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How effective are mRNA vaccines in preventing hospitalizations due to the omicron variant? Population-based studies have suggested that the omicron (B.1.1.529) variant can evade immunity from prior infection and vaccination. Whether this influences the hospitalization rates due to COVID-19 is an important question that investigators are just beginning to answer. This retrospective study was conducted in a South African population and was based on healthcare data. The effectiveness of the BNT162b2 vaccine against hospitalizations was estimated during the period when the delta variant was predominant (September 1 to October 31; proxy delta period) and during the period when the omicron variant was predominant (November 15 to December 7; proxy omicron period). In total, 133,437 PCR tests were considered during the proxy delta period, and 78,173 tests were considered during the proxy omicron period. Overall test positivity (independently of vaccination status): 24.4% during the proxy omicron period 6.4% during the proxy delta period Test positivity among the fully immunized (≥ 14 days after the second dose of BNT162b2 vaccine): 33% during the proxy omicron period 8.2% during the proxy delta period Proportion of hospitalized patients with a positive PCR who were fully immunized: 28.2% during the proxy omicron period 8.3% during the proxy delta period Vaccine effectivenes to prevent hospitalization: 70% (95% CI, 62 to 76) during the proxy omicron period 93% (95% CI, 90 to 94) during the proxy delta period Limitations include that this study analyzed a single community (restricting generalizability), and that it did not include information on the severity of the disease in those patients who were hospitalized. The take‑home message? In this population-based, retrospective study, two doses of the BNT162b2 (Pfizer–BioNTech) vaccine was 70% effective in preventing hospitalization during the omicron period, which was lower than the estimated effectiveness during the delta period (93%). This highlights the importance of booster dosages and development of variant-specific vaccines. Title of study Effectiveness of BNT162b2 vaccine against omicron variant in South Africa Authors Bekker LG et al. Journal NEJM Original study https://doi.org/10.1056/NEJMc2119270 Open in QxMD Read AMBOSS Links COVID-19
Breakthrough infections after SARS-CoV-2 vaccination in patients with immune dysfunction Persons with a weakened immune system were excluded from the initial SARS-CoV-2 vaccine effectiveness trials. To bridge this evidence gap, this retrospective cohort study analyzed the risk for breakthrough infections in partially and fully vaccinated patients with immune disorders (i.e., HIV infection, multiple sclerosis, rheumatoid arthritis, solid organ transplant, and bone marrow transplantation) from December 10, 2020, to October 14, 2021. Data were obtained from the National Covid Cohort Collaborative (N3C), which provided information on 664,722 partially and fully vaccinated individuals. Out of this sample, a total of 35,512 patients with an immune disorder were identified. The overall breakthrough infection rate (IR) in fully immunized individuals was 5.0 per 1000 person-months. Compared to individuals with full vaccination and without immune dysfunction, the overall incidence of breakthrough infection was higher in individuals with an immune dysfunction: Individuals without immune dysfunction: IR of 7.1 per 1000 person-months Individuals with solid organ transplant: 15.7 per 1000 person-months Individuals with rheumatoid arthritis: 9.3 per 1000 person-months Individuals with HIV infection: 9.1 per 1000 person-months Individuals with multiple sclerosis: 8.9 per 1000 person-months Individuals with bone marrow transplant 8.6 (95% CI, 8.0-9.1) per 1000 person-months Furthermore, the time to breakthrough infection after completing immunizations was significantly shorter in individuals with immune dysfunction compared to those without immune dysfunction. Limitations include that vaccinations received outside the hospital setting may have been underreported. The take‑home message? This trial provides evidence that vaccinated individuals with compromised immune systems are at higher risk for breakthrough infections with SARS-CoV-2. This emphasizes the importance of mask-wearing and social distancing, and the need to investigate additional measures such as booster vaccinations in this population. Title of study Association between immune dysfunction and COVID-19 breakthrough infection after SARS-CoV-2 vaccination in the US Authors Sun J et al. Journal JAMA Internal Medicine Original study https://doi.org/10.1001/jamainternmed.2021.7024 Open in QxMD Read AMBOSS Links COVID-19
Does cataract surgery decrease the risk of dementia? Visual impairment may contribute to cognitive decline in older individuals, but whether surgery to restore vision can delay the onset of dementia has not been thoroughly investigated In this prospective, longitudinal nonrandomized cohort study, 3038 participants aged 65 years or older with cataract or glaucoma and no signs of dementia were screened every two years for the onset of dementia. Participants who received a cataract extraction (n = 1382) had a reduced risk of dementia compared to those who did not (n = 1656; HR 0.71; 95% CI, 0.62–0.83). However, the effect was not observed in participants with glaucoma who received glaucoma surgery vs. those who did not (n = 728; HR, 1.08; CI, 0.75–1.56). Limitations include the nonrandomized nature of the study and the possibility of coding errors due to the indications for surgery as well as the diagnoses of cataract and glaucoma having been extracted from electronic medical records. Furthermore, 91% of study participants were self-reported White race, limiting generalizability to other populations. The take‑home message? While cataract surgery, which restores vision, appears to reduce the risk of dementia in older individuals, the same effect was not observed in participants who received glaucoma surgery, which does not restore vision. This corroborates the association of vision loss and dementia, suggesting new paths for prevention of cognitive decline. Title of study Association between cataract extraction and development of dementia Authors Lee CS et al. Journal JAMA Internal Medicine Original study https://doi.org/10.1001/jamainternmed.2021.6990 Open in QxMD Read
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