scholarly journals Effectiveness of different booster regimens for preventing infection and adverse outcomes in Puerto Rico

2021 ◽  
Author(s):  
Rafael A Irizarry ◽  
Monica M Robles Fontan
Keyword(s):  
Puerto Rico ◽  
Observational Studies ◽  
Incidence Rates ◽  
Vaccine Effectiveness ◽  
Adverse Outcomes ◽  
Time Varying ◽  
Test Results ◽  
Department Of Health ◽  
Vaccine Manufacturer ◽  
Recent Laboratory

Recent laboratory and observational studies have demonstrated that the COVID-19 vaccine effectiveness wanes over time. In response, several jurisdictions have authorized the administration of booster doses. Since August 13, 2021, Puerto Rico has administered 540,140 booster shots. We used data collected and made public by the Puerto Rico Department of Health (PRDH) to evaluate the effectiveness of four different booster regimens at preventing SARS-CoV-2 laboratory confirmed infections and adverse COVID-19 outcomes. Specifically, we analyzed data from all 115,995 SARS-CoV-2 infections occurring since the vaccination process commenced on December 15, 2020. We combined vaccination status, SARS-CoV-2 test results, and COVID-19 hospitalizations and deaths data, and fit a statistical model that adjusted for time-varying incidence rates and age group, to estimate time-varying vaccine effectiveness against infection and adverse outcomes. We find that, after 6 months, the mRNA-1273 and BNT162b2 effectiveness against infection wanes substantially to 61% (58%-63%) and 36% (34%-39%), respectively, while the Ad26.COV2.S wanes to 35% (31%-39%) after two months. However, after a booster shot of the corresponding initial vaccine manufacturer, effectiveness increased to 87% (83%- 91%) and 82% (79%- 85%) for mRNA-1273 and BNT162b2, respectively. The effectiveness for Ad26.COV2.S followed by either a mRNA-1273 or BNT162b2 booster increased to 88% (71%-100%), substantially higher than 65% (59%-70%), the peak effectiveness reached with just one shot. We also found that heterologous booster regimens restored effectiveness. Furthermore, we did not observe waning after two months of the booster shot. Finally, we found that all booster regimens provided increased protection against COVID-19 hospitalizations and deaths. Code and data to reproduce the analyses are provided here: https://github.com/rafalab/booster-eff-pr.

scholarly journals Time-varying effectiveness of the mRNA-1273, BNT162b2 and Ad26.COV2.S vaccines against SARS-CoV-2 infections and COVID-19 hospitalizations and deaths: an analysis based on observational data from Puerto Rico

2021 ◽  
Author(s):  
Monica M. Robles-Fontan ◽  
Elvis G. Nieves ◽  
Iris Cardona-Gerena ◽  
Rafael A Irizarry
Keyword(s):  
Puerto Rico ◽  
Age Groups ◽  
Vaccination Rate ◽  
Incidence Rates ◽  
Vaccination Status ◽  
Time Varying ◽  
Department Of Health ◽  
Before And After ◽  
The Usa ◽  
Status Data

Background We collected hospitalization, death, and vaccination status data for all 86,488 laboratory- confirmed SARS-CoV-2 infections in Puerto Rico since the first COVID-19 vaccine was administered starting on December 15, 2020 and ending September 24, 2021. Using these data we estimated real-world time-varying effectiveness of the mRNA-1273 (Moderna), BNT162b2 (Pfizer), and Ad26.COV2.S (J & J) COVID-19 vaccines to quantify the public health benefits of Puerto Rico's immunization campaign. Furthermore, we compared the effectiveness of the COVID-19 vaccines before and after the dominance of the Delta variant. As of this writing, Puerto Rico had a higher vaccination rate and lower SARS-CoV-2 infection rate than all 50 States in the USA. Methods We used data obtained from the integration of the Puerto Rico Department of Health databases holding vaccination status, SARS-CoV-2 test results, and COVID-19 hospitalizations, and deaths. We estimated time-varying vaccine effectiveness against SARS-CoV-2 infections by fitting a statistical model that adjusts for time-varying incidence rates, age, gender, and day of the week. We also used this model to estimate the relative risk of hospitalization and deaths comparing vaccinated to unvaccinated individuals. Code and data are provided to reproduce the analysis here: https://github.com/rafalab/vax-eff-pr Results All vaccines were effective at reducing risks for all outcomes across all age groups. At the peak of their protection, mRNA-1273, BNT162b2, and Ad26.COV2.S had an effectiveness of 87% (85% - 89%), 85% (82% - 87%), and 65% (58% - 70%), with Ad26.COV2.S reaching this peak 32 days after the being considered fully vaccinated. After four months, effectiveness waned to about 73%, 58%, and 32% for mRNA-1273, BNT162b2, and Ad26.COV2.S, respectively. All vaccines had a lower effectiveness for those over 85 years, with the decrease in effectiveness particularly low for the Ad26.COV2.S vaccine. We found no clear evidence that effectiveness was different after the Delta variant became dominant. For those infected, the vaccines provided further protection against hospitalization and deaths across all age groups, although the protection was less for those above 85 years. Using the rates observed for the unvaccinated we would have observed 6,109 and 2,071 hospitalizations and deaths among the vaccinated population but we instead observed 728 and 164, respectively. Conclusions The mRNA-1273 and BNT162b2 vaccines where highly effective across all age groups. They were still effective after four months although the protection did wain. The Ad26.COV2.S vaccine was effective but to a lesser degree, especially for the older age groups, and with the protection waning substantially sooner in comparison to the other two vaccines.

Incidence of Multiple Sclerosis in Puerto Rico, 2014: A Population-Based Study

2017 ◽  
Vol 48 (1-2) ◽  
pp. 55-60 ◽  
Author(s):  
Angel Chinea ◽  
Carlos F. Ríos-Bedoya ◽  
Cristina Rubi ◽  
Ivonne Vicente ◽  
Eduardo R. Estades ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Puerto Rico ◽  
Incidence Rate ◽  
Latin American ◽  
Population Based ◽  
Incidence Rates ◽  
Service Planning ◽  
Insurance Companies ◽  
Mcdonald Criteria ◽  
Department Of Health

Background: Multiple sclerosis (MS) affects millions of people worldwide. The estimates for MS incidence are difficult to obtain but are important for understanding MS etiology, developing prevention strategies, and service planning. This study is aimed at estimating the 2014 incidence of MS in Puerto Rico (PR). Methods: The PR MS Foundation's registry was used as the data source. Neurologists, specialty pharmacies, MRI centers, health insurance companies, and the PR Department of Health identified MS cases missed by the registry. MS patients were 18 years and older and met the 2010 revised McDonald criteria. Age-standardized MS incidence rates and their corresponding 95% CIs were computed. Results: A total of 144 new MS cases were diagnosed in 2014. The age-standardized MS incidence rate was 5.1/100,000 (95% CI 4.3-5.9). The incidence rate was 7.1/100,000 (95% CI 5.7-8.5) for females and 2.9/100,000 (95% CI 2.0-3.8) for males. MS cases were mostly females (72.9%) with a mean age of 41.0 years (±1.0). Conclusion: According to the country estimates, PR has a higher MS incidence than other Caribbean and Latin American countries, but a lower incidence compared to countries at higher latitudes. Our findings provide insights into the MS etiology in the Hispanic population that require additional research.

scholarly journals Incidence and time-varying predictors of HIV and sexually transmitted infections among male sex workers in Mexico City

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Karla Y. Ganley ◽  
Marta Wilson-Barthes ◽  
Andrew R. Zullo ◽  
Sandra G. Sosa-Rubí ◽  
Carlos J. Conde-Glez ◽  
...  
Keyword(s):  
Sexually Transmitted Infections ◽  
Mexico City ◽  
Sex Workers ◽  
Incidence Rates ◽  
Consistent Condom ◽  
Vaginal Intercourse ◽  
Time Varying ◽  
Male Sex Workers ◽  
Sexually Transmitted ◽  
Male Sex

Abstract Background Male sex workers are at high-risk for acquisition of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). We quantified incidence rates of STIs and identified their time-varying predictors among male sex workers in Mexico City. Methods From January 2012 to May 2014, male sex workers recruited from the largest HIV clinic and community sites in Mexico City were tested for chlamydia, gonorrhea, syphilis, hepatitis, and HIV at baseline, 6-months, and 12-months. Incidence rates with 95% bootstrapped confidence limits were calculated. We examined potential time-varying predictors using generalized estimating equations for a population averaged model. Results Among 227 male sex workers, median age was 24 and baseline HIV prevalence was 32%. Incidence rates (per 100 person-years) were as follows: HIV [5.23; 95% confidence interval (CI): 2.15–10.31], chlamydia (5.15; 95% CI: 2.58–9.34), gonorrhea (3.93; 95% CI: 1.88–7.83), syphilis (13.04; 95% CI: 8.24–19.94), hepatitis B (2.11; 95% CI: 0.53–4.89), hepatitis C (0.95; 95% CI: 0.00–3.16), any STI except HIV (30.99; 95% CI: 21.73–40.26), and any STI including HIV (50.08; 95% CI: 37.60–62.55). In the multivariable-adjusted model, incident STI (excluding HIV) were lower among those who reported consistently using condoms during anal and vaginal intercourse (odds ratio = 0.03, 95% CI: 0.00–0.68) compared to those who reported inconsistently using condoms during anal and vaginal intercourse. Conclusions Incidence of STIs is high among male sex workers in Mexico City. Consistent condom use is an important protective factor for STIs, and should be an important component of interventions to prevent incident infections.

The Physical Context of Child Development

2021 ◽  
Vol 30 (1) ◽  
pp. 41-48
Author(s):  
Gary W. Evans
Keyword(s):  
Child Development ◽  
Observational Studies ◽  
Physiological Stress ◽  
Personal Characteristics ◽  
Adverse Outcomes ◽  
Structural Quality ◽  
Physical Context ◽  
Physical Setting ◽  
Physical Features

Child development reflects interactions between personal characteristics and the physical and social environment. Psychology, however, lacks analysis of physical features that influence child development. In this article, I describe a preliminary taxonomy of physical-setting characteristics that can influence child development, focusing on environmental stressors such as noise, crowding, and chaos along with structural quality of housing, day care, and schools. Adverse outcomes associated with suboptimal physical settings during childhood include cognitive and socioemotional difficulties along with chronic physiological stress. Both direct effects on the child as well as indirect effects occurring via significant persons surrounding the child are described. Methodological limitations, particularly reliance on observational studies, are a weakness in the current literature, but increasingly more rigorously obtained findings yield converging evidence of the effects of physical settings on child development.

scholarly journals Statin use and clinical outcomes in patients with COVID-19: An updated systematic review and meta-analysis

2021 ◽  
pp. postgradmedj-2020-139172
Author(s):  
Rimesh Pal ◽  
Mainak Banerjee ◽  
Urmila Yadav ◽  
Sukrita Bhattacharjee
Keyword(s):  
Clinical Outcomes ◽  
Observational Studies ◽  
Fixed Effects ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Adverse Outcomes ◽  
Fixed Effects Model ◽  
Adjusted Risk ◽  
Risk Estimates ◽  
Statin Use

PurposeObservations studies have shown that prior use of statins is associated with a reduced risk of adverse clinical outcomes in patients with COVID-19. However, the available data are limited, inconsistent and conflicting. Besides, no randomised controlled trial exists in this regard. Hence, the present meta-analysis was conducted to provide an updated summary and collate the effect of statin use on clinical outcomes in COVID-19 using unadjusted and adjusted risk estimates.MethodsPubMed, Scopus and Web of Science databases were systematically searched using appropriate keywords till December 18 2020, to identify observational studies reporting clinical outcomes in COVID-19 patients using statins versus those not using statins. Prior and in-hospital use of statins were considered. Study quality was assessed using the Newcastle-Ottawa Scale. Unadjusted and adjusted pooled odds ratio (OR) with 95% CIs were calculated.ResultsWe included 14 observational studies pooling data retrieved from 19 988 patients with COVID-19. All the studies were of high/moderate quality. Pooled analysis of unadjusted data showed that statin use was not associated with improved clinical outcomes (OR 1.02; 95% CI 0.69 to 1.50, p=0.94, I2=94%, random-effects model). However, on pooling adjusted risk estimates, the use of statin was found to significantly reduce the risk of adverse outcomes (OR 0.51; 95% CI 0.41 to 0.63, p<0.0005, I2=0%, fixed-effects model).ConclusionsStatin use is associated with improved clinical outcomes in patients with COVID-19. Individuals with multiple comorbidities on statin therapy should be encouraged to continue the drug amid the ongoing pandemic.

scholarly journals Effectiveness of Ultraviolet-C Room Disinfection on Preventing Healthcare-Associated Clostridioides difficile Infection

2020 ◽  
Vol 41 (S1) ◽  
pp. s33-s33
Author(s):  
Michihiko Goto ◽  
Erin Balkenende ◽  
Gosia Clore ◽  
Rajeshwari Nair ◽  
Loretta Simbartl ◽  
...  
Keyword(s):  
Acute Care ◽  
Acute Care Hospitals ◽  
Incidence Rates ◽  
Positive Test ◽  
Negative Binomial Regression Model ◽  
Test Results ◽  
Clostridioides Difficile ◽  
Ultraviolet C ◽  
Healthcare Associated ◽  
Uv C

Background: Enhanced terminal room cleaning with ultraviolet C (UVC) disinfection has become more commonly used as a strategy to reduce the transmission of important nosocomial pathogens, including Clostridioides difficile, but the real-world effectiveness remains unclear. Objectives: We aimed to assess the association of UVC disinfection during terminal cleaning with the incidence of healthcare-associated C. difficile infection and positive test results for C. difficile within the nationwide Veterans Health Administration (VHA) System. Methods: Using a nationwide survey of VHA system acute-care hospitals, information on UV-C system utilization and date of implementation was obtained. Hospital-level incidence rates of clinically confirmed hospital-onset C. difficile infection (HO-CDI) and positive test results with recent healthcare exposures (both hospital-onset [HO-LabID] and community-onset healthcare-associated [CO-HA-LabID]) at acute-care units between January 2010 and December 2018 were obtained through routine surveillance with bed days of care (BDOC) as the denominator. We analyzed the association of UVC disinfection with incidence rates of HO-CDI, HO-Lab-ID, and CO-HA-LabID using a nonrandomized, stepped-wedge design, using negative binomial regression model with hospital-specific random intercept, the presence or absence of UVC disinfection use for each month, with baseline trend and seasonality as explanatory variables. Results: Among 143 VHA acute-care hospitals, 129 hospitals (90.2%) responded to the survey and were included in the analysis. UVC use was reported from 42 hospitals with various implementation start dates (range, June 2010 through June 2017). We identified 23,021 positive C. difficile test results (HO-Lab ID: 5,014) with 16,213 HO-CDI and 24,083,252 BDOC from the 129 hospitals during the study period. There were declining baseline trends nationwide (mean, −0.6% per month) for HO-CDI. The use of UV-C had no statistically significant association with incidence rates of HO-CDI (incidence rate ratio [IRR], 1.032; 95% CI, 0.963–1.106; P = .65) or incidence rates of healthcare-associated positive C. difficile test results (HO-Lab). Conclusions: In this large quasi-experimental analysis within the VHA System, the enhanced terminal room cleaning with UVC disinfection was not associated with the change in incidence rates of clinically confirmed hospital-onset CDI or positive test results with recent healthcare exposure. Further research is needed to understand reasons for lack of effectiveness, such as understanding barriers to utilization.Funding: NoneDisclosures: None

scholarly journals Impact of hepatitis B vaccine in Tunisia 20 years after its introduction

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Lahchaichi ◽  
M Ben Hadj ◽  
H Bouguerra ◽  
K Talmoudi ◽  
A Bahrini ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Vaccination Coverage ◽  
Vaccine Effectiveness ◽  
Coverage Rate ◽  
Hbv Infection ◽  
Hepatitis B Vaccination ◽  
Reference Laboratory ◽  
Test Results ◽  
Vaccination Coverage Rate ◽  
The Impact

Abstract Introduction Vaccination against hepatitis B represents the most effective preventive measure to reduce the global impact of this infection. In Tunisia hepatitis B vaccination was introduced for health professionals in 1992 and for the general population in 1995. The objectives of this study were to evaluate the impact of vaccination twenty years after its introduction. Methods It was a descriptive study of data provided by the national survey of prevalence of Hepatitis B in Tunisia, which was a household-based study conducted in 2015. Blood samples sent to the reference laboratory to test markers of hepatitis B virus infection. The Vaccine effectiveness rate was calculated using the following formula: VE = 1 - Odds-ratio (OR), where OR = ratio of odds of being vaccinated among subjects with positive HBsAg test results to the odds of being vaccinated among subjects with negative HBsAg test results. Results Approximately a quarter of our population reported having been vaccinated against HBV, a coverage rate of 26.9%. Among subjects above 20 years of age, this rate was 85.3%. Besides, 83.7% of vaccinated subjects had received the three required doses of the HBV vaccine. Analysis of vaccination status by great regions of the country showed that the vaccination coverage rate was higher in the southern region. Regarding HBsAg prevalence, the rate was significantly higher among unvaccinated subjects 0.3% vs 2.2% in those vaccinated (OR = 0.11 [0.07-0.18]). We found that among vaccinated subjects, the serologic response rate at vaccination was only 63.2% which represented 16.2% of the total population. The vaccine effectiveness indicated that vaccination reduced by 88.6% the risk of HBV infection. Conclusions These results demonstrate that vaccination against hepatitis B introduced in the national immunization schedule since 1995 has reduced the infection although the vaccination coverage rate remains below 90%. Key messages Importance of vaccination that reduced by 88.6% the risk of HBV infection. More effort required to raise awareness about vaccination against HBV.

scholarly journals 2156

2017 ◽  
Vol 1 (S1) ◽  
pp. 24-25
Author(s):  
Caroline Presley ◽  
Marie Griffin ◽  
Jea Young Min ◽  
Robert Greevy ◽  
Christianne Roumie
Keyword(s):  
Heart Failure ◽  
Observational Studies ◽  
Frailty Index ◽  
Adverse Outcomes ◽  
Diabetes Diagnosis ◽  
Veterans Health ◽  
Health Administration ◽  
Medication Regimen ◽  
Antidiabetic Medication ◽  
Frailty Status

OBJECTIVES/SPECIFIC AIMS: This study is part of a parent grant evaluating antidiabetic medications and risk for heart failure in an observational cohort of Veterans with type 2 diabetes (T2DM). Confounding by indication remains a concern in many observational studies of medications because difficult to measure confounders such as frailty may influence prescribing of different medications based on patient characteristics. Frailty is a multidimensional syndrome of loss of reserves (energy, physical ability, cognition, health) that gives rise to vulnerability to adverse outcomes. The objective of this study is to determine if frailty is a potential confounder in Veterans with T2DM, that is, independently associated with exposure to a specific antidiabetic medications and hospitalization for decompensated heart failure. METHODS/STUDY POPULATION: We conducted a cross-sectional study of patients with diabetes who were hospitalized within the Veterans Health Administration (VHA) Tennessee Valley Healthcare System from 2002 to 2012. Inclusion criteria were: age 18 years or older, receive regular VHA care (prescription fill or visit at least once every 180 d), a diagnosis of T2DM. A probability sample of HF and non-HF hospitalizations was collected. HF hospitalizations were selected on the basis of meeting either a primary diagnosis code (ICD-9) and/or disease related group (DRG) code for HF. For each hospitalization using a standardized chart abstraction tool, data was abstracted on: antidiabetic medication(s), patient frailty status, and reason for hospitalization (HF or non-HF). Antidiabetic medication regimens were categorized as follows: no medication treatment, metformin alone, sulfonylurea alone, insulin alone, insulin and one oral agent, and all other regimens. Patient frailty status was measured using a modified version of the Canadian Health and Aging frailty index (FI), which generates a score (range 0–1) by dividing the number of deficits present by the number of deficits measured. Established categories for FI scores are: non frail ≤0.10, vulnerable 0.10–0.21, frail 0.22–0.45, and very frail >0.45. Patient frailty status at the time of hospitalization was used as a surrogate for patient frailty at the time of prescription of antidiabetic medication; this is a limitation of this approach. Hospitalizations were classified as HF hospitalizations if 2 major or 1 major and 2 minor Framingham criteria were present. FI was compared across antidiabetic medication regimen categories and hospitalization type using analysis of variance (ANOVA) and Student t-test, respectively. RESULTS/ANTICIPATED RESULTS: Of the 500 hospitalizations reviewed, 430 patients had confirmed diabetes diagnosis, adequate data to calculate FI scores, and were included in this analysis. Patients were on average 66.9 (10.9) years old; 99% male and 75% were White. Overall, 268 patients (62.3%) were categorized as frail or very frail. The mean FI score was 0.23 (SD 0.07). FI scores were highest in patients receiving insulin alone (mean 0.26) compared with patients receiving metformin alone (mean 0.22), sulfonylurea alone (mean 0.23), or no medication (mean 0.22). The lowest mean frailty score was seen in patients taking all other drug combinations, 0.19. The differences across these patient groups were statistically significant with p<0.01. Further, 75% of patients on insulin alone were frail or very frail compared with 68% on sulfonylurea alone, 58% on metformin alone, and 58% on no medication. Framingham criteria for acute HF were present for 318 of 430 patients (74.0%). FI scores were higher in patients hospitalized for HF compared with non-HF hospitalizations (mean 0.24 vs. 0.21, p<0.01). A higher proportion of patients hospitalized for HF were classified as frail or very frail compared with those hospitalized for non-HF diagnosis (66.4% vs. 50.9%, p<0.01). DISCUSSION/SIGNIFICANCE OF IMPACT: This study demonstrates that certain antidiabetic medications are associated with patient frailty. In addition, those patients admitted for HF have higher FI scores than those admitted for non-HF diagnoses. Further investigation is planned to assess the degree to which frailty is captured by traditional covariates used in observational studies.

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