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*Corresponding Author: Jose Luis Turabian, Health Center Santa Maria de Benquerencia Toledo, Spain
Citation: Jose Luis Turabian, (2022) Characteristics and Vaccine Booster Effectiveness in Covid-19 Infections Using 15 Days Post-Booster Period as Baseline During the Omicron Wave in A General Medicine Office in Toledo (Spain). J. General medicine and Clinical Practice, 5(2); DOI:10.31579/2639-4162/050
Copyright: © 2022 Jose Luis Turabian, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 21 April 2022 | Accepted: 20 May 2022 | Published: 21 June 2022
Keywords: COVID-19; SARS-CoV-2; COVID-19 vaccine; breakthrough infection; immunization, secondary; general practice
Background: Vaccine covid-19 booster effectiveness (VBE) timing is not clearly known
Objective: To compare the cases of covid-19 in vaccinated booster people with a time of <15 days vs. >= 15 days from booster to infection diagnosis and assess their relative VBE.
Methodology: An observational, longitudinal and prospective study of adult patients with covid-19 breakthrough infections in booster vaccinated people, in general medicine and for the period December 2021 to February 2022, during the omicron variant contagion wave.
Results: Forty-six cases were included, 15 cases of Covid-19 breakthrough infections with booster shot <15 days (33%) with a mean time in days from booster to diagnostic covid-19 of 6 days, and 31 cases with booster > = 15 days (67%) with a time in days from booster to covid-19 diagnostic of 37 days of mean. Relative VBE <15 days (cases where it can be considered that the booster is not yet effective) vs. > = 15 days (cases where it can be considered that the booster is already effective) [1 - (Cases with vaccine Booster shot < 15 days) / (Cases with vaccine Booster shot > = 15 days) x 100] was 60%. Covid-19 cases with booster shot <15 days had been more vaccinated with 2 doses of ChAdOx1 nCoV-19 vaccine (Vaxzevria, Oxford / AstraZeneca) plus booster of mRNA-1273 vaccine (Spikevax, formerly covid-19 Vaccine Moderna).
Conclusion: In the general practice setting in Toledo, Spain, from December 1, 2021 to February 28, 2022, at the peak of omicron infections, booster after a period of <15 days provided 60% relative protection against symptomatic disease vs. > = 15 days. The results suggest that booster received <15 days provided early protection against SARS-CoV-2 infection of symptomatic Covid-19 of 60%. However, this result does not seem logical: this lower early risk may be transient and due to “vaccinated bias.”
The introduction of vaccines against coronavirus disease 2019 (covid-19) marked a turning point in the pandemic, and many lives have been saved thanks to them, reducing illnesses and hospital admissions [1-3]. From the extension of the covid-19 vaccination in December 2020 to the end of the summer of 2021, cases of breakthrough Infection in vaccinated people were rare and their attack rate low; But, starting this year, the omicron variant (B.1.1.529) was breaking records for covid-19 infection in Europe, North America, Africa, and Australia [4, 5].
Four vaccines were authorized in early 2022 for use in the European Union to prevent covid-19, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). These vaccines include, two messenger RNA (mRNA)-based vaccines (BNT162b2 mRNA vaccine [Comirnaty, Pfizer / BioNTech] and mRNA-1273 vaccine [Spikevax, formerly COVID-19 Vaccine Moderna]), and two adenovirus vector-based vaccines (ChAdOx1 nCoV-19 vaccine [Vaxzevria, Oxford / AstraZeneca] and Ad26.COV2.S [Johnson & Johnson–Janssen vaccine]). These vaccines have been shown to be highly effective in preventing mild to severe covid-19 [6]. However, decreased vaccine-induced immunity and the emergence of concerning variants of SARS-CoV-2 with increased transmission and resistance to neutralization have limited their efficacy [5, 7-9].
In this way, the rapid increase in covid-19 cases due to the omicron variant of SARS-CoV-2 in highly vaccinated populations raised concerns about the effectiveness of current vaccines. As early as August 2020, documented accounts of reinfection indicated that immunity to SARS-CoV-2 may only transiently protect from infection [10, 11]. Subsequent studies clearly established that vaccine efficacy against infection and symptomatic disease declines over time, so additional doses of vaccine (boosters) may be beneficial [9]. This was quickly followed by the decision to vaccinate with third doses, starting in the fall of 2021, to all people who received the second dose at least 5 months earlier, regardless of age, in an effort to maintain the efficacy of the vaccine over time [4, 12, 13]. There is now data that strongly suggests that people with the triple vaccine are more likely to avoid serious health complications, hospitalizations and deaths [14]. Three doses of the vaccine are required to achieve protection against omicron similar to the protection that two doses provided against the delta and alpha variants [13].
In this scenario, understanding the epidemiology of SARS-CoV-2 variants and the efficacy of existing vaccines is essential to guide vaccination policies and the development of new vaccines [13]. But, real-world data on vaccine effectiveness (VE) against newer SARS-CoV-2 variants remains limited [10]. Especially there is a lack of data on the period of time after the booster (durability of the effect of the third dose), during which the effectiveness of the booster is maintained [15, 16].
In this context, we present this study, where we estimate the relative effectiveness of the vaccine against symptomatic disease, presumably caused based on the time period studied, by delta and especially omicron variants, after two doses (primary immunization) of the vaccine, and after homologous or heterologous booster doses < 15>15 days.
An observational, longitudinal and prospective study of covid-19 breakthrough infections in vaccinated people with Vaccine Booster was conducted from December 1, 2021 to February 28, 2022, in a general medicine office in Toledo, Spain, which has a list of 2,000 patients> 14 years of age (in Spain, the general practitioners [GPs] care for people > 14 years of age, except for exceptions requested by the child's family and accepted by the GP). The GPs in Spain work within the National Health System, which is public in nature, and are the gateway for all patients to the system, and each person is assigned a GP [17].
Objective of the study
A. To compare the cases of covid-19 breakthrough infections in vaccinated people with vaccine booster with a time of <15> = 15 days from booster to infection diagnosis
B. To evaluate the relative vaccine booster effectiveness (VBE) <15> = 15 days.
Criteria for inclusion and exclusion of participants
The methodology of the study has already been published previously [18]. Only cases of patients fully vaccinated with two doses, plus booster, were included.
1. To consider a person as fully vaccinated (primary vaccination), it was required (19):
1. That they have received 2 doses of vaccine separated by a minimum of 19 days if the first dose was BNT162b2 mRNA vaccine (Comirnaty, Pfizer / BioNTech), 21 days in the case of ChAdOx1 nCoV-19 vaccine (Vaxzevria, Oxford / AstraZeneca) or 25 days in the case of mRNA-1273 vaccine (Spikevax, formerly COVID-19 Vaccine Moderna), and that a minimum period of 7 days has elapsed since the last dose if the last dose was with BNT162b2 mRNA vaccine (Comirnaty), or 14 days if it was with ChAdOx1 nCoV-19 vaccine (Vaxzevria) or mRNA-1273 vaccine (Spikevax). People who received a dose of Janssen vaccine (Johnson & Johnson vaccine) more than 14 days ago were also considered fully vaccinated.
2. Or, that having passed the disease they have received a dose of any of the vaccines, after the minimum period equal to that established for the second doses.
3. In the heterologous regimen in which Vaxzevria (Oxford / AstraZeneca) is used in the first dose and mRNA vaccines in the second, it was considered fully vaccinated after 7 days if the second dose was with Comirnaty, or after 14 days if it was with the Moderna vaccine
2. Definition of homologous or heterologous booster
Currently, the European Commission has authorized four vaccines: Comirnaty, from Pfizer/BioNTech, authorized December 21, 2020; Moderna vaccine, authorized on January 6, 2021; AstraZeneca vaccine, authorized on January 29 and Janssen/Johnson & Johnson vaccine, authorized on March 11, 2021. These four vaccines are currently available in Spain; all of them have been approved by the European Medicines Agency. These vaccines have been shown to be highly effective in preventing mild to severe covid-19 [19]. The original BNT162b2 mRNA vaccine (Comirnaty, Pfizer/BioNTech), mRNA-1273, and ChAdOx1 nCoV-19 vaccine (Vaxzevria, Oxford/AstraZeneca) regimens were homologous induction and booster regimens, whereas the original Ad26. COV2.S vaccine (Janssen vaccine; Johnson & Johnson vaccine) was a single injection regimen.
As of November 23, 2021, in Castilla-La Mancha, the region where the study was carried out, booster doses against covid-19 with messenger RNA (mRNA) vaccines began 6 months after completion the vaccination schedule and after 3 months in case of having received a dose of the Ad26.COV2.S vaccine (Janssen vaccine; Johnson & Johnson vaccine). Recruitment was carried out actively by age cohorts in a descending manner, beginning with those over 80 years of age and people inpatients in centers for the elderly and in other socio-health and health centers (including day centers and occupational centers), regardless of age, people who received a dose of Ad26.COV2.S vaccine (Janssen vaccine; Johnson & Johnson vaccine) as primary vaccination and those with a homologous schedule of Vaxzevria as primary vaccination (first and second dose of Vaxzevria, from AstraZeneca), followed by people aged between 79 to 70 years old, from 69 to 65 years old, 64 to 60 years old, 59 to 50 and 49 to 40 years old, etc. The booster dose was administered with mRNA vaccines (0.3 ml of Comirnaty or 0.25 ml of Spikevax – half the usual dose in primary vaccination).
-Homologous or heterologous booster
Any mRNA vaccine was used to administer the booster dose, regardless of the vaccine used in the primary vaccination. In people with incomplete regimen (in vaccines that require two doses as primary vaccination) the regimen was completed first with mRNA vaccine (0.3 ml of BNT162b2 mRNA vaccine [Comirnaty, Pfizer / BioNTech] or 0.5 ml of mRNA- 1273 vaccine [Spikevax, formerly covid-19 Vaccine Moderna]). The booster dose (0.3 ml Comirnaty or 0.25 ml Spikevax) was given 6 months later. In people for whom a booster dose was recommended who had a history of symptomatic or asymptomatic SARS-CoV-2 infection, a booster dose with mRNA (0.3 ml of Comirnaty or 0. 25 ml of Spikevax) at least 4 weeks after the diagnosis of the infection and from 6 months (subsequently modified on January 13, 2022 to 5 months) if the last dose administered in the primary vaccination was with mRNA vaccine (Comirnaty or Spikevax), and from 3 months if it was an adenovirus vector vaccine (ChAdOx1 nCoV-19 vaccine [Vaxzevria, Oxford / AstraZeneca] or Ad26.COV2.S vaccine [Janssen vaccine; Johnson & Johnson vaccine]) [20].
3. To consider a person completely vaccinated with the booster, it was required:
For the data in this study, all covid-19 cases in people fully vaccinated with the booster were included, regardless of time to covid-19 diagnosis.
All possibilities of reinforcement were considered:
-Full homologous booster dose:
A. 2 doses of BNT162b2 mRNA vaccine (Comirnaty, Pfizer / BioNTech) with Pfizer-BioNTech booster
B. 2 doses of mRNA-1273 vaccine (Spikevax, formerly covid-19 Vaccine Moderna) with Moderna booster
-The 6 possible combinations of heterologous booster doses:
A. 2 doses of BNT162b2 mRNA vaccine (Comirnaty, Pfizer / BioNTech) with mRNA-1273 vaccine booster (Spikevax, formerly covid-19 Vaccine Moderna)
B. 2 doses of ChAdOx1 nCoV-19 vaccine (Vaxzevria, Oxford / AstraZeneca) with booster of mRNA-1273 vaccine (Spikevax, formerly covid-19 Vaccine Moderna)
C. 2 doses of ChAdOx1 nCoV-19 vaccine (Vaxzevria, Oxford / AstraZeneca) with booster of BNT162b2 mRNA vaccine (Comirnaty, Pfizer / BioNTech)
D. 1 dose of Ad26.COV2.S (Janssen vaccine; Johnson & Johnson vaccine) with mRNA-1273 vaccine booster (Spikevax, formerly covid-19 Vaccine Moderna)
E. 1 dose of Ad26.COV2.S (Janssen vaccine; Johnson & Johnson vaccine) with booster of BNT162b2 mRNA vaccine (Comirnaty, Pfizer / BioNTech)
F. 2 doses of mRNA-1273 vaccine (Spikevax, formerly covid-19 Vaccine Moderna) with booster of BNT162b2 mRNA vaccine (Comirnaty, Pfizer / BioNTech)
4. Diagnosis of covid-19
The diagnosis was performed with reverse transcriptase polymerase chain reaction (PCR) oropharyngeal swab tests or antigen testing. Rapid antigen tests began to be carried out for symptomatic patients with less than 5 days of evolution. The PCR tests were performed both in symptomatic patients and in asymptomatic contacts. The cases included confirmed cases and asymptomatic carriers. Information on covid-19 patients and their contacts was obtained from the registry systems used by general medical services in the consultation. A symptomatic confirmed case with active infection was considered to be any person with a clinical picture of sudden onset acute respiratory infection of any severity that occurs, among others, with fever, cough or feeling of shortness of breath. Other symptoms such as odynophagia, anosmia, ageusia, muscle pain, diarrhea, chest pain or headache, among others, were also considered symptoms of suspected SARS-CoV-2 infection according to clinical criteria; and a positive PCR or rapid antigen test positive [19, 21].
The onset date of a confirmed case was defined as the date of the first appearance of self-reported clinical symptoms [20]. The onset date for an asymptomatic carrier was defined as the date a positive covid-19 PCR test was obtained [22]. Previous SARS-CoV-2 infection was defined as a positive result in the PCR assay or antigen test at least 90 days before a new positive result [23].
Calculation of VBE [24-26] We calculated the VBE, which was estimated as a percentage [13, 24-26], as follows:
1- [Cases with vaccine booster shot <15> = 15 days] × 100
Collected variables
The following variables were collected:
-Age and sex
-Chronic diseases (defined as "any alteration or deviation from normal that has one or more of the following characteristics: is permanent, leaves residual impairment, is caused by a non-reversible pathological alteration, requires special training of the patient for rehabilitation, and / or can be expected to require a long period of control, observation or treatment” [27], classified according to the International Statistical Classification of Diseases and Health-Related Problems, CD-10 Version: 2019 [28]
-Social-occupancy class (according to the Registrar General's classification of occupations and social status code) [29-30]
-If they were Health Care Workers
-Problems in the family context (complex families) based on the genogram and in the experience of the GP for their continuity of care and knowledge of the family (genogram is a schematic model of the structure and processes of a family, which included the family structure, life cycle and family relational patterns. It was understood that "complex" genograms present families with psychosocial problems) [31-34]
-Ethnic minority
-Vaccine type: Comirnaty (Pfizer-BioNTech-BNT162b2 mRNA; Pfizer / BioNTech), Moderna-mRNA-1273 mRNA, Vaxzevria (AstraZeneca), and Janssen / Johnson & Johnson vaccine (Currently, the European Commission has licensed four vaccines: Comirnaty, Pfizer / BioNTech, licensed December 21, 2020; Moderna vaccine, licensed January 6; AstraZeneca vaccine, licensed 29 December and the Janssen / Johnson & Johnson vaccine, authorized on March 11. In Spain, these four vaccines are currently available, all of which have been approved by the European Medicines Agency) [35]
Sample
All patients with covid-19 breakthrough infections in vaccinated people with vaccine booster at the consultation of general medicine for the period December 2021 to February 2022, were included.
Sample size
Sample size was calculated for two unpaired groups, with a Two-sided Confidence Level (1-alpha) of 95%, Power (% probability of detection) of 80%, Ratio of controls per case of 2:1, Proportion of covid-19 with exposure to 2 doses of ChAdOx1 nCoV-19 vaccine (Vaxzevria, Oxford / AstraZeneca) plus mRNA-1273 vaccine (Spikevax, formerly covid-19 Vaccine Moderna) booster > = 15 days of 10%, and proportion of covid-19 with exposure to 2 doses of ChAdOx1 nCoV-19 vaccine (Vaxzevria, Oxford / AstraZeneca) plus mRNA-1273 vaccine (Spikevax, formerly COVID-19 Vaccine Moderna) booster < 15>
Statistical analysis
The bivariate comparisons were performed using the Chi Square test (X2), X2 with Yates correction or Fisher exact test when necessary (according to the number the expected cell totals), for percentages, and the Student test for the mean.
Forty-six cases were included, 15 cases of covid-19 breakthrough infections in vaccinated people with vaccine booster shot <15> = 15 days (67%), with a time in days from booster to covid-19 of 37.41+-19.17 (15-84 days).
Cases with vaccine booster shot > = 15 days differed statistically from those with vaccine booster shot <15>
VARIABLES | COVID-19 BREAKTHROUGH INFECTIONS <15> N=15 | COVID-19 BREAKTHROUGH INFECTIONS > = 15 DAYS AFTER BOOSTER N=31 | STATISTICAL SIGNIFICANCE |
Age in years (Arithmetic mean + - Standard deviation; Range) | 54.06+-12.40 (34-71 years) | 53.61+-14.35 (26-90 years) | t= 0.10483. p= .458495. NS |
> = 65 years | 5 (33) | 8 (26) | X2 with Yates correction= 0.0332. p= .855407. NS |
= < 45> | 3 (33) | 9 (29) | X2 with Yates correction= 0.0875. p= .767342. NS |
Women | 7 (47) | 20 (65) | X2= 1.3284. p= .249082. NS |
Previous symptomatic COVID-19 | 2 (13) | 5 (16) | Fisher exact test=1. NS |
Time in days from Booster to covid-19 in breakthrough infections in vaccinated people (Arithmetic mean + - Standard deviation; Range) | 6.53+-3.31 (1-13 days) | 37.41+-19.17 (15-84 days) | NR |
Symptomatic covid-19 in breakthrough infections in vaccinated people | 14 (93) | 27 (87) | Fisher exact test=1. NS |
Duration of symptoms in days of covid-19 in breakthrough infections in vaccinated people (Arithmetic mean + - Standard deviation; Range) | Symptomatic N=14
6.85+-2.56 (3-10 days) | Symptomatic N=27
5.29+-3.09 (2-15 days) | t= 1.61622. p= .057054. NS |
Covid-19 breakthrough infections in vaccinated people with severity moderate and severe | 1 (Pneumonia) (7) | 0 | Fisher exact test= 0.3261. NS |
Social-occupancy class of patients (people with some type of labor specialization) | 8 (53) | 17 (55) | X2= 0.0092. p= .92345. NS |
Health care workers with covid-19 breakthrough infections in vaccinated people | 2 (13) | 11 (35) | X2 with Yates correction= 1.4758. p= .224433. NS |
Sick leave for covid-19 breakthrough infections in vaccinated people | 3 (20) | 17 (55) | X2= 4.9927. p= .025455. Significant at p < .05. |
Ethnic minority with covid-19 breakthrough infections in vaccinated people | 1 (7) | 2 (6) | Fisher exact test=1. NS |
Complex family with covid-19 breakthrough infections in vaccinated people | 2 (13) | 2 (6) | Fisher exact test statistic value is= 0.5868. NS |
Chronic diseases presence in covid-19 breakthrough infections in vaccinated people | 14 (93) | 21 (68) | X2 with Yates correction= 2.368. p= .123843. NS |
Table 1: Covid-19 Breakthrough Infections <15> = 15 Days after Booster
( ): Denotes percentages; NS: Not significant; NR: Not Relevant
SYMPTOMS * ACCORDING TO WHO, ICD-10 GROUPS | COVID-19 BREAKTHROUGH INFECTIONS <15> N=15 | COVID-19 BREAKTHROUGH INFECTIONS > = 15 DAYS AFTER BOOSTER N=31 | STATISTICAL SIGNIFICANCE |
General (discomfort, asthenia, myalgia, fever, arthralgias) | 12 (30) | 22 (32) | X2= 0.0243. p= .87606. NS |
Respiratory (cough, dyspnea, chest pain) | 10 (26) | 14 (20) | X2= 0.3731. p= .54134. |
ENT (anosmia / ageusia, odynophagia, rhinorrhea, pharyngeal dryness-mucus, epixtasis) | 12 (30) | 29 (41) | X2= 1.422. p= .233073. NS |
Digestive (anorexia, nausea / vomiting, diarrhea, abdominal pain) | 3 (7) | 0 | Fisher exact test = 0.0458. The result is significant at p < .05. |
Neurological (headache, dizziness, mental confusion -brain fog) | 3 (7) | 5 (7) | Fisher exact test=1. NS |
Total symptoms* | 40 (100) | 70 (100) | --- |
( ): Denotes percentages; NS: Not significant; *Patients could have more than one symptom. The percentages are over the total of symptoms
Table 2: Symptoms in Covid-19 Breakthrough Infections <15> = 15 Days after Booster
CHRONIC DISEASES* ACCORDING TO WHO, ICD-10 GROUPS | COVID-19 BREAKTHROUGH INFECTIONS <15> N=15 | COVID-19 BREAKTHROUGH INFECTIONS > = 15 DAYS AFTER BOOSTER N=31 | STATISTICAL SIGNIFICANCE |
-II Neoplasias | 1 (2) | 4 (4) | Fisher exact test=1. NS |
-III Diseases of the blood | 0 | 1 (1) | Fisher exact test=1. NS |
-IV Endocrine | 7 (16) | 17 (18) | X2= 0.1022. p= .749184. NS |
-V Mental | 3 (6) | 5 (5) | Fisher exact test= 0.7104. NS |
-VI-VIII Nervous and Senses | 5 (11) | 9 (9) | X2 with Yates correction= 0.0003. p= .98663 |
-IX Circulatory system | 4 (9) | 14 (14) | X2= 0.6502. p= .420056. NS |
-X Respiratory system | 3 (6) | 5 (5) | Fisher exact test= 0.7104. NS |
-XI Digestive system | 6 (13) | 12 (12) | X2= 0.0183. p= .892529. NS |
-XII Diseases of the skin | 6 (13) | 2 (2) | X2 with Yates correction is 5.2781. p= .021595. Significant at p < .05. |
-XIII Musculo-skeletal | 6 (13) | 11 (11) | X2= 0.0995. p= .75245. NS |
-XIV Genitourinary | 5 (11) | 18 (19) | X2= 0.3887. p= .532984. |
TOTAL chronic diseases* | 46 (100) | 98 (100) | --- |
( ): Denotes percentages; NS: Not significant; * Patients could have more than one chronic disease. The percentages are over the total of chronic diseases
Table 3: Chronic Diseases in Covid-19 Breakthrough Infections <15> = 15 Days after Booster
VACCINE TYPE | COVID-19 BREAKTHROUGH INFECTIONS <15> N=15 | COVID-19 BREAKTHROUGH INFECTIONS > = 15 DAYS AFTER BOOSTER N=31 | STATISTICAL SIGNIFICANCE |
HOMOLOGOUS booster dose |
|
|
|
2 doses of BNT162b2 mRNA vaccine (Comirnaty, Pfizer / BioNTech) with BNT162b2 mRNA vaccine (Comirnaty, Pfizer / BioNTech) booster | 2 (13) | 3 (10) | Fisher exact test= 0.6557. NS |
2 doses of mRNA-1273 vaccine (Spikevax, formerly COVID-19 Vaccine Moderna) with mRNA-1273 vaccine (Spikevax, formerly COVID-19 Vaccine Moderna) booster | 0 | 2 (6) | Fisher exact test= 0.5507. NS |
HETEROLOGOUS booster dose |
|
|
|
2 doses of BNT162b2 mRNA vaccine (Comirnaty, Pfizer / BioNTech) with mRNA-1273 vaccine (Spikevax, formerly COVID-19 Vaccine Moderna) booster | 5 (33) | 20 (64) | X2= 3.9617. p= .046547. Significant at p < .05. |
2 doses of ChAdOx1 nCoV-19 vaccine (Vaxzevria, Oxford / AstraZeneca) with mRNA-1273 vaccine (Spikevax, formerly COVID-19 Vaccine Moderna) booster | 7 (47) | 3 (10) | X2 with Yates correction= 6.1006. p= .013513. Significant at p < .05. |
1 dose of Ad26.COV2.S (Janssen vaccine; Johnson & Johnson vaccine) with mRNA-1273 vaccine (Spikevax, formerly COVID-19 Vaccine Moderna) booster | 0 | 3 (10) | Fisher exact test= 0.5405. NS |
2 doses of mRNA-1273 vaccine (Spikevax, formerly COVID-19 Vaccine Moderna) with BNT162b2 mRNA vaccine (Comirnaty, Pfizer / BioNTech) booster | 1 (7) | 0 | Fisher exact test= 0.3261. NS |
TOTAL | 15 (100) | 31 (100) | --- |
( ): Denotes percentages; NS: Not significant
Table 4: Vaccine Type in Covid-19 Breakthrough Infections <15> = 15 Days after Booster
Relative VBE <15> 0 15 days [1 - (Cases with vaccine booster shot < 15> = 15 days) x 100] was found to be 60%. (TABLE 5).
Cases with vaccine booster shot <15> | GROSS INCIDENCE RATE | Cases with vaccine booster shot > = 15 days | GROSS INCIDENCE RATE |
15/46 | 33% | 31/46 | 67% |
Relative vaccine booster effectiveness <15> = 15 days:
1 - [Covid-19 cases incidence with vaccine Booster <15> = 15 days] × 100 = 60%
Table 5: Relative Vaccine Booster Effectiveness > = 15 vs. <15>
The turning points and waves of infections in the history of the covid-19 pandemic are marked by the mutation of the virus, that allow it to escape the first-line immune defences, specifically the antibodies; that is why breakthrough infections are seen in vaccinated people [37]. The omicron variant of SARS-CoV-2 began spreading rapidly and outpacing other variants in late 2021. Its broke records day after day, largely due to a series of mutations in the virus' spike protein that makes vaccines much less effective in stopping infection than in earlier variants [38-4].
Evidence of the high transmissibility of the omicron variant was corroborated by the rapid increase in reported covid-19 cases. In Spain during the so-called sixth wave in December 2021 and January 2022, this highly infectious strain of SARS-CoV-2 has brought covid-19 rates to the highest level ever seen [5, 41]. This situation triggered calls to intensify vaccination programs, including the provision of booster doses of the vaccine [42]. However, neutralization of the omicron variant after the primary two-dose vaccine regimen was less than previous variants, but increased substantially after a booster dose [15]. Along these lines, it has been reported that the efficacy of mRNA vaccines to prevent hospital admissions associated with covid-19 was 86% for three doses against the omicron variant [13]. Other studies have observed a pronounced immune response after the third dose of BNT162b2 mRNA vaccine (Comirnaty, Pfizer / BioNTech) in people older than 60 years, against the Delta variant, a 33- and 51-fold increase in IgG and neutralizing antibodies, respectively; and neutralizing antibody levels after the third dose were 9.34-fold higher than after the second dose [2]. But on the other hand, another study reported an infection rate of 25% of participants in the three-dose control group being infected with the omicron variant, most with negligible symptoms. However, most infected participants were potentially infectious, with relatively high viral loads (nucleocapsid gene cycle threshold, ≤25). In addition, models from the University of Washington estimate that 90% of omicron cases will be asymptomatic compared to 40% for previous variants [43, 44].
In our study, the proportion of asymptomatic patients was very low both in cases of covid-19 with booster <15>=15 days (7% and 13%, respectively), but it must be taken into account that were cases that consulted the GP, or infection was diagnosed after contact tracing, but no general screening activity was carried out. On the other hand, the symptoms presented by our patients were all mild, except for 1 pneumonia case, in the booster group < 15>
When does VBE drop?
Multiple time points have been used for VE assessment: ≥ 7 days (13, 45), from 10 to 14 days after shot (9), or at 2 to 4, 5 to 9, and 10 or more weeks after a booster [10]. VE is known progressively decrease over time since the primary vaccination series are completed. In this way, BNT162b2 mRNA vaccine (Comirnaty, Pfizer / BioNTech) and mRNA-1273 vaccine (Spikevax, formerly covid-19 Vaccine Moderna) booster shots have been reported to lose some effectiveness after four months [46]. Likewise, it has been published that for the ChAdOx1 nCoV-19 vaccine (Vaxzevria, Oxford / AstraZeneca), BNT162b2 mRNA vaccine (Comirnaty, Pfizer / BioNTech), or mRNA-1273 vaccine (Spikevax, formerly covid-19 Vaccine Moderna), the VE against Omicron progressively decreased to <15>
A boost of BNT162b2 or mRNA-1273, after the primary course of ChAdOx1 nCoV-19 or BNT162b2, substantially increased the protection. But that protection decreased over time (10). With the current data, there is already evidence of a reduction in protection against symptomatic disease ten weeks after the booster dose, with a reduction in vaccine effectiveness from 15% to 25
Covid-19 vaccines showed excellent efficacy until the end of December 2021 when the world registered the highest number of infections related to the Omicron variant. On the other hand, it is not clearly known from what moment after the shot can it be considered effectiveness, and how long after the vaccine booster shot can be considered protective. In the context of the general medicine clinic in Toledo, Spain, from December 1, 2021 to February 28, 2022, in the peak period of omicron infections, the relative effectiveness of the homologous or heterologous booster vaccine, after a period of < 15> = 15 days of the shot provided 60% protection against symptomatic disease. However, at first glance, this result does not seem logical; it should be the other way around. This lower early risk may be transitory and due to different biases, especially the “vaccinated bias”; This lower early risk has been observed in previous studies and may be the result of not including as “cases” (in our study, booster < 15>
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The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
