Waning Effectiveness of SARS-CoV-2 mRNA Vaccines in Older Adults: A Rapid Review

The U.S. Centers for Disease Control and Prevention (CDC) and other health agencies have recently recommended a booster dose of COVID-19 vaccines for specific vulnerable groups including adults 65 years and older. There is limited evidence whether vaccine effectiveness in older adults decreases over time, especially against severe COVID-19. We performed a rapid review of published studies available through 04 November 2021 that provide effectiveness data on mRNA vaccines approved/licensed in the United States and identified eight eligible studies which evaluated vaccine effectiveness in older adults. There is evidence of a decline in vaccine effectiveness against both SARS-CoV-2 infection and severe COVID-19 in older adults among studies which analyzed data up to July-October 2021. Our findings suggest that vaccine effectiveness diminishes in older adults, which supports the current recommendation for a booster dose in this population.

“It’s good to feel like you’re doing something”: a qualitative study examining state health department employees’ views on why ineffective programs continue to be implemented in the USA

Background Mis-implementation, the inappropriate continuation of programs or policies that are not evidence-based or the inappropriate termination of evidence-based programs and policies, can lead to the inefficient use of scarce resources in public health agencies and decrease the ability of these agencies to deliver effective programs and improve population health. Little is known about why mis-implementation occurs, which is needed to understand how to address it. This study sought to understand the state health department practitioners’ perspectives about what makes programs ineffective and the reasons why ineffective programs continue. Methods Eight state health departments (SHDs) were selected to participate in telephone-administered qualitative interviews about decision-making around ending or continuing programs. States were selected based on geographic representation and on their level of mis-implementation (low and high) categorized from our previous national survey. Forty-four SHD chronic disease staff participated in interviews, which were audio-recorded and transcribed verbatim. Transcripts were consensus coded, and themes were identified and summarized. This paper presents two sets of themes, related to (1) what makes a program ineffective and (2) why ineffective programs continue to be implemented according to SHD staff. Results Participants considered programs ineffective if they were not evidence-based or if they did not fit well within the population; could not be implemented well due to program restraints or a lack of staff time and resources; did not reach those who could most benefit from the program; or did not show the expected program outcomes through evaluation. Practitioners described several reasons why ineffective programs continued to be implemented, including concerns about damaging the relationships with partner organizations, the presence of program champions, agency capacity, and funding restrictions. Conclusions The continued implementation of ineffective programs occurs due to a number of interrelated organizational, relational, human resources, and economic factors. Efforts should focus on preventing mis-implementation since it limits public health agencies’ ability to conduct evidence-based public health, implement evidence-based programs effectively, and reduce the high burden of chronic diseases. The use of evidence-based decision-making in public health agencies and supporting adaptation of programs to improve their fit may prevent mis-implementation. Future work should identify effective strategies to reduce mis-implementation, which can optimize public health practice and improve population health.

Application of Big Data in Digital Epidemiology

Epidemiology is the study of dynamics of health and disease in human population. It aims to identify the occurrence, pattern, and etiology of human diseases so that the causes of these diseases can be understood, which in turn will help in preventing their spread. In traditional epidemiology, the data is collected by various public health agencies through various means. Many times, the actual figures vary a lot from the one reported. Sometimes this difference is due to human errors, but most of the time, it is due to intentional underreporting. Big data techniques can be used to analyze this huge amount of data so as to extract useful information from it. The electronic health data is so large and complex that it cannot be processed using traditional software and hardware. It is also not possible to manage this data using traditional data management tools. This data is huge in terms of volume as well as diversity and the speed at which it is being generated. The ability to combine and analyze these different sources of data has huge impact on epidemic tracking.

Home Health Agencies With More Socially Vulnerable Patients Have Poorer Experience of Care Ratings

Objectives Examine the relationships between dual eligibility and race/ethnicity characteristics of Medicare-Certified Home Health Agencies (CHHAs) and experience of care ratings. Methods Analysis of 2017 national Consumer Assessment of Healthcare Providers and Systems and matched datasets of 10,906 CHHAs Results CHHAs with higher concentrations of dual-eligible patients were less likely to have high experience of care ratings for all three domains (e.g., for care delivery, quartile 4 vs. 1: odds ratio [OR] = 0.622, p < .001); CHHAs with higher concentrations of racial/ethnic minorities generally were less likely to have high experience of care ratings in care delivery (e.g., Black: quartile 4 vs. 1: OR = 0.418, p<0.001), communication (e.g., Black: quartile 4 vs. 1: OR = 0.316, p<0.001), and specific care issues (e.g., Hispanic: quartile 4 vs. 1: OR = 0.397, p < .001). Discussion CHHAs with greater concentrations of dual-eligible patients and racial/ethnic minorities were more likely to have poor experience of care ratings.

Checklist to select contract Research Organization for early phase Bioavailability/Bioequivalence Clinical Studies in Healthy Adult Human Volunteers

Nowadays health agencies of regulated markets are becoming stringent regarding the bio-studies. So clinical/contract research organization (CRO) need to be selected carefully after their detailed assessment. As per requirement of bio-study CRO should be assessed with the study specific checklist of questions before awarding the bio-study. Questions related to various services of study like: Clinic phase, analytical phase, Pharmacokinetic and statistical phase, ethics approval, QA/QC, record handing etc. and related to CRO capabilities are discussed here with their relevance to conclude the abilities of CRO for successful execution of bio-study. Hence, this paper focuses all possible questions which need to be assessed before selection of CRO mainly for Bioavailability/Bioequivalence (BABE) study in healthy adult volunteers. Properly selected CRO will help for smooth execution of study and quality report and subsequently, hassle-free approval of dossier submitted to regulatory agency.

Time series analysis of government information about COVID-19 on social media and the number of new cases during the first 6 months of the pandemic: the Brazil case

This retrospective study sought to assess the association between the evolution of the COVID-19 pandemic in Brazil and the quality of educational materials published in the official profiles of Brazilian government health agencies on Instagram. Posts about COVID-19, published between January 31 and August 15, 2021, were selected, dated, quantified and classified according to their content by three researchers. Public’s engagement was calculated by the number of likes, comments and views. The quality of the educational posts was assessed by two trained and calibrated researchers (Kappa intra and inter-examiners, k=0.96 and k=0.92, respectively), using the Brazilian version of the Clear Communication Index (BR-CDC-CCI), the number of new COVID-19 cases was collected using the COVID-19 epidemic calculator provided by PAHO at https://covid-calc.org/. The relationship between the evolution of the COVID-19 indicator and the quality of educational posts was calculated using the statistical model of a fortnightly time series. On average, educational posts reached 6.4 in the BR-CDC-CCI score (median = 6.5). In the multiple model adjusted for the amount of educational posts and public engagement, it was observed that for each increase of one point in the BR-CDC-CCI score, there was a reduction of 327,864 new cases of Covid-19 (p <0.001). It was concluded that there was a relationship between the low quality of posts and the greater number of new cases of the disease, indicating the need for greater attention from Brazilian government agencies with the quality of information made available on social networks to help control the COVID-19 pandemic.

COVID Vaccine Rollout for Older People: East Meets West

Older adults should be one of the first groups to receive COVID-19 vaccines, because the risk of dying from COVID-19 increases with age. However, it takes time to distribute the vaccines to different countries, and the challenges in administering vaccines may differ by health system characteristics and local culture. This international symposium will discuss the vaccine rollout issues in eight countries (Isreal, Japan, South Korea, China, France, United Kingdom, Canada, and United States). We will use an interview and dialog format, instead of presentations. We will cover extensive topics including: Availability - What vaccines? Access, Acceptance, Caregivers – How are providers responding/handling caregivers wanting to be vaccinated?Cost/Financing Issues, Distribution Logistics/Transport/Safety, Lessons Learned, Mutations/Variants, Partnerships needed to vaccinate homebound patients (community partners; home health agencies, etc.), Who can/should provide vaccination? The situation with COVID-19 is still very fluid. Countries are at different stages of vaccinating older people. The chair didn't ask the speakers to write an abstract now, instead, the speakers will collect more information during the next few months and plan to have a prep meeting one month before the Annual Meeting.

Patient-Rated Performance of Home Health Agencies and Hospitalization Risk: A Propensity-Score Matched Analysis

Home health care is the most commonly used home- and community-based service to older adults “Aging in Place”. Patient experience of healthcare services is a critical aspect of patient-centered care. Indeed, policymakers have linked patient-rated quality of care to payment to healthcare providers. This study aimed to examine the association between patient-rated care performance of home health agencies and risk for hospitalization among Medicare beneficiaries. This study used several national datasets from 2016 and included 491,718 individuals from 8,459 home health agencies. Home health agencies’ performance was measured using patient experience star rating from the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS). Propensity score matching was used to balance the differences in patient characteristics at baseline between those receiving care from high-performing home health agencies and those in lower-performing agencies. On average, patients were 80.5 years old, 65% female, 81% White, 10% Black, and 6% Hispanic, with 90% taking 5 or more medications. Patients had a mean score of 1.73 (SD=1.69) on the Charlson Index. Respectively, 10% and 16% of patients were hospitalized within 30 and 60 days of home health care initiation. Estimates of logistic regression after propensity score matching found that patients receiving care from lower-performing agencies were at similar risk for both 30-day (OR=0.99, p=0.817) and 60-day (OR=1.02, p=0.616) hospitalization following the start of home health care, compared to those in high-performing agencies. Our findings suggest discrepancies (or no relationship) between patient experience and objective outcomes of home health care.