% higher than age-population–weighted mortality over the same time interval in 2017 to 2019, for a total excess death count of 413,592. We use data on weekly death counts by cause, as well as life tables, to quantify excess mortality and life years lost from both COVID-19 and non–COVID-19 causes by race/ethnicity, age, and gender/sex. Excess mortality from non–COVID-19 causes is substantial and much more heavily concentrated among males and minorities, especially Black, non-Hispanic males, than COVID-19 deaths. Thirty-four percent of the excess life years lost for males is from non–COVID-19 causes. While minorities represent 36% of COVID-19 deaths, they represent 70% of non–COVID-19 related excess deaths and 58% of non–COVID-19 excess life years lost. Black, non-Hispanic males represent only 6.9% of the population, but they are responsible for 8.9% of COVID-19 deaths and 28% of 2020 excess deaths from non–COVID-19 causes. For this group, nearly half of the excess life years lost in 2020 are due to non–COVID-19 causes.

Download Full-text

Performance and QOL after Geriatric Cochlear Implantation

Otolaryngology ◽

10.1016/j.otohns.2008.05.186 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P57-P58

Author(s):

Alexandros Georgolios ◽

Kelley Melissa Dodson ◽

Cristina Baldassari ◽

Patrick G Maiberger ◽

Aristides Sismanis

Keyword(s):

Quality Of Life ◽

Hearing Loss ◽

Patient Satisfaction ◽

Cochlear Implantation ◽

Age Groups ◽

The Elderly ◽

Time Interval ◽

Comorbid Conditions ◽

Glasgow Benefit Inventory

Objective To assess audiologic performance and quality of life in geriatric cochlear implantation patients and to determine whether comorbid medical conditions, etiology, and duration of hearing loss impact audiologic and quality of life outcomes. Methods Geriatric patients who underwent cochlear implantation between 1990 and 2006 were evaluated. Inclusion criteria were 55 years of age or older at time of implantation and post-lingual hearing loss. Patients with primary language other than English were excluded. 49 cochlear implant recipients were identified. A group of younger implanted patients was used as a control. All patients completed standardized audiologic tests including the Hearing In Noise Test. Validated surveys, including the Glasgow Benefit Inventory and the Hearing Handicap Inventory for the Elderly, were used to assess quality of life. Results The mean age at implantation was 69.5 (range 58–85) and the average time interval from the implantation to the completion of the surveys was 73.2 months (6 to 229). Identified comorbid conditions included hypertension, diabetes, and malignancies, among others. Audiologic performance and quality of life scores between the two groups were similar. In the geriatric group there was no difference in patient satisfaction between subgroups with 0–1, 2–3 or > 3 comorbid conditions. Conclusions Our results suggest that the audiologic performance and quality of life scores between the older and younger age groups are similar. In the geriatric group associated comorbidities did not interfere with patient satisfaction as assessed by survey instruments.

Download Full-text

Productivity-adjusted life years lost due to type 2 diabetes in Germany in 2020 and 2040

Diabetologia ◽

10.1007/s00125-021-05409-3 ◽

2021 ◽

Author(s):

Thaddäus Tönnies ◽

Annika Hoyer ◽

Ralph Brinks

Keyword(s):

Type 2 Diabetes ◽

Age Groups ◽

Population Level ◽

Future Trends ◽

Productivity Losses ◽

Life Years ◽

Working Age ◽

Life Years Lost ◽

Age And Sex

Abstract Aims/hypothesis Type 2 diabetes can lead to reduced productivity during working age. We aimed to estimate productive life years lost associated with type 2 diabetes on the individual and population level in Germany in 2020 and 2040, while accounting for future trends in mortality. Methods Based on a mathematical projection model, we estimated age- and sex-specific productivity losses associated with type 2 diabetes during working age (20–69 years) in Germany in 2020 and 2040. Productivity losses in terms of excess mortality (years of life lost, YLL) and reductions in labour force participation, presenteeism and absenteeism (years of productivity lost, YPL) were summed to calculate productivity-adjusted life years (PALY) lost. Input data for the projection were based on meta-analyses, representative population-based studies and population projections to account for future trends in mortality. Results Compared with a person without type 2 diabetes, mean PALY lost per person with type 2 diabetes in 2020 was 2.6 years (95% CI 2.3, 3.0). Of these 2.6 years, 0.4 (95% CI 0.3, 0.4) years were lost due to YLL and 2.3 (95% CI 1.9, 2.6) years were lost due to YPL. Age- and sex-specific results show that younger age groups and women are expected to lose more productive life years than older age groups and men. Population-wide estimates suggest that 4.60 (95% CI 4.58, 4.63) million people with prevalent type 2 diabetes in 2020 are expected to lose 12.06 (95% CI 10.42, 13.76) million PALY (1.62 million years due to YLL and 10.44 million years due to YPL). In 2040, individual-level PALY lost are projected to slightly decrease due to reductions in YLL. In contrast, population-wide PALY lost are projected to increase to 15.39 (95% CI 13.19, 17.64) million due to an increase in the number of people with type 2 diabetes to 5.45 (95% CI 5.41, 5.50) million. Conclusions/interpretation On the population level, a substantial increase in productivity burden associated with type 2 diabetes was projected for Germany between 2020 and 2040. Efforts to reduce the incidence rate of type 2 diabetes and diabetes-related complications may attenuate this increase. Graphical abstract

Download Full-text

Optimizing the impact of low-efficacy influenza vaccines

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1802479115 ◽

2018 ◽

Vol 115 (20) ◽

pp. 5151-5156 ◽

Cited By ~ 19

Author(s):

Pratha Sah ◽

Jan Medlock ◽

Meagan C. Fitzpatrick ◽

Burton H. Singer ◽

Alison P. Galvani

Keyword(s):

Age Groups ◽

Population Level ◽

The Elderly ◽

The United States ◽

Vaccine Uptake ◽

Influenza Vaccines ◽

Health Practitioner ◽

Specific Distribution ◽

Life Years ◽

The Impact

The efficacy of influenza vaccines varies from one year to the next, with efficacy during the 2017–2018 season anticipated to be lower than usual. However, the impact of low-efficacy vaccines at the population level and their optimal age-specific distribution have yet to be ascertained. Applying an optimization algorithm to a mathematical model of influenza transmission and vaccination in the United States, we determined the optimal age-specific uptake of low-efficacy vaccine that would minimize incidence, hospitalization, mortality, and disability-adjusted life-years (DALYs), respectively. We found that even relatively low-efficacy influenza vaccines can be highly impactful, particularly when vaccine uptake is optimally distributed across age groups. As vaccine efficacy declines, the optimal distribution of vaccine uptake shifts toward the elderly to minimize mortality and DALYs. Health practitioner encouragement and concerted recruitment efforts are required to achieve optimal coverage among target age groups, thereby minimizing influenza morbidity and mortality for the population overall.

Download Full-text

Vaccination strategies for minimizing loss of life in Covid-19 in a Europe lacking vaccines

10.1101/2021.01.29.21250747 ◽

2021 ◽

Cited By ~ 1

Author(s):

Patrick Hunziker

Keyword(s):

European Union ◽

Age Groups ◽

Vaccine Dose ◽

Vaccination Strategy ◽

The Elderly ◽

The European Union ◽

Social Contacts ◽

Loss Of Life ◽

Vaccination Strategies ◽

Reduced Dose

AbstractAim and BackgroundWe aimed at identifying vaccination strategies that minimize loss of life in the Covid-19 pandemic. Covid-19 mainly kills the elderly, but the pandemic is driven by social contacts that are more frequent in the young. Vaccines elicit stronger immune responses per dose in younger persons. As vaccine production is a bottleneck, many countries have adopted a strategy of first vaccinating the elderly and vulnerable, while postponing vaccination of the young.MethodsBased on published age-stratified immunogenicity data of the Moderna mRNA-1273 vaccine, we compared the established “one dose fits all” approach with tailored strategies: The known differential immunogenicity of vaccine doses in different age groups is exploited to vaccinate the elderly at full dose, while the young receive a reduced dose, amplifying the number of individuals receiving the vaccine early. A modeling approach at European Union scale with population structure, Covid-19 case and death rates similar to Europe in late January 2021 is used.ResultsWhen the elderly were vaccinated preferentially, the pandemic initially continued essentially unchecked, as it was dominantly driven by social contacts in other age groups. Tailored strategies, including regular dosing in the elderly but reduced dose vaccination in the young, multiplied early vaccination counts, and even with some loss in protection degree for the individual person, the protective effect towards stopping the pandemic and protecting lives was enhanced, even for the elderly. In the European Union, pandemic duration (threshold >100’000 cases/day) was shortened from 53 to 18-24 days; cumulative death count over 100 days was reduced by >30’000. Data suggest that the findings may be relevant to both, the Moderna and the Pfizer-BioNTech mRNA vaccines.ConclusionProtecting the vulnerable, minimizing overall deaths and stopping the pandemic is best achieved by an adaptive vaccination strategy using an age-tailored vaccine dose, in this model parameterized to European demographics, coronavirus transmission observations and vaccine characteristics.

Download Full-text

Serological survey of anti-group A rotavirus IgM in UK adults

Epidemiology and Infection ◽

10.1017/s0950268803008720 ◽

2003 ◽

Vol 131 (1) ◽

pp. 719-726 ◽

Cited By ~ 15

Author(s):

M. J. COX ◽

G. F. MEDLEY

Keyword(s):

Disease Incidence ◽

Age Groups ◽

The Elderly ◽

Cross Reactivity ◽

Immunoglobulin M ◽

Recent Infection ◽

Group A Rotavirus ◽

Group A ◽

High Concentrations ◽

The Uk

Rotaviral associated disease of infants in the UK is seasonal and infection in adults not uncommon but the relationship between these has been little explored. Adult sera collected monthly for one year from routine hospital samples were screened for the presence of anti-group A rotavirus immunoglobulin M class antibodies as a marker of recent infection. Anti-rotavirus IgM was seen in all age groups throughout the year with little obvious seasonal variation in the distribution of antibody levels. IgM concentrations and the proportion seropositive above a threshold both increased with age with high concentrations consistently observed in the elderly. Results suggest either high infection rates of rotavirus in adults, irrespective of seasonal disease incidence in infants, IgM persistence or IgM cross-reactivity. These results support recent evidence of differences between infant and adult rotavirus epidemiology and highlight the need for more extensive surveys to investigate age and time related infection and transmission of rotavirus.

Download Full-text

Effect of Age on the Outcome of Hospital Treated Depression

The British Journal of Psychiatry ◽

10.1192/bjp.168.1.76 ◽

1996 ◽

Vol 168 (1) ◽

pp. 76-81 ◽

Cited By ~ 19

Author(s):

T. A. Tuma

Keyword(s):

Age Groups ◽

Significant Proportion ◽

The Elderly ◽

Adult Patients ◽

Hospital Treatment ◽

Melancholic Depression ◽

Residual Symptoms ◽

Duration Of Illness ◽

One Year ◽

The Uk

BackgroundDepression affects a significant proportion of the expanding elderly population in the UK. Reports of a poorer prognosis for older than for younger adult patients have been challenged by recent papers.MethodThe casenotes of 56 adults (mean age 47.8 years) and 54 elderly (mean age 72.9 years) patients with primary depression were assessed one year after receiving hospital treatment. Outcome measures were compared with earlier reported findings and factors possibly influencing outcome were explored.ResultsThe pattern of outcome in both age groups was broadly similar, thus: adults v. elderly: recovered 44.6% v. 44.4%; relapsed and recovered 23.2% v. 24%; residual symptoms 19.6% v. 13% and chronic depression 7.1% v. 5.5%. In the adults there were two natural deaths and one suicide. In the elderly there were two cases of dementia and five natural deaths, which was double the expected death rate. Predictors of poor outcome were melancholic depression in adults and longer duration of illness at intake and an increasing number of previous episodes of affective disorder in the elderly.ConclusionThe outcome of treated depressive illnesses appears similar in elderly and adult patients. Associated physical ill health did not adversely affect outcome in the elderly group.

Download Full-text

Effects of Simultaneous Cognitive Task on Gait Event Accuracy with Auditory Stimuli: Comparison between Young Adults in Their 20s and the Elderly in their 70s

Applied Sciences ◽

10.3390/app11020734 ◽

2021 ◽

Vol 11 (2) ◽

pp. 734

Author(s):

Jin-Seung Choi ◽

Jung-Gil Kim ◽

Jun-Hyeong Cho ◽

Gye-Rae Tack

Keyword(s):

Young Adults ◽

Cognitive Task ◽

Age Groups ◽

The Elderly ◽

Young Group ◽

Cognitive Tasks ◽

Auditory Stimuli ◽

Time Interval ◽

Heel Contact ◽

Auditory Cueing

The purpose of this study was to compare the difference in the accuracy of gait events between young and older adults during metronomic walking by auditory cueing. Additionally, age-specific changes in the gait event accuracy according to additional simultaneous cognitive tasks were examined. The time interval (or temporal error) between the auditory cue (i.e., metronome) and the heel contact was used as the accuracy of the gait event. Fifteen young group (YG, 24.7 ± 0.8 years) and 14 elderly (EG, 78.4 ± 5.5 years) people participated in the experiment. The temporal errors under two gait conditions (MET: walking with metronome; MET + BC: walking with metronome while counting backward) were compared for each group. The results revealed that all the temporal errors of EG were significantly greater than those of YG. While the addition of simultaneous cognitive tasks resulted in a significant increase in temporal error in both age groups, the coefficient of variation (CV) of the temporal error significantly increased only in the EG group. In other words, although heel contact accuracy with auditory stimuli was affected by the simultaneous cognitive task in both groups, it was demonstrated that the variability of the error in the young adults remained constant. Therefore, the time error measurement used in this study has the potential to be used as a tool to judge the gait instability of the elderly compared with young adults.

Download Full-text

Factors affecting adherence to non-pharmaceutical interventions for COVID-19 infections in the first year of the pandemic in the UK

BMJ Open ◽

10.1136/bmjopen-2021-054200 ◽

2021 ◽

Vol 11 (10) ◽

pp. e054200

Author(s):

Xuejie Ding ◽

David M Brazel ◽

Melinda C Mills

Keyword(s):

Labour Force ◽

Age Groups ◽

First Year ◽

Factors Affecting ◽

Logistic Regression Models ◽

Individual Level ◽

Lower Infection ◽

The Uk ◽

Pharmaceutical Interventions ◽

Infection Study

ObjectiveNon-pharmaceutical interventions (NPIs), including wearing face covering/masks, social distancing and working from home, have been introduced to control SARS-CoV-2 infections. We provide individual-level empirical evidence of whether adherence reduces infections.Setting and participantsThe COVID-19 Infection Study (CIS) was used from 10 May 2020 to 2 February 2021 with 409 009 COVID-19 nose and throat swab tests nested in 72 866 households for 100 138 individuals in the labour force aged 18–64.AnalysisORs for a positive COVID-19 test were calculated using multilevel logistic regression models, stratified by sex and time, by an index of autonomy to abide by NPIs, adjusted for various socioeconomic and behavioural covariates.ResultsInability to comply with NPIs predicted higher infections when individuals reported not wearing a face covering outside. The main effect for inability to comply was OR 0.79 (95% CI 0.67 to 0.92), for wearing face covering/masks was OR 0.29 (95% CI 0.15 to 0.56) and the interaction term being OR 1.25 (95% CI 1.07 to 1.46). The youngest age groups had a significantly higher risk of infection (OR 1.52, 95% CI 1.28 to 1.82) as did women in larger households (OR 1.04, 95% CI 1.02 to 1.06). Effects varied over time with autonomy to follow NPIs only significant in the pre-second lockdown May–November 2020 period. Wearing a face covering outside was a significant predictor of a lower chance of infection before mid-December 2020 when a stricter second lockdown was implemented (OR 0.44, 95% CI 0.27 to 0.73).ConclusionThe protective effect of wearing a face covering/mask was the strongest for those who were the most unable to comply with NPIs. Higher infection rates were in younger groups and women in large households. Wearing a face covering or mask outside the home consistently and significantly predicted lower infection before the 2020 Christmas period and among women.

Download Full-text