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Document Type
Rapid Review
Review Code
EOC012201v2 RR
Question Submitted
January 22, 2021
Date Completed
May 10, 2021
Status
5. Updated review
Review History
EOC012201 RR: February 1, 2021
Research Team
EOC
: May 10, 2021 Version: 2 Review History: EOC012201 RR: February 1, 2021 Cite As: Badea
Document Type
Rapid Review
Review Code
EOC012201v2 RR
Question Submitted
January 22, 2021
Date Completed
May 10, 2021
Status
5. Updated review
Review History
EOC012201 RR: February 1, 2021
Research Team
EOC
Updated Key Findings
New search completed April 19, 2021 containing 29 grey literature sources and 128 published articles
Review of new search resulted in confirmation of previously compiled information, review update deemed not necessary at this time, relevant evidence has been added to the evidence table to reflect updated review
Key Findings
Vaccine hesitancy towards the COVID vaccine varies from 2% to 44% in the general population, depending on country, phase of pandemic and specific population
Vaccine hesitancy tends to be lower in healthcare workers than the general population, but still exists at rates up to 56%, again, dependent on the country of residence and phase of the pandemic
The most commonly cited reasons for vaccine hesitancy are concerns about the efficacy and safety, largely due to the expedited testing/approval process
Country of residence and corresponding trust in government/pharmaceutical industries can have a significant role in vaccine acceptance
Strategies to increase vaccine uptake should range from personal-level interventions such as patient education materials to health system level interventions such as healthcare provider training and targeted population vaccine acceptance campaigns
Category
Healthcare Services
Infection Prevention and Control
Subject
Vaccination
Health Planning
Population
All adults
Clinical Setting
Public Health
Priority Level
Level 2 One week (7 days)
Cite As
Badea, A; Reeder, B; Groot, G; Mueller, M; Young, C. What are the causes of vaccine hesitancy? What programs/approaches have been successful in reducing vaccine hesitancy? 2021 May 10 Document no.: EOC012201v2 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 11 p. (CEST evidence search report).
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Document Type
Rapid Review
Review Code
INF031801v7 RR
Question Submitted
March 18, 2021
Date Completed
July 20, 2021
Status
5. Updated review
Review History
INF031801v5 RR: June 22, 2021
INF031801v4 RR: June 3, 2021
INF031801v3 RR: May 24, 2021
INF031801v2 RR: May 14, 2021
INF031801 RR: March 31, 2021
Research Team
Infectious Disease
: INF031801v7 RR Review Date: July 20, 2021 Version: 7 Review History: INF031801 RR
Document Type
Rapid Review
Review Code
INF031801v7 RR
Question Submitted
March 18, 2021
Date Completed
July 20, 2021
Status
5. Updated review
Review History
INF031801v5 RR: June 22, 2021
INF031801v4 RR: June 3, 2021
INF031801v3 RR: May 24, 2021
INF031801v2 RR: May 14, 2021
INF031801 RR: March 31, 2021
Research Team
Infectious Disease
Updated Key Findings
July 16, 2021
There have been further effectiveness studies published that are in line with previous study results.
June 24, 2021, it was announced that nearly all the 300 deaths per day in the country were among unvaccinated individuals. For the entire month of May 2021 only 150 deaths out of 18,000 (0.8%) were among fully vaccinated people
Pfizer and BioNTech announced in a press release on July 8th that their ongoing third booster trial were producing promising data. They intend to publish more definitive data as it becomes available as well as submit to a peer-reviewed journal and intend to submit the data to the FDA, EMA and other regulatory authorities in the coming week. Canada, the UK, and the USA have stated that they will wait for more information before making a decision on third doses, but Israel has said they will begin third doses for those in higher risk groups for infection
A study from Ontario Canada found that partial vaccination (14+ days past first dose), vaccine effectiveness against symptomatic Delta (B.1.617) infection was 56% for Pfizer (BNT162b2), 72% for Moderna (mRNA-1273), and 67% for AstraZeneca (ChAdOx1-S), and for full vaccination (7+ days past second dose), vaccine effectiveness against symptomatic Delta (B.1.617) infection Pfizer (BNT162b2) increased protection to 87% (95% CI, 64–95%) results for fully vaccinated individuals with Moderna (mRNA-1273) and AstraZeneca (ChAdOx1-S) were not provided. While the studies leading to these results have attempted to correct for co-variates with logistic regression, Given the varying deployment of these vaccines (ie. Pfizer was offered to certain patients at certain times, Moderna offered initially to areas where storage was a concern, and AstraZeneca having differing guidelines for qualification for administration), it is impossible to directly compare these numbers without significant confounders. These numbers should not be used to make comparisons on brand superiority; rather, as a general sense of how effective a single dose of any vaccine is.
In Scotland between April 1- May 28, 2021 the estimated effectiveness of Pfizer (BNT162b2) against variant COVID-19 infection was found to be 92% (95% CI 90–93) for Alpha (B.1.1.7) and 79% (75–82) for Delta (B.1.617.2) For AstraZeneca (ChAdOx1-S) the estimated effectiveness was found to be 73% (95% CI 66–78) for Alpha (B.1.1.7) and 60% (53–66) for Delta (B.1.617.2)
Canadian data provided by the Public Health Agency of Canada (PHAC) shows that breakthrough infections among fully vaccinated Canadian’s account for 0.5% of reported since the vaccination rollout began in December 2020 (data collected excludes Québec, Saskatchewan and Newfoundland and Labrador), additionally only 0.0027% of COVID-19 deaths occurred among partially vaccinated individuals and 0.0018% among fully vaccinated individuals
In terms of transmission from infected vaccinated individuals: A study of 40 HCWs who had breakthrough asymptomatic COVID-19 infections following two doses of Pfizer (BNT162b2) identified 74 close contacts who were in contact within 48 hours of the positive test result, or during the 10-day quarantine period. Of those close contacts only 3 close contacts tested positive at the beginning of the quarantine period (1 symptomatic, 2 asymptomatic) and of the 23 spousal relationships (assumed to be in closer contact) none tested positive during the quarantine period or experienced COVID-19 symptoms.
A study considering 30,494 pregnant women vaccinated with Pfizer (BNT162b2) (16,039) and Moderna (mRNA-1263) (14,455) as of March 10, 2021, found that the rates of side effects and complications in vaccinated pregnant women did not seem significantly different from those of unvaccinated pregnant women. Follow up completed with 1815 pregnant women (275 already completed pregnancy) showed similar or lower rates of miscarriages, preterm births, stillbirths, hypertensive disorders of pregnancy, diabetes, growth restriction and perinatal mortality than what were expected from population-based estimates.
Key Findings
July 2, 2021
There have been further effectiveness studies published that are in line with previous study results.
NACI now recommends that those who received AstraZeneca (ChAdOx1-S) for their first vaccine preferentially receive a mRNA COVID-19 vaccine as their second dose. They have also advised that Pfizer (BNT162b2) and Moderna (mRNA-1273) can be used interchangeably as first or second doses.
Preliminary results from the Canadian Partnership for Tomorrow’s Health (CanPath) COVID-19 Antibody Study, show a high degree of variability in the level of antibodies produced by a single dose of a COVID-19 vaccine, emphasizing the importance of receiving a second dose in a two-dose regimen.
Public Health England reporting on a recently completed study between April 5th to May 16th that found: o 2 doses of the Pfizer (BNT162b2) vaccine were 88% effective against symptomatic disease from the B.1.617.2 variant (Delta) 2 weeks after the second dose. o 2 doses of the AstraZeneca vaccine were 60% effective against symptomatic disease from the B.1.617.2 variant (Delta). o Both vaccines were 33% effective against symptomatic disease from the B.1.617.2 variant (Delta), 3 weeks after the first dose.
The deputy director of the Immunization Safety Office at the CDC has said that the agency has received reports of 1,226 cases of myocarditis, with 827 (67.5%) reported after then second dose of either the Moderna (mRNA-1273) or Pfizer (BNT162b2) vaccine. In total, that's approximately 12.6 heart inflammation cases per million doses administered in the United States. The CDC has affirmed that the known and potential benefits of COVID-19 vaccination outweigh the known and potential risks of myocarditis and encourage people to continue getting their second dose of either the Moderna (mRNA-1273) or Pfizer (BNT162b2) vaccine.
“COVID arm”, is a harmless hypersensitivity response that occurs after an mRNA COVID-19 vaccine previously potentially mistaken for cellulitis. Distinguishing features of COVID arm from cellulitis include pruritus as a common finding, occurrence approximately a week after vaccination, a lack of progression of symptoms, rapid response to topical steroids, and/or spontaneous resolution, usually over 4 to 5 days.
Category
Epidemiology
Infection Prevention and Control
Subject
Vaccines
Immunity
Infection Prevention and Control
Clinical Presentation
Population
All
Clinical Setting
Community
ICU
Medicine Unit
Primary care
Public Health
Priority Level
Level 3 Two weeks (14 days)
Cite As
Lashta, E; Azizian, A; Lee, S; Shumilak, G; Reeder, B; Groot, G; Howell-Spooner, B; Miller, L. How effective are COVID-19 vaccines? 2021 Jul 20, Document no.: INF031801v7 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 74 p. (CEST rapid review report)
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Less detail
Document Type
Rapid Review
Review Code
EOC031801v7 RR
Question Submitted
March 18, 2021
Date Completed
June 24, 2021
Status
5. Updated review
Review History
EOC031801v7 RR; June 24, 2021
EOC031801v6 RR; June 17, 2021
EOC031801v5 RR; June 2, 2021
EOC031801v4 RR; May 17, 2021
EOC031801v3 RR: May 3, 2021
EOC031801v2 RR: April 20, 2021
EOC031801 RR: March 25, 2021
Research Team
EOC
History: EOC031801 RR – EOC031801v6 RR: March 25 – June 2, 2021 Cite As: Badea, A; Lee, S
Document Type
Rapid Review
Review Code
EOC031801v7 RR
Question Submitted
March 18, 2021
Date Completed
June 24, 2021
Status
5. Updated review
Review History
EOC031801v7 RR; June 24, 2021
EOC031801v6 RR; June 17, 2021
EOC031801v5 RR; June 2, 2021
EOC031801v4 RR; May 17, 2021
EOC031801v3 RR: May 3, 2021
EOC031801v2 RR: April 20, 2021
EOC031801 RR: March 25, 2021
Research Team
EOC
Updated Key Findings
June 24, 2021 General - vaccine modelling study using US data found that if a variant has 30% increased transmissibility, increasing from 1 million to 3 million daily doses has the potential to avert 152 thousand hospitalizations and nearly 48.5 thousand deaths Alpha - UK data analysis of household clustering found that the odds of clustering with the Alpha variant are 2.3 compared to wild type, and likelihood is higher if the index case is over 70 years - family clustering in Israel occurred in 90.4% of susceptible cases when Alpha was prevalent, compared to 59% in Spring 2020 - several reports of vaccine breakthrough outbreaks in Pifzer vaccinated individuals in LTC and HCW settings, however protection against hospitalization largely maintained, deaths occurring in those who with complicated medical histories or vaccine non-responders - a study in British Columbia assessing single-dose mRNA vaccination in those over 70 years found a 67% efficacy against Alpha infection at least 21 days following vaccination Beta - two new case series of mRNA vaccine breakthrough outbreaks in LTC settings; one in staff only and one in staff and residents – only 9/138 residents infected with 3 having fatal outcomes Gamma - study in British Columbia assessing single-dose mRNA vaccination in those over 70 years found a 61% efficacy against Gamma infection at least 21 days following vaccination Delta - as of June 18, 91% of sequenced cases in England are due to Delta - UK data indicating that 1st dose efficacy is 15-20% lower, but protection against hospitalization after two doses is maintained - From the period of April 25 – May 3 to May 20 – June 7, Delta prevalence in the UK increased from 0.10% to 0.15% in a randomly sampled population, estimated R0 of Delta being 1.44 - In the US, Delta prevalence increased from 2.7% at the end of May to 10% in June
Key Findings
June 14, 2021 New naming system developed by WHO WHO Classification & Risk Classification Pango Lineage Country of Origin Alpha (VOC) B.1.1.7 UK Beta (VOC) B.1.351 South Africa Gamma (VOC) P.1 Brazil/Japan Delta (VOC) B.1.617.2 India Epsilon (VOI) B.1.427/B.1.429 United States (California) Zeta (VOI) P.2 Brazil Eta (VOI) B.1.525 Multiple countries Theta (VOI) P.3 Philippines Iota (VOI) B.1.526 United States (New York) Kappa (VOI) B.1.617.1 India
Alpha - In Ontario, as of May 9th, 73% of sequenced VOC cases are of the Alpha variant, and to date, 86% of the variant deaths have been in those 65 years and older - real world data from Qatar of week-by-week analysis following the first dose of Pfizer COVID-19 vaccination indicates that efficacy is negligible for the first two weeks following vaccination and rises during the third week to 65.5% against infection with the Alpha variant; efficacy rises to 89.5% 14 days following the second dose - Pfizer protection against severe, critical or fatal disease caused by all variant ranges from 26.5% in the second week following the first dose to 97.4% two weeks following the second dose - serum analysis 6 months following 2nd dose Moderna vaccination found 96% neutralization of Alpha pseudovirus and 88% of live virus assays - Public Health England data indicates that the efficacy of Pfizer full-dose vaccination to 16May21 is 93%, 66% for full regimen vaccination with AstraZeneca - CoronaVac vaccine serum analysis has found that Alpha variant neutralization efficacy is equal to that of wild-type virus at 82% Beta - Real world data from Qatar indicates that the protection offered by the first dose of Pfizer vaccination is virtually negligible in the first two weeks and rises to 46.5% in the third week against Beta infection. 14 days following the 2nd dose, this efficacy rises to 75%. - a study of ICU admitted VOC cases in France determined the 60-day mortality odds ratio for Beta infection compared to Alpha variant is 5.67 - CoronaVac vaccinee serum analysis indicated a 5.2 fold reduction in Beta neutralization when compared to wild-type virus Gamma - 6 months post Moderna serum analysis found that 85% of samples neutralized Gamma pseudovirus - blood donor sample analysis and modelling indicates at least 16.9% of Gamma infections are presumed reinfections, up to 31% possible - SinoVac trial in Brazil (where gamma VOC predominates) found that after 75% of adults fully vaccinated with 2 doses, deaths decreased by 95%, hospitalizations by 86% and symptomatic cases decreased by 80% Delta - 61% of sequenced cases in England as of May 17th are Delta variant, early data indicates an increased risk of hospitalization compared to Alpha - Efficacy of Pfizer vaccine against Delta was 33.5% following the first dose and rose to 87.9% following the second dose while AstraZeneca was found to only be 59.8% effective against Delta following the second dose in England.
Category
Epidemiology
Healthcare Services
Subject
Health Planning
Variants
Population
All
Clinical Setting
Community
Public Health
Priority Level
Level 3 Two weeks (14 days)
Cite As
Badea, A; Lee, S; Shumilak, G; Reeder, B; Groot, G; Muhajarine, N; Miller, L; Howell-Spooner, B. What is the epidemiology of variants and what are the implications for healthcare? 2021 Jun 24, Document no.: EOC031801v7 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 31 p. (CEST rapid review report).
Related Documents
Documents
Less detail
Document Type
Rapid Review
Review Code
EOC031801v8 RR
Question Submitted
March 18, 2021
Date Completed
July 12, 2021
Status
5. Updated review
Review History
EOC031801v7 RR; June 24, 2021
EOC031801v6 RR; June 17, 2021
EOC031801v5 RR; June 2, 2021
EOC031801v4 RR; May 17, 2021
EOC031801v3 RR: May 3, 2021
EOC031801v2 RR: April 20, 2021
EOC031801 RR: March 25, 2021
Research Team
EOC
History: EOC031801 RR – EOC031801v6 RR: March 25 – June 2, 2021 Cite As: Badea, A; Lee, S
Document Type
Rapid Review
Review Code
EOC031801v8 RR
Question Submitted
March 18, 2021
Date Completed
July 12, 2021
Status
5. Updated review
Review History
EOC031801v7 RR; June 24, 2021
EOC031801v6 RR; June 17, 2021
EOC031801v5 RR; June 2, 2021
EOC031801v4 RR; May 17, 2021
EOC031801v3 RR: May 3, 2021
EOC031801v2 RR: April 20, 2021
EOC031801 RR: March 25, 2021
Research Team
EOC
Updated Key Findings
July 12, 2021 General - modelling based on US mortality data estimate that with wild-type virus, herd immunity could be achieved with 61% of the population fully vaccinated – however a new variant could cause a surge if vaccine coverage against wild-type is low (<50%), the new variants is much more transmissible (more than twice as transmissible) or cross-protection against variant infection is low (<70%). A variant-induced surge could potentially be avoided with vaccination rates reaching 66%, however this does not take into account specific characteristics of existing VOC and may be an underestimation - analysis of viral genetic diversity in 25 countries revealed a decrease in variant genetic diversity with increased rates of mass vaccination, however a direct causation cannot be confirmed Alpha - Ontario analysis of cases June 22-28 found 35.1% Alpha, with an estimated R of 0.71 - Novavaxx phase 3 trial data reported 86.3% effectiveness against symptomatic Alpha infection - US prevalence of Alpha decreased from 67% to 33.4% over 5 weeks due to the growth of Delta/Gamma infections - a Greek case series of 55 positive cases in HCW, 21 occurred in those fully vaccinated with Pfizer, no hospitalizations or deaths were observed - German study found that child and adult induced household secondary case outbreaks are similar for Alpha infections - surveillance done by ECDC of 14 countries that meet minimum sequencing thresholds (10%) found 69.5% Alpha infections - analysis of incubation time found that Alpha incubation time is a mean of 3.53 days vs 4.3 days for wild-type - sex-specific analysis found that women infected with the Alpha variant have a 1.82 hazard ratio of ICU admission and 1.30 hazard ratio of mortality (compared to wild-type) versus men (0.74 for ICU admission, 0.82 for mortality, contradicting previous findings of more severe outcomes in men infected with COVID-19 Gamma - analysis of Brazil data found that the case fatality rate for Gamma was 1.54 times higher than other variants Delta - As of June 22nd, 95% of sequenced cases in England are Delta cases and while secondary attack cases are higher for Delta vs Alpha, the vaccine effectiveness against hospitalization is maintained - In Europe, surveillance in 14 countries meeting minimum sequencing thresholds found only 5.2% Delta, however the Imperial College of London national prevalence study found an increase from 0.10% to 0.15% prevalence from April-May to May-June, with a doubling time of 11 days and an estimated R of 1.44 – however the weakened link between cases and hospitalizations was maintained for those >65 years (fully vaccinated in England) - in Africa, Delta cases are reported to be doubling every 3 weeks with a 15% increase in deaths over previous weeks and 2/3 of severe disease cases in those under 45 years being cause by Delta – with only 2% of Africa’s population of 1.3 billion having received at least one dose - a Delta outbreak in China was analysed and found that the mean incubation time for Delta infection was 4.4 days versus wild-type reported mean of 5.2 days and 64.7% of transmissions occurred in the pre-symptomatic phase (versus 59.2% for wild-type) - Increasingly reports seem to indicate that delta variant is becoming a dominant variant in various jurisdictions.
Key Findings
June 24, 2021 General - vaccine modelling study using US data found that if a variant has 30% increased transmissibility, increasing from 1 million to 3 million daily doses has the potential to avert 152 thousand hospitalizations and nearly 48.5 thousand deaths Alpha - UK data analysis of household clustering found that the odds of clustering with the Alpha variant are 2.3 compared to wild type, and likelihood is higher if the index case is over 70 years - family clustering in Israel occurred in 90.4% of susceptible cases when Alpha was prevalent, compared to 59% in Spring 2020 - several reports of vaccine breakthrough outbreaks in Pifzer vaccinated individuals in LTC and HCW settings, however protection against hospitalization largely maintained, deaths occurring in those who with complicated medical histories or vaccine non-responders - a study in British Columbia assessing single-dose mRNA vaccination in those over 70 years found a 67% efficacy against Alpha infection at least 21 days following vaccination Beta - two new case series of mRNA vaccine breakthrough outbreaks in LTC settings; one in staff only and one in staff and residents – only 9/138 residents infected with 3 having fatal outcomes Gamma - study in British Columbia assessing single-dose mRNA vaccination in those over 70 years found a 61% efficacy against Gamma infection at least 21 days following vaccination Delta - as of June 18, 91% of sequenced cases in England are due to Delta - UK data indicating that 1st dose efficacy is 15-20% lower, but protection against hospitalization after two doses is maintained - From the period of April 25 – May 3 to May 20 – June 7, Delta prevalence in the UK increased from 0.10% to 0.15% in a randomly sampled population, estimated R0 of Delta being 1.44 - In the US, Delta prevalence increased from 2.7% at the end of May to 10% in June
Category
Epidemiology
Healthcare Services
Subject
Health Planning
Variants
Population
All
Clinical Setting
Community
Public Health
Priority Level
Level 3 Two weeks (14 days)
Cite As
Badea, A; Lee, S; Shumilak, G; Reeder, B; Groot, G; Muhajarine, N; Miller, L; Howell-Spooner, B. What is the epidemiology of variants and what are the implications for healthcare? 2021 Jul 12, Document no.: EOC031801v8 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 34 p. (CEST rapid review report).
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