vaccine

Not the strongest methodology but still suggests the RSV vaccine is very effective for reducing RSV-related hospitalizations in people over 75. James W. Mold, MD, MPH

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Importance: Clinical trials have demonstrated high vaccine efficacy (VE) against lower respiratory tract disease (LRTD) but enrolled a smaller proportion of persons aged 75 years or older and those with comorbidities than seen in highest-risk populations in clinical practice settings. Additionally, VE against respiratory syncytial virus (RSV)-related hospitalizations and emergency department (ED) visits is not yet fully described.

Objective: To estimate Respiratory Syncytial Virus Prefusion F (RSVpreF) effectiveness in older adults.

Design, setting, and participants: This was a retrospective case-control study with a test negative design. Cases were adults aged 60 years or older with hospitalizations or ED visits at Kaiser Permanente of Southern California for LRTD from November 24, 2023, to April 9, 2024, who had respiratory swabs collected and tested for RSV. Two control definitions were prespecified: (1) strict controls included RSV-negative LRTD events that were negative for human metapneumovirus, SARS-CoV-2, and influenza, and positive for a nonvaccine preventable cause (primary) and (2) broad controls included all RSV-negative LRTD events (sensitivity analysis). Enhanced specimen collection was conducted to salvage clinical respiratory swabs not tested for RSV during routine care. Data were analyzed from May to September 2024.

Exposure: RSVpreF vaccine receipt during the first RSV season after licensure and 21 or more days before LRTD event.

Main outcomes and measures: Estimated VE against first episode of RSV-related LRTD hospitalization or ED visit.

Results: A total of 7047 LRTD-related hospitalizations or ED encounters with RSV testing results were included. The mean (SD) age was 76.8 (9.6) years; 3819 (54.2%) were female; 839 (11.9%) were non-Hispanic Asian or Pacific Islander, 2323 (33.0%) were Hispanic, 1197 (17.0%) were non-Hispanic Black, and 2602 (36.9%) were non-Hispanic White; 998 (14.2%) were immunocompromised; and 6573 (93.3%) had 1 or more Charlson comorbidity. Using strict controls, estimated adjusted VE was 91% (95% CI, 59%-98%). Using broad controls, estimated adjusted VE was 90% (95% CI, 59%-97%).

Conclusions and relevance: In a high-risk, general population, RSVpreF vaccination conferred protection against RSV-related LRTD in the hospital and ED settings among US adults aged 60 years or older, the majority of whom were aged 75 years or older and had comorbidities. These data support use of this vaccine in older adults.

Author/s:

Sara Y Tartof, Negar Aliabadi, Gabriella Goodwin, Jeff Slezak, Vennis Hong

Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel

Saige Blanchard — Thu, 07 Oct 2021 23:14:35 +0000

Date Added:

October 7, 2021

Journal/Publication:

New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Pages:

1-10

URL:

Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/NEJMoa2109730

Keywords

PMID (1):

34614328

MeSH

Coronavirus

retrospective studies

During active surveillance in Israel, the incidences of symptomatic myocarditis following the Pfizer COVID vaccine were on the order of 1 (after first dose) to 4 (after the second dose) per 100,000 for males and .1/ 100,000 and 0.5 per 100,000 for females. However, the rates were 1.5/100,00 (after first dose) and 13/100,000 (after second dose) in males 16 – 24 years of age. James W. Mold, MD, MPH

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Background: Approximately 5.1 million Israelis had been fully immunized against coronavirus disease 2019 (Covid-19) after receiving two doses of the BNT162b2 messenger RNA vaccine (Pfizer-BioNTech) by May 31, 2021. After early reports of myocarditis during adverse events monitoring, the Israeli Ministry of Health initiated active surveillance.

Methods: We retrospectively reviewed data obtained from December 20, 2020, to May 31, 2021, regarding all cases of myocarditis and categorized the information using the Brighton Collaboration definition. We analyzed the occurrence of myocarditis by computing the risk difference for the comparison of the incidence after the first and second vaccine doses (21 days apart); by calculating the standardized incidence ratio of the observed-to-expected incidence within 21 days after the first dose and 30 days after the second dose, independent of certainty of diagnosis; and by calculating the rate ratio 30 days after the second dose as compared with unvaccinated persons.

Results: Among 304 persons with symptoms of myocarditis, 21 had received an alternative diagnosis. Of the remaining 283 cases, 142 occurred after receipt of the BNT162b2 vaccine; of these cases, 136 diagnoses were definitive or probable. The clinical presentation was judged to be mild in 129 recipients (95%); one fulminant case was fatal. The overall risk difference between the first and second doses was 1.76 per 100,000 persons (95% confidence interval [CI], 1.33 to 2.19), with the largest difference among male recipients between the ages of 16 and 19 years (difference, 13.73 per 100,000 persons; 95% CI, 8.11 to 19.46). As compared with the expected incidence based on historical data, the standardized incidence ratio was 5.34 (95% CI, 4.48 to 6.40) and was highest after the second dose in male recipients between the ages of 16 and 19 years (13.60; 95% CI, 9.30 to 19.20). The rate ratio 30 days after the second vaccine dose in fully vaccinated recipients, as compared with unvaccinated persons, was 2.35 (95% CI, 1.10 to 5.02); the rate ratio was again highest in male recipients between the ages of 16 and 19 years (8.96; 95% CI, 4.50 to 17.83), with a ratio of 1 in 6637.

Conclusions: The incidence of myocarditis, although low, increased after the receipt of the BNT162b2 vaccine, particularly after the second dose among young male recipients. The clinical presentation of myocarditis after vaccination was usually mild.

Author/s:

Mevorach, D., Anis, E., Cedar, N., Bromberg, M., Haas, E. J., Nadir, E., Olsha-Castell, S., Arad, D., Hasin, T., Levi, N., Asleh, R., Amir, O., Meir, K., Cohen, D., Dichtiar, R., Novick, D., Hershkovitz, Y., Dagan, R., Leitersdorf, I., Ben-Ami, R., Miskin, I., Saliba, W., Muhsen, K., Levi, Y., Green, M. S., Beinan-Boker, L., Alroy-Preis, S.

Coronavirus: Vaccines and Immunity - An interview with Gregory A. Poland, M.D. from the Mayo Vaccine Research Group

John Bayhi — Thu, 26 Mar 2020 14:17:09 +0000

Date Added:

March 26, 2020

Journal/Publication:

JAMALive

Publisher:

American Medical Association

Publication Date:

March 24, 2020

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Video

Keywords

COVID-19

2019 novel coronavirus

2019-nCOV

vaccine

immunology

A 30-minute videotaped interview with a Mayo immunologist regarding the immunology of COVID19. Worth watching. James W. Mold, MD, MPH

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As COVID-19 spreads globally, populations who survive their illness will become immune. Mayo Vaccine Research Group Director Gregory Poland, MD discusses antibody responses, the duration of immunity, herd immunity, vaccine candidates, and the prospects for using convalescent serum to passively immunize unexposed high-risk people. Livestreamed March 24, 13:00 CDT (GMT-05:00). #JAMALive #Coronavirus #COVID19 #SARSCoV2

Author/s:

Bauchner, H