The coronavirus disease 2019 (COVID-19) pandemic spread across the world from late 2019 onwards, causing almost seven million deaths and over a hundred times that number of infections. Post-COVID-19 conditions (PCC) or long COVID syndromes began to be reported early in the course of the pandemic. A new study in The BMJ explores how far vaccination averted PCC.
Within a year of the onset of COVID-19, vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were rolled out in many countries, the first dose in Sweden being given in December 2020. Vaccination is credited with a reduction in the incidence and severity of acute infection, reinfection, and breakthrough infection.
However, PCC is suspected to affect millions of COVID-19 survivors. In Sweden, it affected 2% of previously infected adults. PCC typically occurs within three months of the start of acute COVID-19, may last two months or more, and cannot be accounted for by other factors.
Symptoms of PCC include fatigue, breathlessness, brain fog, headaches and muscle pain, and chest pain. These have been classified into four clusters, namely, chronic fatigue-like syndrome, respiratory syndrome, chronic pain syndrome, and neurosensorial syndrome.
Earlier research suggested that being vaccinated against the virus might protect against PCC following break-through infections, but the evidence was of low certainty due to the presence of confounding factors.
The present Swedish study aimed to explore how well primary vaccination (two primary doses plus one booster dose) could avert PCC. The participants came from the Swedish Covid-19 Investigation for Future Insightsa Population Epidemiology Approach using Register Linkage (SCIFI-PEARL) project.
This included all COVID-19-positive adults on the register between the end of December 2020 and early February 2022, almost 590,000 people from the two largest regions of Sweden. Various events were recorded, including their first COVID-19 infection, movement out of the country, vaccination, reinfection, or a PCC diagnosis, until their death or until follow-up ended on November 30, 2022.
The researchers defined vaccinated individuals as those who had received one or more doses of the vaccine before becoming COVID-19-positive. They evaluated the odds of developing PCC with or without vaccination, compensating for sex, age, other illnesses, the general health of the individual, the circulating variant at the time of infection, and the socioeconomic profile of the participant.
The results indicated that at a median of 129 days of follow-up after COVID-19 was diagnosed, PCC incidence was higher among the unvaccinated vs vaccinated group. Among those who had one or more doses of vaccine before becoming infected, a total of ~300,000 people, about 0.4%, were diagnosed with PCC during follow-up. Conversely, the incidence of PCC was 1.4% among the almost equal number of unvaccinated individuals.
About 1% of the vaccinated group experienced reinfections vs 3% of the unvaccinated group. Most (60%) unvaccinated individuals were infected during the Alpha variant dominant phase, but three-quarters of vaccinated individuals were infected with the emergence of Omicron.
Despite a very low level of hospitalization following a COVID-19 infection, the odds of hospital admission were higher among the unvaccinated at 4% vs 1.5% for the vaccinated.
Further analysis showed that among the vaccinated, about a tenth took only one dose, while just over 200,000 had two doses. About 73,000 had at least three doses. Significantly more women were vaccinated, at 57% vs 44% for men, and vaccinated individuals had a median age of 42 years vs 39 years among the unvaccinated.
The longest median follow-up of 250 days before PCC was diagnosed was observed among those who had three or more doses of vaccine vs 42 days among those with only one dose. The median time to PCC diagnosis was similar overall, at ~17-18 days, for vaccinated and unvaccinated groups.
Thus, the risk of PCC was reduced by almost 60% after one or more doses of a COVID-19 vaccine. The vaccine effectiveness against PCC was thus calculated to be 58% overall. In more detail, it increased with each dose, from 21% for one dose, ~60% for two, and 73% for three doses of the vaccine.
The study indicates that COVID-19 vaccination is closely linked to a lower risk of PCC. In other words, the risk of PCC was four times higher in the unvaccinated group vs the vaccinated, though both were relatively rare at 1.4% vs 0.4%, respectively.
Earlier studies generally showed a protective effect of vaccination but with limited reliability due to the large differences between studies and low certainty of evidence. The current study excluded all unvaccinated people who subsequently received one or more vaccine doses during the period of follow-up from the original unvaccinated group to ensure rigorous methodology was preserved.
The protective effect might be explained by a lower viral load during acute infection, resulting in reduced viral persistence and, therefore less acute and long-term activation of abnormal immune responses. Earlier, these authors demonstrated a 37% risk of PCC among COVID-19 cases who required intensive care unit (ICU) admission. Such severe infections are reduced following vaccination, which is one pathway leading to a lower PCC risk.
However, other mechanisms also appear to be at work to foster vaccine-induced protection against PCC, which may occur even in those without a confirmed COVID-19 infection.
The results from this study highlight the importance of complete primary vaccination coverage against COVID-19, not only to reduce the risk of severe acute covid-19 infection but also the burden of PCC in the population.
Short of soldiers, the US Army is recalling former soldiers who had been fired from their jobs after refusing to get jabbed by the COVID-19 vaccine, according to a report in the New York Post. The army is sending letters to the ex-soldiers and urging them to apply to rejoin.
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The army retracting its earlier position comes almost a year after Congress forced the Pentagon to roll back its mandate that required all troops to receive the COVID-19 vaccine.
As part of the overall Covidmandate rescission process mandated by Congress, the Army this month mailed the letters to approximately 1,900 individuals who had previously been separated, Bryce Dubee, the army spokesman was quoted as saying by the publication.
Of the 1,900 letters sent, only 19 have returned to active duty but the army was hopeful that more will return as the news spreads.
Watch |Gravitas: Will USrun out of soldiers? Army Short of 10,000 Troops | Here's Why
The former soldiers are being urged to contact the Army, Army Reserve, or National Guard recruiter. Notably, almost 8,000 soldiers were shown the door at the peak of the coronavirus crisis when they stuck to their pro-choice motto.
It isstill not clear if the re-hired soldiers will be restored to their old job profiles. Moreover, there is no clear-cut list of standards for acceptance back into the service but the Post stated that applicants will be considered on a case-by-case basis.
It was in August 2021 that Defense Secretary Lloyd Austin sent a memo, mandating the soldiers to get vaccinated. While the majority complied, a section doubted the efficacy of the newly minted vaccines and refused to follow the order.
However, the Republicans contested the decision, arguing that it would hurt the military in the long run. For 15 months, the mandate remained in force before being taken down as COVID-19 numbers dropped.
The US Army is facing a crunch in the number of personnel joining the service. The strength fell from an original485,000 in late 2021 to around 452,000 active-duty soldiers in 2023. The recruitment board of the army fell 10,000 short of its hiring goal of 65,000 in 2023 alone.
(With inputs from agencies)
London: Long Covid is less likely among the vaccinated before infections, but among those unvaccinated, the risk is four times more, a study revealed. The study published by The BMJ showed that receiving at least one dose of COVID-19 vaccine before the first infection is strongly associated with a reduced risk of developing long Covid. Researchers from the University of Gothenburg, Sweden, said their results "highlight the importance of primary vaccination against COVID-19 to reduce the burden of post-Covid conditions in the population".
The team investigated the effectiveness of primary Covid vaccination (the first two doses and the first booster dose within the recommended schedule) against Long Covid conditions in 589,722 adults (aged 18 and over). Individuals were followed from a first Covid infection until a diagnosis of Long Covid condition, vaccination, reinfection, death, emigration or end of follow-up whichever came first. The average follow-up was 129 days in the total study population (vaccinated: 197 days, not vaccinated: 112 days).
Of the 299,692 vaccinated individuals with Covid, 1,201 were diagnosed with Long Covid during follow-up, compared with 4,118 of 290,030 unvaccinated individuals. Those who received one or more Covid vaccines before the first infection were 58 per cent less likely to receive a diagnosis of post-Covid condition than unvaccinated individuals.
And vaccine effectiveness increased with each successive dose before infection (a dose-response effect). This is an observational study, which provides less conclusive evidence of causality, and the researchers point to several limitations such as limited data on post-Covid condition symptoms and that the diagnosis code is not yet validated, the potential impact of reinfections on vaccine effectiveness, and expectations about the protective effect of vaccination.
The findings, combined with evidence from other studies, highlight the association between the immune system and the development of post-viral conditions, and underline the importance of timely vaccination during pandemics, said researchers in a linked editorial. They called for continued investigation into the evolution of long-term residual symptoms of Covid and other viral illnesses as well as steps to "improve the accuracy of recording both recovery and continued illness after infection, and in quantifying key family, social, financial, and economic outcomes".
"Such estimates are fundamental to unlocking the funding required for future research and increased investment in specialist clinical services offering treatment and rehabilitation to support patients with post-viral conditions," they said.
Unvaccinated individuals almost four times as likely to be diagnosed than those vaccinated before first infection
Receiving at least one dose of a covid-19 vaccine before the first infection is strongly associated with a reduced risk of developing post-covid-19 condition, commonly known as long covid, finds a study published by The BMJ today.
The findings, based on data for more than half a million Swedish adults, show that unvaccinated individuals were almost four times as likely to be diagnosed with long covid than those who were vaccinated before the first infection.
The researchers stress that causality cannot be directly inferred from this observational evidence, but say their results "highlight the importance of primary vaccination against covid-19 to reduce the burden of post-covid-19 condition in the population."
The effectiveness of covid-19 vaccines against SARS-CoV-2 infection and severe complications of acute covid-19 are already known, but their effectiveness against long covid is less clear because most previous studies have relied on self-reported symptoms.
To address this, researchers investigated the effectiveness of primary covid-19 vaccination (the first two doses and the first booster dose within the recommended schedule) against post-covid-19 condition using data from the SCIFI-PEARL project, a register based study of the covid-19 pandemic in Sweden.
Their findings are based on 589,722 adults (aged 18 and over) from the two largest regions of Sweden with a first covid-19 infection registered between 27 December 2020 and 9 February 2022.
Individuals were followed from a first covid-19 infection until a diagnosis of post-covid-19 condition, vaccination, reinfection, death, emigration or end of follow-up (30 November 2022), whichever came first. Average follow-up was 129 days in the total study population (vaccinated: 197 days, not vaccinated: 112 days).
Individuals who had received at least one covid-19 vaccine dose before infection were considered vaccinated.
A range of factors including age, sex, existing conditions, number of healthcare contacts during 2019, education level, employment status, and dominant virus variant at time of infection were also accounted for in the analysis.
Of 299,692 vaccinated individuals with covid-19, 1,201 (0.4%) were diagnosed with post-covid-19 condition during follow-up, compared with 4,118 (1.4%) of 290,030 unvaccinated individuals.
Those who received one or more covid-19 vaccines before the first infection were 58% less likely to receive a diagnosis of post-covid-19 condition than unvaccinated individuals.
And vaccine effectiveness increased with each successive dose before infection (a dose-response effect). For example, the first dose reduced the risk of post-covid-19 condition by 21%, two doses by 59%, and three or more doses by 73%.
This is an observational study, which provides less conclusive evidence of causality, and the researchers point to several limitations such as limited data on post-covid-19 condition symptoms and that the diagnosis code is not yet validated, the potential impact of reinfections on vaccine effectiveness, and expectations about the protective effect of vaccination.
However, this was a large, well designed study based on high quality, individual level registry data with a low risk of self-reporting bias, suggesting that the results are robust.
As such, the authors conclude: "The results from this study highlight the importance of complete primary vaccination coverage against covid-19, not only to reduce the risk of severe acute covid-19 infection but also the burden of post-covid-19 condition in the population."
These findings, combined with evidence from other studies, highlight the association between the immune system and the development of post-viral conditions, and underline the importance of timely vaccination during pandemics, say researchers in a linked editorial.
They call for continued investigation into the evolution of long term residual symptoms of covid-19 and other viral illnesses as well as steps to "improve the accuracy of recording both recovery and continued illness after infection, and in quantifying key family, social, financial, and economic outcomes."
"Such estimates are fundamental to unlocking the funding required for future research and increased investment in specialist clinical services offering treatment and rehabilitation to support patients with post-viral conditions," they conclude.
Getting vaccinated could significantly reduce the risk of developing long Covid, with more jabs offering greater protection, according to a study.
Researchers found that people who had three or more doses of the vaccine were 73 per cent less likely to develop long Covid after an infection than those who were unvaccinated.
They also found that people were 21 per cent less likely to develop the condition after the first dose and 59 per cent less likely after the second, according to the study published in the BMJ.
The results from this study highlight the importance of getting vaccinated against Covid-19 not only to reduce the risk of severe infection but also the risk of long Covid, Maria Bygdell, of the University of Gothenburg, told i.
Estimates of how many people in the UKhave long Covid, defined as having symptoms for three months or longer, vary from around one to 2 million.
The most common lasting symptoms are fatigue, difficulty thinking or concentrating and joint pains.
But other persistent symptoms include a loss or change of sense of smell or taste, shortness of breath, severe fatigue, chest tightness or pain, and poor memory, according to the latest findings from Imperial College Londons REACT study.
It was already well known that vaccines reduce the risk of severe illness after a Covid infection as well as, to a lesser extent, the risk of becoming infected in the first place.
Meanwhile, previous research has suggested that jabs could also reduce the risk of long Covid which can develop from mild as well as serious cases of the virus, although less commonly so.
But these earlier studies have tended to be small, based on self-reported symptoms, which are typically less reliable, and conducted in trial conditions, researchers say.
They have also typically lumped together the different numbers of doses for each person, despite individual variations in the number of jabs.
As such, the findings of previous research have been highly variable.
By contrast, this is a large study of 589,722 adults based on real-world data and clinical diagnoses, and it splits out the benefit of each successive dose.
This makes it the most comprehensive study into the benefits of vaccines against long Covid which should go a long way to settling the matter, researchers say.
Dr Bygdell points out that the study was observational, meaning that it identified an association between vaccines and reduced long Covid risk, rather than establishing cause and effect.
As such, there may have been some other reason for the link. But the researchers are confident their findings are solid and strongly back the case for vaccinations to reduce the risk of long Covid.
A range of factors including age, sex, existing conditions, number of healthcare contacts during 2019, education level, employment status, and dominant virus variant at time of infection were also accounted for in the analysis, they say.
In a BMJ editorial about the significance of the research, Manoj Sivan, of Leeds University, said These are impressive findings It is reassuring that Covid-19 vaccines have a clear and clinically important protective effect against post-Covid-19 condition.
Dr Sivan also has a theory about the protection offered against long Covid.
He said: Vaccines activate the immune systems antibody and T-cell responses, enabling the neutralisation or destruction of [the virus], reducing the severity of infection and risk of hospital admission and death. These mechanisms could also explain the protective effect of vaccines against post-Covid-19 condition.
On the differences between this study and previous research in this area, Dr Bygdell added: A few studies have previously evaluated the potential protective effect of vaccines on long Covid. However, they have been relatively small, seldom population-based and [have] often not evaluated the effect for a different number of vaccine doses.
We have conducted a large study based on all adult residents in the two largest regions in Sweden. We have also used a clinical diagnosis of post-Covid-19 condition compared to other studies who often used self-reported symptoms after Covid-19.
The findings from the Swedish Covid-19 investigation for Future Insights is based on data for more than half a million Swedish adults, according to the British Medical Journal.
It shows unvaccinated individuals were almost four times as likely to be diagnosed with long-Covid than those who were vaccinated before first infection.
The researchers point out causality cannot be directly inferred from this observational evidence, but say their results highlight the importance of primary vaccination against Covid-19 to reduce the burden of the condition in the population.
The effectiveness of Covid-19 vaccines against the infection and severe complications of acute Covid-19 are already known, but their impact against long-Covid is less clear because most previous studies have relied on self-reported symptoms.
To address this, researchers investigated the effectiveness of primary Covid-19 vaccination the first two doses and the first booster dose within the recommended schedule against post-Covid-19 condition using data from the SCIFI-PEARL project, a register-based study of the pandemic in Sweden.
Individuals were followed from a first Covid-19 infection until a diagnosis of post-Covid-19 condition, vaccination, reinfection, death, emigration or end of follow-up.The average follow-up was 129 days in the total study population.
Individuals who had received at least one Covid-19 vaccine dose before infection were considered vaccinated.
A range of factors including age, sex, existing conditions, number of healthcare contacts, education level, employment status, and dominant virus variant at time of infection were also accounted for in the analysis.
Of 299,692 vaccinated people with Covid-19, 1,201 (0.4pc) were diagnosed with a post-Covid-19 condition during follow-up, compared to 4,118 (1.4pc) of 290,030 unvaccinated people.
Those who received one or more Covid-19 vaccines before the first infection were 58pc less likely to receive a diagnosis of post-Covid-19 condition than unvaccinated individuals.
And vaccine effectiveness increased with each successive dose before infection. For example, the first dose reduced the risk of post-Covid-19 condition by 21pc, two doses by 59pc, and three or more doses by 73pc.
These findings, combined with evidence from other studies, highlight the association between the immune system and the development of post-viral conditions, and underline the importance of timely vaccination during pandemics, say researchers in a linked editorial.
They call for continued investigation into the evolution of long-term residual symptoms of Covid-19 and other viral illnesses as well as steps to improve the accuracy of recording both recovery and continued illness after infection, and in quantifying key family, social, financial and economic outcomes.
Such estimates are fundamental to unlocking the funding required for future research and increased investment in specialist clinical services.
IOWA CITY When the phrase something is going around becomes common in schools, offices, and inevitably health care clinics every fall, a frequent fear especially among older patients and the parents of infants is that the something is RSV.
Although the common and highly contagious RSV short for respiratory syncytial virus runs a mild, cold-like course for most people, it can hit infants and patients over 60 hard, even requiring hospitalization.
But, for the first time, a vaccine now is available for those high-risk groups thanks, in part, to University of Iowa Health Care trial work.
There are actually two vaccines on the market, UIHC nurse practitioner Christina Kopp told The Gazette about the shots marketed for adults over the age of 60 and for pregnant women, 32 to 36 weeks pregnant.
Between 58,000 and 80,000 children under age 5 are hospitalized for RSV annually in the U.S., according to the U.S. Centers for Disease Control and Prevention. Between 100 and 300 kids die from RSV nationally every year.
The goal is that the mom can pass the antibodies on to the newborn and have a good antibody supply in that newborn until it starts to drop about six months of age, Kopp said.
Every year in the United States, 60,000 to 160,000 older adults are hospitalized for RSV and 6,000 to 10,000 die, according to the CDC.
The new vaccines became available in May after long-sought Food & Drug Administration approval and after decades of RSV-vaccine related efforts and, more recently, groundbreaking trials.
One vaccine, Arexvy by GSK, is approved for people 60 and older; a second, Abrysvo by Pfizer, also is approved for pregnant women near the end of their term.
Both contain part of the RSV virus and work by inciting an immune response that can protect from future illness.
The UI participated in a clinical trial for the Pfizer RSV vaccine, led by Dr. Patricia Winokur, executive dean of the UI Carver College of Medicine. The UI site enrolled about 150 Iowans.
Winokur said the vaccines were very effective.
They were tested in really big clinical trials, with about 40,000 people in each of the trials for the two vaccines, and about 85 percent of people were protected from having serious RSV disease, Winokur said for a UI Health Care report on the vaccines in October. That is a pretty good track record.
The immunity, according to the trials, seemed to last two years, which is really encouraging, Winokur said.
UIHC, among its current vaccine and treatment trials, is participating in a phase investigating the Pfizer RSV vaccines effectiveness for adults at high risk for severe complications from the virus.
If you are a solid organ transplant recipient, are currently undergoing dialysis, or are currently being treated for cancer, and would be interested in participating in this trial, please complete the survey, according to a UIHC appeal for trial participants.
Other vaccines UIHC is investigating include an mRNA vaccine for shingles, a new pediatric flu vaccine and an updated COVID vaccine.
Steve Varga, UI RSV expert and professor of microbiology and immunology, said RSV can be more threatening to infants because their airways are small and still growing.
But developing an RSV vaccine has been a struggle since scientists started in earnest in the 1960s, according to Varga. Initial trials failed, in that vaccines they tested caused children to experience worse disease than when they were naturally infected with RSV.
The terrible failure of that vaccine trial was such a shock to the scientific community that it effectively halted RSV vaccine development for decades, according to Varga. It also led to many of the new safeguards for conducting and monitoring clinical trials that are used today to ensure the safe development of vaccines and therapies.
A breakthrough in RSV vaccine work came several years ago when scientists determined how to target a protein on the surface of the virus.
Immunology has also advanced significantly, Varga said. And scientists now know why the original vaccine failed.
Still, no RSV cure or treatment exists with supportive care the best bet, including things like Tylenol or ibuprofen as needed, along with rest and fluids.
RSV preventive antibody products have been OKd for infants and young children with conditions that put them at higher risk for severe illness but theyre in short supply, making the vaccines for pregnant women the best way to protect newborns.
The highest risk group is those really young infants, and so getting those pregnant moms able to get vaccinated and transfer those antibodies is a really good protection, said Kopp, the UI nurse practitioner.
Today, pregnant women are advised to get vaccines, including flu, Tdap, COVID and now RSV.
Kopp said she wishes that full list had been available to her a year ago.
Last year, I actually was pregnant myself and had a baby in October of 2022, Kopp said. And I remember hearing about the RSV vaccine coming soon and I was like, I wish that it was available so that I could get it. One of the biggest fears, as a health care provider, is having a newborn at home and worrying about RSV.
People can schedule a flu or COVID shot with the University of Iowa Hospitals and Clinics either online or through My Chart at https://uihc.org/get-vaccinated
People eligible for the RSV vaccines 60 and older, or pregnant women (32 to 36 weeks) can talk with their doctor about getting the vaccine.
Source: UI Health Care
Vanessa Miller covers higher education for The Gazette.
Comments: (319) 339-3158; vanessa.miller@thegazette.com
In rural areas, especially in developing countries, the long distance to a medical facility may hinder a population from getting vaccinations, and especially booster doses.
Vaccinesfor everything from influenza to COVID-19 to pneumococcal diseasesare stored at a low temperature forstability andare typically administrated through ahypodermicneedle and syringe from a health care professional.
What if we were able to mail people vaccines that dont need refrigeration and they could apply them totheir own skinlike a bandage? asked Thanh Nguyen, associate professor of mechanical engineering and biomedical engineeringat the University of Connecticut.And what if we could easily vaccinate peopleoncewhere theywouldntneed a booster? We couldpotentiallyeradicate polio, measles, rubella, and COVID-19.
The answer, Nguyen believes, is administrating vaccines through aprogrammablemicroneedle array patch with anovelprocess he isdeveloping athis lab at UConn.
By adhering anearly painless, 1-centimeter-squarebiodegradablepatch to the skin, a person can receive apreprogrammed deliveryof highly-concentrated vaccines in powder formover monthsandeliminatethe need for boosters.The primary argument is that getting vaccines and boosters is a pain, Nguyen said. Youhave togo back two or three times to get these shots. With the microneedle platform, you put it on once, anditsdone. You have yourvaccineand you have your boosters. Youdonthave to go back to the doctor or hospital.
This month, UConns Institute of Materials Science received athree-yeargrant from the Bill & Melinda Gates Foundation to support Nguyens research on Single-Administration Self-boosting Microneedle Platform for Vaccines and Therapeutics. The projectsgoalis to develop a low-cost manufacturing process.
TheNguyen Research Grouphas already been working to thermally-stabilize vaccines and other therapeutics so they can stay inside the skin fora long period. In 2020,Nature Biomedical Engineeringpublished a studyby Nguyen and his colleaguesreporting that, in rats, microneedles loaded with a clinically available vaccine (Prevnar-13) against a bacteriumprovidedsimilar immune protectionasmultiple bolus injections.
Weve been able to show this technology is safe and effective in the small animal model, but now the question is, how do we translate it into the commercialized stage and make it useful to the end user, which is the human, he said.
With support from the Gates Foundation, Nguyenwill be able to test his microneedle platform on a larger animala pig, which has skinsimilar tohumans. And if the results are similar, Nguyenpredictsthis technology could be manufactured, at an affordable cost, enabling both domestic and global health impact.
Nguyensmicroneedle platform also caught the attention of the United States Department of Agriculture. In September, the USDA: Research, Education, and Economics division awarded Nguyen with a two-year grant for a study titled Delivery of FMDV Protein Antigens Using a Programmable Transdermal Microneedle System.
The Foot-and-Mouth Disease Virus(FMDV) is a highly contagious disease that affects the health of livestock such as cows, pigs, sheep, and goats.When an outbreak occurs, the disease leaves affected animals weakened and unable to produce meat and milk. FMDV causes production losses and hardships for farmers and ranchers, and has serious impacts on livestock trade.
And while vaccines exist, like with humans, boosters are required tokeep the vaccine effective.
USDA is interested in the technology because the patch will be able to deliver the initial dose and subsequent doses, or boosters, to animals without the need for rounding up and handling multiple animals at once, Nguyen explained. This decreases stress on the animals and increases safety for the animals and their handlers.
The microneedle platform is among the latest applications the Nguyen Research Group is exploring in the arena of vaccine/drug delivery, tissue regenerative engineering, smart piezoelectric materials, electronic implants, and bioelectronics. Since joining the College of Engineering in 2016, Nguyen has discovered a method of sending electric pulses through a biodegradable polymer to assist with cartilage regeneration; hes designed a powerful biodegradable ultrasound device that could make brain cancers more treatable; and he used microneedle patches to deliver antibody therapies, which have been proven successful in treating HIV, autoimmune disorders such as multiple sclerosis, and certain types of cancer.
Christina Tamburro, post-award grants and contracts specialist for UConns Institute of Materials Science said IMS is grateful to both the Gates Foundation and USDA for supporting Professor Nguyens drug delivery research.
This is a wonderful application of material science and this is what were all about. Ultimately, this is going to save lives and it cant get better than that, she said.
Among a cohort of patients who received a flu vaccine, there was a 26% decreased risk of heart attacks and a 33% reduction in cardiovascular deaths, according to one study.1 These findings suggest a connection between influenza vaccination and reduced risk of cardiovascular diseases (CVDs).
While differing viewpoints exist regarding the impact of influenza vaccination on CVDs, some observational investigations have found a favorable connection between influenza vaccination and the reduction of cardiovascular incidents, such as acute myocardial infarction (MI).
This systemic review published in Scientific Reports, aimed to assess the possible association between influenza vaccination and a decreased likelihood of experiencing cardiovascular events.1
Revealing a compelling insight into the potential benefits of influenza vaccination, our comprehensive meta-analysis, based on the latest randomized controlled trial (RCT) data, demonstrates a significant interaction between influenza vaccination and the reduction of major cardiovascular events, wrote the researchers of the study. Notably, patients who received the influenza vaccine experienced a remarkable risk reduction of over 20% in cardiovascular death.
The researchers conducted a search of 275 English-literature studies using PubMed/MEDLINE, EMBASE, and the Cochrane CENTRAL databases through August 1, 2023, using the search terms myocardial disease and influenza vaccines. The review was conducted on RCTs exploring the potential link between influenza vaccination and the subsequent risk of developing CVDs.
Participants in the analysis had a diagnosis of CVD and the outcome was lower risk of cardiovascular events. Conference abstracts, case reports, and studies comparing high and low doses of influenza vaccination were excluded from the analysis.
The final analysis of 5 studies included 4529 patients who received the flu vaccine and 4530 patients who received a placebo. The average age of participants was 61 years. The study follow-up lasted an average of 9 months.
Of these participants, a total of 517 individuals experienced significant cardiovascular events compared with 621 cases among individuals who were administered a placebo (risk ratio [RR], 0.70; 95% CI, 0.55-0.91). Additionally, there was a decreased risk of heart attacks in vaccinated patients (RR, 0.74; 95% CI, 0.56-0.97) and a significant reduction in cardiovascular death events (RR, 0.67; 95% CI, 0.45-0.98).
These findings revealed a significant link between influenza vaccination and the reduction of major cardiovascular events among patients with recent cardiovascular diseases, in which there may be potential benefits of targeting this high-risk group for vaccination.
Regarding the potential mechanisms behind why vaccination protects heart health, the researchers note the possibilities of lowering inflammation caused by influenza, preventing secondary infections, and ensuring the stability of atherosclerotic plaque, which can become destabilized during the flu.
However, the researchers believe that further research is needed to better understand the precise mechanisms driving this association and to understand the potential long-term impact of influenza vaccination on cardiovascular outcomes.
In the meantime, health care providers and policymakers should take heed of these findings and consider prioritizing influenza vaccination for patients with recent CVDs as a feasible and potentially life-saving preventive measure, wrote the researchers.
This article originally appeared in AJMC.
Testing vaccine hesitancy hypotheses using multiple datasets presents challenges. Datasets associated with household-level and contextual factors have different geographic support, defined as the area, shape, size, and orientation of spatial measurement. Data on vaccine acceptance tend to come from household-level surveys; data on political violence are typically point-level event coordinates; data on elections tend to be measured by electoral constituencies (e.g. legislative districts); key development indicators, like road infrastructure, may be available as polyline features. These data come in different formats and structures (delimited text, vectors of location attributes, raster images); areal units are not nested and have misaligned borders; some of the data (e.g. surveys) may not be georeferenced at all. Different data integration choices may yield different results, raising concerns over generalizability [5]. Differences in sampling, question wording and sequence, primary sources, operational definitions, digital image processing algorithms, and other factors ensure that no two datasets are perfect substitutes for one another, making it difficult to distinguish case-specific idiosyncracies from general patterns, and to ask, "what does country A tell us about country B?" Finally, survey data pose a separate challenge of distinguishing "snapshots" of public attitudes from stable long-term trends. We illustrate how to mitigate some of these common challenges. The SUNGEO system accounts for these issues.
SUNGEO allows users to combine data across otherwise incompatible geographic units into a common format, and facilitates the analysis and visualization of processed geospatial data (Fig.1). It includes a user-friendly web interface and API, where researchers can select among many existing variables, choose levels and methods of spatiotemporal (dis)aggregation, interpolation and integration, and decide on the boundaries of their subnational datasets. Its large collection of pre-processed data enables users to replicate their research designs across different scales, data sources, countries, and integration procedures. SUNGEO also includes an open-source software package in the R statistical programming language to process user-supplied data, merge it with pre-loaded geo-referenced data, and produce a more customizable output based on user needs and specifications. It includes an archiving tool, which allows users to contribute original data to the repository.
Overview of the SUNGEO system
This demonstration uses vaccination hesitancy data from the World Bank Groups High Frequency Phone Surveys (HFPS). The HFPS was a longitudinal cohort (panel) study on the socio-economic impacts of COVID-19 conducted in 53 countries and contexts between 2020 and 2022, with a subset of surveys including questions on vaccination hesitancy. We analyzed surveys from Indonesia, Kenya, and Malawi, as they: 1) were larger surveys with rigorous sampling methods representative of the general population; 2) included granular geographic information; and 3) were from three distinct regions (East Africa, Southern Africa, and South-East Asia). The survey datasets include sampling weights, based on the inclusion probabilities of the cell phones and landlines through which respondents were reached, along with first-time and attrition non-response weighting adjustments, and calibration with auxiliary information on regional population size, respondent sex, age group, and educational attainment. More information on each dataset can be found from the World Bank Group [6].
Contextual variables were provided from SUNGEO's preprocessed spatial data archive. Sub-national data on political violence are available for 195 countries through SUNGEO's partnership with the xSub data repository, which hosts leading event databases, including the Armed Conflict Location and Event Data Project (ACLED), the National Violence Monitoring System (NVMS), the Social Conflict Analysis Database (SCAD), and the Uppsala Conflict Data Program's Georeferenced Event Dataset (UCDP-GED). We chose among these by re-estimating our empirical models with each dataset on violence, and selecting the data source that yielded the strongest model fit (NVMS for Indonesia, UCDP-GED for Kenya, SCAD for Malawi; see Additional file 2: Appendix B3). Data on legislative elections in 168 countries are available through the Constituency-Level Elections Archive (CLEA). As a proxy measure for economic development, we used local road density, which can be calculated using the Global Roads Open Access Data Set (gRoads). More information on these datasets can be found from their respective sources [7,8,9,10,11]. We also used SUNGEO to extract data on other geographic variables that may affect attitudes toward, or the availability of, vaccines. These include ethno-linguistic fractionalization, average night light intensity, and terrain (see Additional file 2: Appendix B2 for details and estimation results) [12,13,14].
a. Vaccine surveys
HFPS data are available through the Inter-university Consortium for Political and Social Research (ICPSR). ICPSR secured the World Banks permission to access HFPS data, then carried out a disclosure risk review to prevent direct or inferential re-identification of individuals or organizations. The curation process included generating question text employing the social science variables database to compare across studies,reviewing data to ensure all translations were correct and to create the variable and values list, conducting quality control, and hosting of the data on the ICPSR website in a fully searchable format. Further detail can be found in Additional file 1: Appendix A. In Additional file 2: Appendix B1, we examine sample attrition patterns across rounds, and find that respondents who dropped out of these samples were statistically similar on observables to those who remain.
b) Contextual data
Disaggregated data on violence, elections and economic development are available through SUNGEO. In aggregate form, the violence data are event counts, representing the number of incidents of political violence observed in each spatial unit over the two decades prior to the first survey. The election data are weighted averages of local "Top-1" competitiveness from the most recent legislative election, measured as one minus the winning vote margin, where values of 1 indicate that the most recent parliamentary election was very close, and 0 indicates that it was not competitive because the winner received almost all of the votes. We also considered alternative measures of electoral competitiveness, but the "Top-1" measure yielded a generally stronger model fit (Additional file 2: Appendix B3). The road density data are local sums of primary and secondary road lengths in each administrative unit, divided by that unit's area in square kilometers.
For each country, we used SUNGEO to extract data on political violence, legislative election data, and road infrastructure data, along with other contextual datasets (Additional file 2: Appendix B1). For Indonesia and Malawi, our spatial units were level-2 administrative divisions. For Kenya, we used level-1 administrative divisions.
To link data to household-level vaccine surveys, we used SUNGEO's R package to geocode survey sampling units, assigning a pair of geographic coordinates to each unique location. This allowed us to match each surveyed household to its corresponding level-2 (or level-1, in Kenya) spatial unit, and merge the datasets geographically (see Additional file 2: Appendix B1).
We examined why some households express stable, pro-vaccine preferences, while others remain vaccine hesitant, or change their minds. Vaccine hesitancy varies spatially (across households) and temporally, with households changing their position. In the Indonesian survey, 73% of households gave the same answer to the vaccine intent question in two consecutive rounds (e.g. "yes" in rounds 4 and 5, or "no" in rounds 4 and 5). In Kenya, 68% gave the same answer across two rounds. In Malawi, 63% gave the same answer. Because the same households may give different responses on different occasions, we needed an empirical strategy that explicitly accounts for this shifting dynamic.
We modeled the survey responses as a stochastic process (Markov Chain) with two states. When asked the question, if the vaccination was available for you at no cost, would you take the vaccination, a household may either:
Express an intent to receive the Covid-19 vaccine ("yes"), or
Not express such an intent ("no").
From one round to another, a household will have some probability of staying with their previous response, and some probability of transitioning to another response. We model these transition probabilities as conditional on a series of household-level and contextual covariates:
$$text{Pr}(mathrm{y}_{mathrm{i},mathrm{t}};=;1);=;text{logit}^{-1};left[mathrm{x}_{mathrm{i}}{{theta}}_{0};+;{mathrm{y}}_{mathrm{i},mathrm{t}-1};cdot;{mathrm{x}}_{mathrm{i}}upgamma;+;{alpha}_{{mathrm{k}}_{(mathrm{i})}}+;{tau}_{mathrm{t}};+;{varepsilon}_{mathrm{i},mathrm{t}}right]$$
(1)
where y i,t is 1 if household i says "yes" in round t, and 0 if the household says "no", y i,t-1 is a first-order temporal lag, k(i) is a fixed effect for the administrative unit k in which i is located, t is a fixed effect for each survey round, and i,t are robust standard errors, clustered by administrative unit and survey round. The vector of covariates x i includes household-level measures like respondent's age and gender, and an indicator for whether the household is located in an urban area, as well as contextual information on violence, electoral competitiveness, road density, night light intensity, ELF, and terrain.
0 are regression coefficients for households that said "no" to the vaccine at t-1, and 1=0+ are coefficients for households that said "yes" at t-1. We will use these coefficient estimates to generate predicted probabilities of vaccine intent, and to construct transition probability matrices.
We estimated the model in Eq.(1) separately on integrated survey datasets from Indonesia, Kenya and Malawi.
