Can vaccination roll-out be more equitable if population risk is taken into account?

Background COVID-19 vaccination in many countries, including England, has been prioritised primarily by age. However, people of the same age can have very different health statuses. Frailty is a commonly used metric of health and has been found to be more strongly associated with mortality than age among COVID-19 inpatients. Methods We compared the number of first vaccine doses administered across the 135 NHS Clinical Commissioning Groups (CCGs) of England to both the over 50 population and the estimated frail population in each area. Area-based frailty estimates were generated using the English Longitudinal Survey of Ageing (ELSA), a national survey of older people. We also compared the number of doses to the number of people with other risk factors associated with COVID-19: atrial fibrillation, chronic kidney disease, diabetes, learning disabilities, obesity and smoking status. Results We estimate that after 79 days of the vaccine program, across all Clinical Commissioning Group areas, the number of people who received a first vaccine per frail person ranged from 4.4 (95% CI 4.0-4.8) and 20.1 (95% CI 18.3-21.9). The prevalences of other risk factors were also poorly associated with the prevalence of vaccination across England. Conclusions Vaccination with age-based priority created area-based inequities in the number of doses administered relative to the number of people who are frail or have other risk factors associated with COVID-19. As frailty has previously been found to be more strongly associated with mortality than age for COVID-19 inpatients, an age-based priority system may increase the risk of mortality in some areas during the vaccine roll-out period. Authorities planning COVID-19 vaccination programmes should consider the disadvantages of an age-based priority system.

Defective neutralizing antibody response to SARS-CoV-2 in vaccinated dialysis patients

Patients on dialysis are at risk of severe course of SARS-CoV-2 infection. Understanding the neutralizing activity and coverage of SARS-CoV-2 variants of vaccine-elicited antibodies is required to guide prophylactic and therapeutic COVID-19 interventions in this frail population. By analyzing plasma samples from 130 hemodialysis (HD) and 13 peritoneal dialysis patients after two doses of BNT162b2 or mRNA-1273 vaccines, we found that 35% of the patients had low-level or undetectable IgG antibodies to SARS-CoV-2 Spike (S). Neutralizing antibodies against the vaccine-matched SARS-CoV-2 and Delta variant were low or undetectable in 49% and 77% of patients, respectively, and were further reduced against other emerging variants. The fraction of non-responding patients was higher in SARS-CoV-2-naive HD patients immunized with BNT162b2 (66%) than those immunized with mRNA-1273 (23%). The reduced neutralizing activity correlated with low antibody avidity, consistent with a delayed affinity maturation of SARS-CoV-2 S-specific B cells. These data indicate that dialysis patients should be considered for an additional boost and other therapeutic strategies, including early immunotherapy with monoclonal antibodies.

COVID-19 vaccine race: watch your step for cancer patients

SummaryPatients with cancer should benefit from COVID-19 vaccination. Some of the most advanced vaccine candidates are mRNAs encapsulated into lipid carriers, and small liposomes are expected to accumulate in tumour tissues through the enhanced and permeation retention effect. However, to what extent solid tumours could take up a significant part of the vaccine dose as well remains unknown. This calls for a careful evaluation of the efficacy of these promising mRNA COVID-19 vaccines administered as lipid carriers for patients with solid tumours, including a possible re-appraisal of the dosing for optimal protection of this specific and frail population.

Association between air pollution and Pediatric Intensive Care Units hospitalization rates

Background In the last years air pollution has been linked to an increased risk of several children respiratory pathologies, especially low respiratory tract infections. In more severe cases, the child could be hospitalized in Pediatric Intensive Care Unit (PICU). The present study aims to evaluate the association between the exposure to air pollution and (i) PICU admissions and (ii) hospitalization rates among children with a previous PICU admission. Methods PICU admissions due to respiratory diseases were collected from 2010 to 2019 in Padua hospital (Italy) based on a large clinical Italian register. Furthermore, for subjects admitted in 2013, all subsequent hospitalizations have been tracked until 2019 from hospital discharge records. Environmental data were obtained from monitoring stations located within 20 km from the children residence. A conditional logistic regression based on a time-stratified case-crossover design will be performed to evaluate the association between hospital admissions and NO2, PM2.5 and PM10 in aerodynamic diameter. Results The registry contains data about more than 30000 PICU admissions, of which around 30 % are of children under one year of age. An increased prevalence for respiratory diseases' admissions, from 18% in 2010 to 24% in 2019 can be observed. More than 400 children were admitted to Padua's PICU in 2013. In the following years, all these subjects experienced at least one hospitalization (median 2, [IQR 1-5]) for more than 2000 hospital admissions from 2014 up to 2019. Conclusions Exposure of infants to air pollution could lead to more severe outcome as hospitalization as a result of a vulnerable lung condition that eases virus infections. This condition identifies a particularly frail population. With this approach, an association between air pollution and PICU admissions could be investigated in order to adopt public health policies aimed at safeguarding this frail population. Key messages The study would detect an association between air pollution and hospital admissions as severe outcomes in infants and children. Furthermore, this is the first study that would assess if there is an association between these two factors in more frail subjects already hospitalized in a Pediatric Intensive Care Unit.