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1. Short- and longer-term all-cause mortality among SARS-CoV-2- infected individuals and the pull-forward phenomenon in Qatar: a national cohort study

Author: Hiam Chemaitelly, Jeremy Samuel Faust, Harlan M. Krumholz, Houssein H. Ayoub, Patrick Tang, Peter Coyle, Hadi M. Yassine, Asmaa A. Al Thani, Hebah A. Al-Khatib, Mohammad R. Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Subjects: COVID-19, Acute infection, Immunity, Death, Long COVID, Cohort study, Infectious and parasitic diseases, RC109-216
Abstract: Objectives: We assessed short-, medium-, and long-term all-cause mortality risks after a primary SARS-CoV-2 infection. Methods: A national, matched, retrospective cohort study was conducted in Qatar to assess risk of all-cause mortality in the national SARS-CoV-2 primary infection cohort compared with the national infection-naïve cohort. Associations were estimated using Cox proportional-hazards regression models. Analyses were stratified by vaccination status and clinical vulnerability status. Results: Among unvaccinated persons, within 90 days after primary infection, the adjusted hazard ratio (aHR) comparing mortality incidence in the primary-infection cohort with the infection-naïve cohort was 1.19 (95% confidence interval 1.02-1.39). aHR was 1.34 (1.11-1.63) in persons more clinically vulnerable to severe COVID-19 and 0.94 (0.72-1.24) in those less clinically vulnerable. Beyond 90 days after primary infection, aHR was 0.50 (0.37-0.68); aHR was 0.41 (0.28-0.58) at 3-7 months and 0.76 (0.46-1.26) at ≥8 months. The aHR was 0.37 (0.25-0.54) in more clinically vulnerable persons and 0.77 (0.48-1.24) in less clinically vulnerable persons. Among vaccinated persons, mortality incidence was comparable in the primary-infection versus infection-naïve cohorts, regardless of clinical vulnerability status. Conclusions: COVID-19 mortality was primarily driven by an accelerated onset of death among individuals who were already vulnerable to all-cause mortality, but vaccination prevented these accelerated deaths.
Published: 2023
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2. Addressing bias in the definition of SARS-CoV-2 reinfection: implications for underestimation

Author: Hiam Chemaitelly, Houssein H. Ayoub, Patrick Tang, Hadi M. Yassine, Asmaa A. Al Thani, Mohammad R. Hasan, Peter Coyle, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Subjects: reinfection, bias, time window, immunity, COVID-19, epidemiology, Medicine (General), R5-920
Abstract: IntroductionReinfections are increasingly becoming a feature in the epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, accurately defining reinfection poses methodological challenges. Conventionally, reinfection is defined as a positive test occurring at least 90 days after a previous infection diagnosis. Yet, this extended time window may lead to an underestimation of reinfection occurrences. This study investigated the prospect of adopting an alternative, shorter time window for defining reinfection.MethodsA longitudinal study was conducted to assess the incidence of reinfections in the total population of Qatar, from February 28, 2020 to November 20, 2023. The assessment considered a range of time windows for defining reinfection, spanning from 1 day to 180 days. Subgroup analyses comparing first versus repeat reinfections and a sensitivity analysis, focusing exclusively on individuals who underwent frequent testing, were performed.ResultsThe relationship between the number of reinfections in the population and the duration of the time window used to define reinfection revealed two distinct dynamical domains. Within the initial 15 days post-infection diagnosis, almost all positive tests for SARS-CoV-2 were attributed to the original infection. However, surpassing the 30-day post-infection threshold, nearly all positive tests were attributed to reinfections. A 40-day time window emerged as a sufficiently conservative definition for reinfection. By setting the time window at 40 days, the estimated number of reinfections in the population increased from 84,565 to 88,384, compared to the 90-day time window. The maximum observed reinfections were 6 and 4 for the 40-day and 90-day time windows, respectively. The 40-day time window was appropriate for defining reinfection, irrespective of whether it was the first, second, third, or fourth occurrence. The sensitivity analysis, confined to high testers exclusively, replicated similar patterns and results.DiscussionA 40-day time window is optimal for defining reinfection, providing an informed alternative to the conventional 90-day time window. Reinfections are prevalent, with some individuals experiencing multiple instances since the onset of the pandemic.
Published: 2024
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3. Effects of previous infection, vaccination, and hybrid immunity against symptomatic Alpha, Beta, and Delta SARS-CoV-2 infections: an observational studyResearch in context

Author: Heba N. Altarawneh, Hiam Chemaitelly, Houssein H. Ayoub, Patrick Tang, Mohammad R. Hasan, Hadi M. Yassine, Hebah A. Al-Khatib, Asmaa A. Al Thani, Peter Coyle, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Subjects: COVID-19, Booster, Reinfection, Variant, Case-control, Test-negative, Medicine, Medicine (General), R5-920
Abstract: Summary: Background: Protection against SARS-CoV-2 symptomatic infection and severe COVID-19 of previous infection, mRNA two-dose vaccination, mRNA three-dose vaccination, and hybrid immunity of previous infection and vaccination were investigated in Qatar for the Alpha, Beta, and Delta variants. Methods: Six national, matched, test-negative, case-control studies were conducted between January 18 and December 18, 2021 on a sample of 239,120 PCR-positive tests and 6,103,365 PCR-negative tests. Findings: Effectiveness of previous infection against Alpha, Beta, and Delta reinfection was 89.5% (95% CI: 85.5–92.3%), 87.9% (95% CI: 85.4–89.9%), and 90.0% (95% CI: 86.7–92.5%), respectively. Effectiveness of two-dose BNT162b2 vaccination against Alpha, Beta, and Delta infection was 90.5% (95% CI, 83.9–94.4%), 80.5% (95% CI: 79.0–82.0%), and 58.1% (95% CI: 54.6–61.3%), respectively. Effectiveness of three-dose BNT162b2 vaccination against Delta infection was 91.7% (95% CI: 87.1–94.7%). Effectiveness of hybrid immunity of previous infection and two-dose BNT162b2 vaccination was 97.4% (95% CI: 95.4–98.5%) against Beta infection and 94.5% (95% CI: 92.8–95.8%) against Delta infection. Effectiveness of previous infection and three-dose BNT162b2 vaccination was 98.1% (95% CI: 85.7–99.7%) against Delta infection. All five forms of immunity had >90% protection against severe, critical, or fatal COVID-19 regardless of variant. Similar effectiveness estimates were observed for mRNA-1273. A mathematical model accurately predicted hybrid immunity protection by assuming that the individual effects of previous infection and vaccination acted independently. Interpretation: Hybrid immunity, offering the strongest protection, was mathematically predicted by assuming that the immunities obtained from previous infection and vaccination act independently, without synergy or redundancy. Funding: The Biomedical Research Program and the Biostatistics, Epidemiology, and the Biomathematics Research Core, both at Weill Cornell Medicine-Qatar, Ministry of Public Health, Hamad Medical Corporation, Sidra Medicine, Qatar Genome Programme, Qatar University Biomedical Research Center, and Qatar University Internal Grant ID QUCG-CAS-23/24-114.
Published: 2023
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4. Population immunity of natural infection, primary-series vaccination, and booster vaccination in Qatar during the COVID-19 pandemic: an observational studyResearch in context

Author: Suelen H. Qassim, Hiam Chemaitelly, Houssein H. Ayoub, Peter Coyle, Patrick Tang, Hadi M. Yassine, Asmaa A. Al Thani, Hebah A. Al-Khatib, Mohammad R. Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Subjects: COVID-19, Immunity, Natural infection, Vaccine, Test-negative, Epidemiology, Medicine (General), R5-920
Abstract: Summary: Background: Waning of natural infection protection and vaccine protection highlight the need to evaluate changes in population immunity over time. Population immunity of previous SARS-CoV-2 infection or of COVID-19 vaccination are defined, respectively, as the overall protection against reinfection or against breakthrough infection at a given point in time in a given population. Methods: We estimated these population immunities in Qatar's population between July 1, 2020 and November 30, 2022, to discern generic features of the epidemiology of SARS-CoV-2. Effectiveness of previous infection, mRNA primary-series vaccination, and mRNA booster (third-dose) vaccination in preventing infection were estimated, month by month, using matched, test-negative, case–control studies. Findings: Previous-infection effectiveness against reinfection was strong before emergence of Omicron, but declined with time after a wave and rebounded after a new wave. Effectiveness dropped after Omicron emergence from 88.3% (95% CI: 84.8–91.0%) in November 2021 to 51.0% (95% CI: 48.3–53.6%) in December 2021. Primary-series effectiveness against infection was 84.0% (95% CI: 83.0–85.0%) in April 2021, soon after introduction of vaccination, before waning gradually to 52.7% (95% CI: 46.5–58.2%) by November 2021. Effectiveness declined linearly by ∼1 percentage point every 5 days. After Omicron emergence, effectiveness dropped from 52.7% (95% CI: 46.5–58.2%) in November 2021 to negligible levels in December 2021. Booster effectiveness dropped after Omicron emergence from 83.0% (95% CI: 65.6–91.6%) in November 2021 to 32.9% (95% CI: 26.7–38.5%) in December 2021, and continued to decline thereafter. Effectiveness of previous infection and vaccination against severe, critical, or fatal COVID-19 were generally >80% throughout the study duration. Interpretation: High population immunity against infection may not be sustained beyond a year, but population immunity against severe COVID-19 is durable with slow waning even after Omicron emergence. Funding: The Biomedical Research Program and the Biostatistics, Epidemiology, and the Biomathematics Research Core, both at Weill Cornell Medicine-Qatar, Ministry of Public Health, Hamad Medical Corporation, Sidra Medicine, Qatar Genome Programme, Qatar University Biomedical Research Center, and Qatar University Internal Grant ID QUCG-CAS-23/24-114.
Published: 2023
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5. Protection of Omicron sub-lineage infection against reinfection with another Omicron sub-lineage

Author: Hiam Chemaitelly, Houssein H. Ayoub, Peter Coyle, Patrick Tang, Hadi M. Yassine, Hebah A. Al-Khatib, Maria K. Smatti, Mohammad R. Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Subjects: Science
Abstract: The level of immunity induced by infection with different SARS-CoV-2 Omicron sub-lineages against infection with other sub-lineages is not known. Here, the authors use data from Qatar and show that infection with BA.1 induces strong protection against infection with BA.2, and vice versa, for several weeks.
Published: 2022
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6. Duration of mRNA vaccine protection against SARS-CoV-2 Omicron BA.1 and BA.2 subvariants in Qatar

Author: Hiam Chemaitelly, Houssein H. Ayoub, Sawsan AlMukdad, Peter Coyle, Patrick Tang, Hadi M. Yassine, Hebah A. Al-Khatib, Maria K. Smatti, Mohammad R. Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Subjects: Science
Abstract: The SARS-CoV-2 Omicron variant has subvariants with divergent properties but relative vaccine effectiveness has not been characterized. Here, the authors show that mRNA vaccine effectiveness is similar for the subvariants BA.1 and BA.2, with a decline three months after the second dose and increase after the booster.
Published: 2022
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7. Relative infectiousness of SARS-CoV-2 vaccine breakthrough infections, reinfections, and primary infections

Author: Laith J. Abu-Raddad, Hiam Chemaitelly, Houssein H. Ayoub, Patrick Tang, Peter Coyle, Mohammad R. Hasan, Hadi M. Yassine, Fatiha M. Benslimane, Hebah A. Al-Khatib, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Abdullatif Al-Khal, Mohametabd H. Al-Thani, and Roberto Bertollini
Subjects: Science
Abstract: SARS-CoV-2 breakthrough infections in vaccinated individuals and reinfections in those with prior infection are a public health concern. Here, the authors show that viral loads of vaccine breakthrough infections and reinfections are generally lower than primary infections of unvaccinated individuals, potentially indicating lower infectiousness.
Published: 2022
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8. Effects of SARS-CoV-2 Alpha, Beta, and Delta variants, age, vaccination, and prior infection on infectiousness of SARS-CoV-2 infections

Author: Suelen H. Qassim, Mohammad R. Hasan, Patrick Tang, Hiam Chemaitelly, Houssein H. Ayoub, Hadi M. Yassine, Hebah A. Al-Khatib, Maria K. Smatti, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Abdullatif Al-Khal, Peter Coyle, Imtiaz Gillani, Anvar Hassan Kaleeckal, Riyazuddin Mohammad Shaik, Ali Nizar Latif, Einas Al-Kuwari, Andrew Jeremijenko, Adeel A. Butt, Roberto Bertollini, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, and Laith J. Abu-Raddad
Subjects: COVID-19, SARS-CoV-2 variant, vaccine, reinfection, breakthrough infection, immunity, Immunologic diseases. Allergy, RC581-607
Abstract: In 2021, Qatar experienced considerable incidence of SARS-CoV-2 infection that was dominated sequentially by the Alpha, Beta, and Delta variants. Using the cycle threshold (Ct) value of an RT-qPCR-positive test to proxy the inverse of infectiousness, we investigated infectiousness of SARS-CoV-2 infections by variant, age, sex, vaccination status, prior infection status, and reason for testing in a random sample of 18,355 RT-qPCR-genotyped infections. Regression analyses were conducted to estimate associations with the Ct value of RT-qPCR-positive tests. Compared to Beta infections, Alpha and Delta infections demonstrated 2.56 higher Ct cycles (95% CI: 2.35-2.78), and 4.92 fewer cycles (95% CI: 4.67- 5.16), respectively. The Ct value declined gradually with age and was especially high for children
Published: 2022
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9. Protection from previous natural infection compared with mRNA vaccination against SARS-CoV-2 infection and severe COVID-19 in Qatar: a retrospective cohort study

Author: Hiam, Chemaitelly, Houssein H, Ayoub, Sawsan, AlMukdad, Peter, Coyle, Patrick, Tang, Hadi M, Yassine, Hebah A, Al-Khatib, Maria K, Smatti, Mohammad R, Hasan, Zaina, Al-Kanaani, Einas, Al-Kuwari, Andrew, Jeremijenko, Anvar Hassan, Kaleeckal, Ali Nizar, Latif, Riyazuddin Mohammad, Shaik, Hanan F, Abdul-Rahim, Gheyath K, Nasrallah, Mohamed Ghaith, Al-Kuwari, Adeel A, Butt, Hamad Eid, Al-Romaihi, Mohamed H, Al-Thani, Abdullatif, Al-Khal, Roberto, Bertollini, and Laith J, Abu-Raddad
Subjects: Microbiology (medical), COVID-19 Vaccines, SARS-CoV-2, mRNA-1273 (Moderna), COVID-19, Microbiology, COVID-19 Testing, Infectious Diseases, BNT162b2 (Pfizer–BioNTech), SDG 3 - Good Health and Well-being, Reinfection, Virology, Humans, RNA, Messenger, Public Health, Qatar, BNT162 Vaccine, Retrospective Studies
Abstract: BackgroundUnderstanding protection conferred by natural SARS-CoV-2 infection versus COVID-19 vaccination is important for informing vaccine mandate decisions. We compared protection conferred by natural infection versus that from the BNT162b2 (Pfizer–BioNTech) and mRNA-1273 (Moderna) vaccines in Qatar. MethodsWe conducted two matched retrospective cohort studies that emulated target trials. Data were obtained from the national federated databases for COVID-19 vaccination, SARS-CoV-2 testing, and COVID-19-related hospitalisation and death between Feb 28, 2020 (pandemic onset in Qatar) and May 12, 2022. We matched individuals with a documented primary infection and no vaccination record (natural infection cohort) with individuals who had received two doses (primary series) of the same vaccine (BNT162b2-vaccinated or mRNA-1273-vaccinated cohorts) at the start of follow-up (90 days after the primary infection). Individuals were exact matched (1:1) by sex, 10-year age group, nationality, comorbidity count, and timing of primary infection or first-dose vaccination. Incidence of SARS-CoV-2 infection and COVID-19-related hospitalisation and death in the natural infection cohorts was compared with incidence in the vaccinated cohorts, using Cox proportional hazards regression models with adjustment for matching factors. FindingsBetween Jan 5, 2021 (date of second-dose vaccine roll-out) and May 12, 2022, 104 500 individuals vaccinated with BNT162b2 and 61 955 individuals vaccinated with mRNA-1273 were matched to unvaccinated individuals with a documented primary infection. During follow-up, 7123 SARS-CoV-2 infections were recorded in the BNT162b2-vaccinated cohort and 3583 reinfections were recorded in the matched natural infection cohort. 4282 SARS-CoV-2 infections were recorded in the mRNA-1273-vaccinated cohort and 2301 reinfections were recorded in the matched natural infection cohort. The overall adjusted hazard ratio (HR) for SARS-CoV-2 infection was 0·47 (95% CI 0·45–0·48) after previous natural infection versus BNT162b2 vaccination, and 0·51 (0·49–0·54) after previous natural infection versus mRNA-1273 vaccination. The overall adjusted HR for severe (acute care hospitalisations), critical (intensive care unit hospitalisations), or fatal COVID-19 cases was 0·24 (0·08–0·72) after previous natural infection versus BNT162b2 vaccination, and 0·24 (0·05–1·19) after previous natural infection versus mRNA-1273 vaccination. Severe, critical, or fatal COVID-19 was rare in both the natural infection and vaccinated cohorts. InterpretationPrevious natural infection was associated with lower incidence of SARS-CoV-2 infection, regardless of the variant, than mRNA primary-series vaccination. Vaccination remains the safest and most optimal tool for protecting against infection and COVID-19-related hospitalisation and death, irrespective of previous infection status. FundingThe Biomedical Research Program and the Biostatistics, Epidemiology, and Biomathematics Research Core, Weill Cornell Medicine-Qatar; Qatar Ministry of Public Health; Hamad Medical Corporation; Sidra Medicine; Qatar Genome Programme; and Qatar University Biomedical Research Center. The Biomedical Research Program and the Biostatistics, Epidemiology, and Biomathematics Research Core, Weill Cornell Medicine-Qatar; Qatar Ministry of Public Health; Hamad Medical Corporation; Sidra Medicine; Qatar Genome Programme; and Qatar University Biomedical Research Center.
Published: 2022
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10. Protection against Reinfection with the Omicron BA.2.75 Subvariant

Author: Hiam Chemaitelly, Patrick Tang, Peter Coyle, Hadi M. Yassine, Hebah A. Al-Khatib, Maria K. Smatti, Mohammad R. Hasan, Houssein H. Ayoub, Heba N. Altarawneh, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar H. Kaleeckal, Ali N. Latif, Riyazuddin M. Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed G. Al-Kuwari, Adeel A. Butt, Hamad E. Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Subjects: General Medicine
Published: 2023
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11. A turning point in COVID-19 severity and fatality during the pandemic: A national cohort study in Qatar

Author: Hiam Chemaitelly, Houssein H. Ayoub, Jeremy Samuel Faust, Peter Coyle, Patrick Tang, Mohammad R. Hasan, Hadi M. Yassine, Hebah A. Al-Khatib, Asmaa A. Al Thani, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Abstract: BackgroundThis study assessed the evolution of COVID-19 severity and fatality by utilizing rigorous and standardized criteria that were consistently applied throughout the pandemic in Qatar.MethodsA national cohort study was conducted on Qataris, using data on COVID-19 acute-care and ICU hospitalizations, as well as severe, critical, and fatal COVID-19 cases classified according to the World Health Organization criteria.ResultsThe cumulative incidence of severe, critical, or fatal COVID-19 after 3.14 years of follow-up was 0.45% (95% CI: 0.43-0.47%). The incidence rate for severe, critical, or fatal COVID-19 throughout the pandemic was 1.43 (95% CI: 1.35-1.50) per 1,000 person-years. In the pre-omicron phase, first omicron wave, and combined phases, it was 2.01 (95% CI: 1.90-2.13), 3.70 (95% CI: 3.25-4.22), and 2.18 (95% CI: 2.07-2.30) per 1,000 person-years, respectively. The post-first omicron phase saw a drastic drop to 0.10 (95% CI: 0.08-0.14) per 1,000 person-years, a 95.4% reduction. Among all severe, critical, and fatal cases, 99.5% occurred during the primary infection. The cumulative incidence of fatal COVID-19 was 0.042% (95% CI: 0.036-0.050%), with an incidence rate of 0.13 (95% CI: 0.11-0.16) per 1,000 person-years. In the post-first omicron phase, the incidence rate of fatal COVID-19 decreased by 90.0% compared to earlier stages. Both severity and fatality exhibited an exponential increase with age and a linear increase with the number of coexisting conditions.ConclusionsThe conclusion of the first omicron wave was a turning point in the severity of the pandemic. While vaccination and enhanced case management reduced severity gradually, the rapid accumulation of natural immunity during the initial omicron wave appears to have played the crucial role in driving this shift in severity.
Published: 2023
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12. Population immunity of natural infection, primary-series vaccination, and booster vaccination in Qatar during the COVID-19 pandemic: An observational study

Author: Suelen H. Qassim, Hiam Chemaitelly, Houssein H. Ayoub, Peter Coyle, Patrick Tang, Hadi M. Yassine, Asmaa A. Al Thani, Hebah A. Al-Khatib, Mohammad R. Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Abstract: SummaryBackgroundWaning of natural infection protection and vaccine protection highlight the need to evaluate changes in population immunity over time. Population immunity of previous SARS-CoV-2 infection or of COVID-19 vaccination are defined, respectively, as the overall protection against reinfection or against breakthrough infection at a given point in time in a given population.MethodsWe estimated these population immunities in Qatar’s population between July 1, 2020 and November 30, 2022, to discern generic features of the epidemiology of SARS-CoV-2. Effectiveness of previous infection, mRNA primary-series vaccination, and mRNA booster (third-dose) vaccination in preventing infection were estimated, month by month, using matched, test-negative, case-control studies.FindingsPrevious-infection effectiveness against reinfection was strong before emergence of Omicron, but declined with time after a wave and rebounded after a new wave. Effectiveness dropped immediately after Omicron emergence from 88.3% (95% CI: 84.8-91.0%) in November 2021 to 51.0% (95% CI: 48.3-53.6%) in December 2021. Primary-series effectiveness against infection was 84.0% (95% CI: 83.0-85.0%) in April 2021, soon after introduction of vaccination, before waning gradually to 52.7% (95% CI: 46.5-58.2%) by November of 2021. Effectiveness declined linearly by ∼1 percentage point every 5 days. After Omicron emergence, effectiveness dropped suddenly from 52.7% (95% CI: 46.5-58.2%) in November 2021 to negligible levels in December 2021. Booster effectiveness dropped immediately after Omicron emergence from 83.0% (95% CI: 65.6 -91.6%) in November 2021 to 32.9% (95% CI: 26.7-38.5%) in December 2021, and continued to decline thereafter. Effectiveness of previous infection and vaccination against severe, critical, or fatal COVID-19 were generally >80% throughout the study duration.InterpretationHigh population immunity may not be sustained beyond a year. This creates fertile grounds for repeated waves of infection to occur, but these waves may increasingly exhibit a benign pattern of infection.FundingThe Biomedical Research Program and the Biostatistics, Epidemiology, and the Biomathematics Research Core, both at Weill Cornell Medicine-Qatar, Ministry of Public Health, Hamad Medical Corporation, Sidra Medicine, Qatar Genome Programme, Qatar University Biomedical Research Center, and Qatar University Internal Grant ID QUCG-CAS-23/24-114.Research in contextEvidence before this studySARS-CoV-2 infection induces protection against reinfection, but this protection wanes with time since last infection. Similarly, COVID-19 primary-series and booster vaccination induce protection against SARS-CoV-2 infection, but this protection also wanes with time since last dose. These immunity patterns demonstrate the need for the concept ofpopulation immunityto track evolution of overall immune protection over time in a given population. Previous-infection and vaccine population immunities in a specific country can be defined as the overall protection against infection at a given point in time in the full national population. A search of PubMed, Google Scholar, and the International Vaccine Access Center’s VIEW-hub databases up to April 21, 2023 using the keywords “vaccination”, “infection”, “immunity”, “protection”, “SARS-CoV-2”, and “COVID-19” did not identify studies that investigated this epidemiological concept for a national population throughout the COVID-19 pandemic.Added value of this studyThis study analyzed the national federated databases for SARS-CoV-2 infection and COVID-19 vaccination in Qatar, a country that experienced SARS-CoV-2 waves dominated by different pre-Omicron variants and Omicron subvariants. Using a matched, test-negative study design, population immunity against infection of each of previous infection, primary-series vaccination, and booster vaccination were characterized at the national level month by month for two calendar years to discern generic features of the epidemiology of SARS-CoV-2. The three forms of population immunity showed rapid variation over time driven by waning of protection. Vaccine-derived population immunity declined by 1 absolute percentage point every 5 days. Omicron introduction immensely reduced the three forms of population immunity within one month by about 50 absolute percentage points. Meanwhile, previous-infection and vaccine population immunities against severe COVID-19 were durable with slow waning even after Omicron emergence.Implications of all available evidenceBoth previous-infection and vaccine population immunities vary rapidly at a national level creating fertile grounds for repeated waves of infection to occur even within months of each other. High levels of population immunity may not be sustained for more than a year or so. Preventing infection/reinfection, transmission, or future waves of infection cannot sustainably be done with current vaccines nor by the entire population being infected. Timely administration of boosters for those vulnerable to severe COVID-19 may remain essential for years to come. Repeated waves of infection may also facilitate further evolution of the virus and continual immune evasion. Emergence of a new variant that is substantially different from circulating variants can suddenly and immensely reduce population immunity leading to large epidemic waves. However, the durability of population immunity against severe COVID-19 will likely curtail the severity of future waves.
Published: 2023
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13. Effects of previous infection, vaccination, and hybrid immunity against symptomatic Alpha, Beta, and Delta infections

Author: Heba N. Altarawneh, Hiam Chemaitelly, Houssein H. Ayoub, Patrick Tang, Mohammad R. Hasan, Hadi M. Yassine, Hebah A. Al-Khatib, Asmaa A. Al Thani, Peter Coyle, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Abstract: BackgroundProtection against SARS-CoV-2 symptomatic infection and severe COVID-19 of previous infection, mRNA two-dose vaccination, mRNA three-dose vaccination, and hybrid immunity of previous infection and vaccination were investigated in Qatar for the Alpha, Beta, and Delta variants.MethodsSix national, matched, test-negative, case-control studies were conducted between January 18-December 18, 2021 on a sample of 239,120 PCR-positive tests and 6,103,365 PCR-negative tests.ResultsEffectiveness of previous infection against Alpha, Beta, and Delta reinfection was 89.5% (95% CI: 85.5-92.3%), 87.9% (95% CI: 85.4-89.9%), and 90.0% (95% CI: 86.7-92.5%), respectively. Effectiveness of two-dose BNT162b2 vaccination against Alpha, Beta, and Delta infection was 90.5% (95% CI, 83.9-94.4%), 80.5% (95% CI: 79.0-82.0%), and 58.1% (95% CI: 54.6-61.3%), respectively. Effectiveness of three-dose BNT162b2 vaccination against Delta infection was 91.7% (95% CI: 87.1-94.7%). Effectiveness of hybrid immunity of previous infection and two-dose BNT162b2 vaccination was 97.4% (95% CI: 95.4-98.5%) against Beta infection and 94.5% (95% CI: 92.8-95.8%) against Delta infection. Effectiveness of previous infection and three-dose BNT162b2 vaccination was 98.1% (95% CI: 85.7-99.7%) against Delta infection. All five forms of immunity had >90% protection against severe, critical, or fatal COVID-19 regardless of variant. Similar effectiveness estimates were observed for mRNA-1273.ConclusionsAll forms of natural and vaccine immunity prior to Omicron introduction provided strong protection against infection and severe COVID-19. Hybrid immunity conferred the strongest protection and its level was consistent with previous-infection immunity and vaccine immunity acting independently of each other.
Published: 2023
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14. Bivalent mRNA-1273.214 vaccine effectiveness against SARS-CoV-2 omicron XBB* infections

Author: Hiam Chemaitelly, Houssein H. Ayoub, Sawsan AlMukdad, Jeremy Samuel Faust, Patrick Tang, Peter Coyle, HADI M. YASSINE, Asmaa Althani, Hebah A. Al-Khatib, Mohammad R. Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar H. Kaleeckal, Ali N. Latif, Riyazuddin M. Shaik, Hanan F. Abdul-Rahim, Gheyath Nasrallah, Mohamed G. Al-Kuwari, Adeel A Butt, Hamad Eid Al-Romaihi, Mohammed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J Abu-Raddad
Abstract: Qatar introduced COVID-19 bivalent vaccination for persons ≥12 years old using the 50-μg mRNA-1273.214 vaccine combining SARS-CoV-2 ancestral and omicron BA.1 strains. We estimated effectiveness of this bivalent vaccine against SARS-CoV-2 infection using a matched, retrospective, cohort study. Matched cohorts included 11,482 persons in the bivalent cohort and 56,806 persons in the no-recent-vaccination cohort. During follow-up, 65 infections were recorded in the bivalent cohort and 406 were recorded in the no-recent-vaccination cohort. None progressed to severe, critical, or fatal COVID-19. Cumulative incidence of infection was 0.80% (95% CI: 0.61-1.07%) in the bivalent cohort and 1.00% (95% CI: 0.89-1.11%) in the no-recent-vaccination cohort, 150 days after the start of follow-up. Incidence during follow-up was dominated by omicron XBB* subvariants including XBB, XBB.1, XBB.1.5, XBB.1.9.1, XBB.1.9.2, XBB.1.16, and XBB.2.3. The adjusted hazard ratio comparing incidence of infection in the bivalent cohort to that in the no-recent-vaccination cohort was 0.75 (95% CI: 0.57-0.97). Bivalent vaccine effectiveness against infection was 25.2% (95% CI: 2.6-42.6%). Effectiveness was 21.5% (95% CI: -8.2-43.5%) among persons with no prior infection and 33.3% (95% CI: -4.6-57.6%) among persons with prior infection. mRNA-1273.214 reduced incidence of SARS-CoV-2 infection, but the protection was modest at only 25%. The modest protection may have risen because of XBB* immune evasion or immune imprinting effects, or combination of both.
Published: 2023
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15. Immune Imprinting and Protection against Repeat Reinfection with SARS-CoV-2

Author: Hiam Chemaitelly, Houssein H. Ayoub, Patrick Tang, Mohammad R. Hasan, Peter Coyle, Hadi M. Yassine, Hebah A. Al-Khatib, Maria K. Smatti, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar H. Kaleeckal, Ali N. Latif, Riyazuddin M. Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed G. Al-Kuwari, Adeel A. Butt, Hamad E. Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Subjects: SARS-CoV-2, Reinfection, Spike Glycoprotein, Coronavirus, Humans, COVID-19, General Medicine, Antibodies, Viral, Immunologic Memory
Published: 2022
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16. Effect of mRNA Vaccine Boosters against SARS-CoV-2 Omicron Infection in Qatar

Author: Laith J. Abu-Raddad, Hiam Chemaitelly, Houssein H. Ayoub, Sawsan AlMukdad, Hadi M. Yassine, Hebah A. Al-Khatib, Maria K. Smatti, Patrick Tang, Mohammad R. Hasan, Peter Coyle, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar H. Kaleeckal, Ali N. Latif, Riyazuddin M. Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, and Roberto Bertollini
Subjects: Vaccines, Synthetic, COVID-19 Vaccines, SARS-CoV-2, Immunization, Secondary, COVID-19, Vaccine Efficacy, General Medicine, Cohort Studies, Boosters against Omicron Infection in Qatar, Immunogenicity, Vaccine, SDG 3 - Good Health and Well-being, Humans, RNA, Messenger, mRNA Vaccines, Qatar, BNT162 Vaccine, 2019-nCoV Vaccine mRNA-1273, Retrospective Studies
Abstract: Waning of vaccine protection against coronavirus disease 2019 (Covid-19) and the emergence of the omicron (or B.1.1.529) variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have led to expedited efforts to scale up booster vaccination. Protection conferred by booster doses of the BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) vaccines in Qatar, as compared with protection conferred by the two-dose primary series, is unclear. We conducted two matched retrospective cohort studies to assess the effectiveness of booster vaccination, as compared with that of a two-dose primary series alone, against symptomatic SARS-CoV-2 infection and Covid-19-related hospitalization and death during a large wave of omicron infections from December 19, 2021, through January 26, 2022. The association of booster status with infection was estimated with the use of Cox proportional-hazards regression models. In a population of 2,239,193 persons who had received at least two doses of BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccine, those who had also received a booster were matched with persons who had not received a booster. Among the BNT162b2-vaccinated persons, the cumulative incidence of symptomatic omicron infection was 2.4% (95% confidence interval [CI], 2.3 to 2.5) in the booster cohort and 4.5% (95% CI, 4.3 to 4.6) in the nonbooster cohort after 35 days of follow-up. Booster effectiveness against symptomatic omicron infection, as compared with that of the primary series, was 49.4% (95% CI, 47.1 to 51.6). Booster effectiveness against Covid-19-related hospitalization and death due to omicron infection, as compared with the primary series, was 76.5% (95% CI, 55.9 to 87.5). BNT162b2 booster effectiveness against symptomatic infection with the delta (or B.1.617.2) variant, as compared with the primary series, was 86.1% (95% CI, 67.3 to 94.1). Among the mRNA-1273-vaccinated persons, the cumulative incidence of symptomatic omicron infection was 1.0% (95% CI, 0.9 to 1.2) in the booster cohort and 1.9% (95% CI, 1.8 to 2.1) in the nonbooster cohort after 35 days; booster effectiveness against symptomatic omicron infection, as compared with the primary series, was 47.3% (95% CI, 40.7 to 53.3). Few severe Covid-19 cases were noted in the mRNA-1273-vaccinated cohorts. The messenger RNA (mRNA) boosters were highly effective against symptomatic delta infection, but they were less effective against symptomatic omicron infection. However, with both variants, mRNA boosters led to strong protection against Covid-19-related hospitalization and death. (Funded by Weill Cornell Medicine-Qatar and others.). Supported by the Biomedical Research Program and the Biostatistics, Epidemiology, and Biomathematics Research Core at Weill Cornell Medicine–Qatar; the Ministry of Public Health; Hamad Medical Corporation; and Sidra Medicine. The Qatar Genome Program and the Qatar University Biomedical Research Center provided the reagents needed for the viral genome sequencing.
Published: 2022
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17. Long-term COVID-19 booster effectiveness by infection history and clinical vulnerability and immune imprinting: a retrospective population-based cohort study

Author: Hiam Chemaitelly, Houssein H Ayoub, Patrick Tang, Peter Coyle, Hadi M Yassine, Asmaa A Al Thani, Hebah A Al-Khatib, Mohammad R Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F Abdul-Rahim, Gheyath K Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A Butt, Hamad Eid Al-Romaihi, Mohamed H Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, Jeremy Samuel Faust, and Laith J Abu-Raddad
Subjects: Infectious Diseases
Published: 2023
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18. The burden of Ischemic Heart Disease and the Epidemiologic Transition in the Eastern Mediterranean Region: 1990-2019

Author: Masoumeh Sadeghi, Marjan Jamalian, Kamran Mehrabani-Zeinabad, Karam I. I. Adawi, Jacek Kopec, Wael AlMahmeed, Hanan F. Abdul Rahim, Hasan A. Farhan, Wagida A. Anwar, Yosef Manla, Ibthihal Fadhil, Michelle Lui, Hamidreza Roohafza, Sheikh Mohammed Shariful Islam, Kadhim Sulaiman, Nooshin Bazargani, Georges Saade, Nejat Hassen, Amani A. Alndejani, Amr Abdin, Khalid AlHabib, Saira Bokhari, Catherine Johnson, Gregory A. Roth, Benjamin Stark, Nizal Sarrafzadegan, and Ali Mokdad
Abstract: Introduction The purpose of this study is to investigate the trends of the burden of ischemic heart disease (IHD) in the Eastern Mediterranean Region (EMR) countries from 1990 to 2019. Method Prevalence, disability-adjusted life years (DALYs), death, DALYs attribution risk factors, healthcare access and quality index (HAQ), and universal health care (UHC) were extracted from the database of the Global Burden of Disease study (GBD) for the EMR countries. Data stratification is based on the social demographic index (SDI). Cardiac rehabilitation data was obtained from the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) and other information was e obtained by an advanced search of individualized countries’ data. Result IHD age-standardized prevalence increased from 4.96% to 5.31% in the EMR from 1990-2019 while it decreased at the global level. In the EMR, the trend of age-standardized IHD death and DALYs rates decreased by 11.39% and 15.36% between 1990 and 2019 respectively, however, both rates were higher than the global rates. The burden of IHD in males was higher than females. The highest decrease of IHD age-standardized prevalence, death and DALYs rate in the EMR countries occurred in Bahrain (-3.72%, -64.95%and-69.08%, respectively). However, the most increase of prevalence happened in Oman with a change of 14.40% and for death and DALY rates was in Pakistan (29.62% and 31.93%, respectively) in the studied period. The top three attributed risk factor to IHD DALYs in the EMR in 2019 were high systolic blood pressure, high low-density lipoprotein cholesterol, and particular matter pollution. The 29-year trend of an attributed risk factor to IHD DALYs in the EMR (1990-2019) showed that the two factors of high fasting plasma glucose (64.03%) and high BMI (23.39%) had an increasing trend, respectively. Conclusion Our results showed an increased trend of the prevalence of IHD in the EMR that requires well planned prevention and treatment strategies. Developing and implementing programs to address the risk factors through health promotion and education, preventive programs, and medical care should be a priority for countries in this region.
Published: 2023
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19. Changes in the burden and underlying causes of heart failure in the Eastern Mediterranean Region, 1990–2019: an analysis of the Global Burden of Disease Study 2019

Author: Razieh Hassannejad, Davood Shafie, Karam I. Turk-Adawi, Ahmad Mohammad Hajaj, Kamran Mehrabani-Zeinabad, Michelle Lui, Jacek A. Kopec, Hanan F. Abdul Rahim, Saeid Safiri, Ibtihal Fadhil, Wagida A. Anwar, Ali H. Mokdad, Sheikh Mohammed Shariful Islam, and Nizal Sarrafzadegan
Subjects: Global burden of disease, Ischemic heart disease, Hypertension, Prevalence, Eastern mediterranean region, Heart failure, General Medicine, Year lived with disability
Abstract: BackgroundThe burden of heart failure (HF) is high globally, but information on its burden in the Eastern Mediterranean Region (EMR) is limited. This study provides a systematic analysis of the burden and underlying causes of HF in the EMR, including at the country level, between 1990 and 2019. MethodsWe used the 2019 Global Burden of Disease (GBD) data for estimates of prevalence, years lived with disability (YLDs), and underlying causes of HF in the EMR. Age-standardised prevalence, YLDs, and underlying causes of HF were compared by 5-year age groups (considering 15 years old and more), sex (male and female), and countries. FindingsIn contrast with the decreasing trend of HF burden globally, EMR showed an increasing trend. Globally, the HF age-standardised prevalence and YLDs decreased by 7.06% (95% UI: −7.22%, −6.9%) and 6.82% (95% UI: −6.98%, −6.66%) respectively, from 1990 to 2019. The HF age-standardised prevalence and YLDs in the EMR in 2019 were 706.43 (95% UI: 558.22–887.87) and 63.46 (95% UI: 39.82–92.59) per 100,000 persons, representing an increase of 8.07% (95% UI: 7.9%, 8.24%) and 8.79% (95% UI: 8.61%, 8.97%) from 1990, respectively. Amongst EMR countries, the age-standardised prevalence and YLDs were highest in Kuwait, while Pakistan consistently had the lowest HF burden. The dramatic increase of the age-standardised prevalence and YLDs were seen in Oman (28.79%; 95% UI: 28.51%, 29.07% and 29.56%; 95% UI: 29.28%, 29.84%), while Bahrain witnessed a reduction over the period shown (−9.66%; 95% UI: −9.84%, −9.48% and−9.14%; 95% UI: −9.32%, −8.96%). There were significant country-specific differences in trends of HF burden from 1990 to 2019. Males had relatively higher rates than females in all age groups. Among all causes of HF in 2019, ischemic heart disease accounted for the highest age-standardised prevalence and YLDs, followed by hypertensive heart disease. InterpretationThe burden of HF in the EMR was higher than the global, with increasing age-standardised prevalence and YLDs in countries of the region. A more comprehensive approach is needed to prevent underlying causes and improve medical care to control the burden of HF in the region. FundingNone.
Published: 2023

20. Short- and longer-term all-cause mortality among SARS-CoV-2-infected persons and the pull-forward phenomenon in Qatar

Author: Hiam Chemaitelly, Jeremy Samuel Faust, Harlan M. Krumholz, Houssein H. Ayoub, Patrick Tang, Peter Coyle, Hadi M. Yassine, Asmaa A. Al Thani, Hebah A. Al-Khatib, Mohammad R. Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Abstract: BackgroundRisk of short- and long-term all-cause mortality after a primary SARS-CoV-2 infection is inadequately understood.MethodsA national, matched, retrospective cohort study was conducted in Qatar to assess the risk of all-cause mortality in the national cohort of people infected with SARS-CoV-2 compared with a reference national control cohort of uninfected persons. Associations were estimated using Cox proportional-hazards regression models.ResultsAmong unvaccinated persons, within 90 days after primary infection, adjusted hazard ratio (aHR) comparing incidence of death in the primary-infection cohort with the infection-naïve cohort was 1.19 (95% CI: 1.02-1.39). The aHR was 1.34 (95% CI: 1.11-1.63) in persons more clinically vulnerable to severe COVID-19 and 0.94 (95% CI: 0.72-1.24) in those less clinically vulnerable to severe COVID-19. In subsequent follow-up, the aHR was 0.50 (95% CI: 0.37-0.68). The aHR was 0.41 (95% CI: 0.28-0.58) in months 3-7 after the primary infection and 0.76 (95% CI: 0.46-1.26) in subsequent months. The aHR was 0.37 (95% CI: 0.25-0.54) in persons more clinically vulnerable to severe COVID-19 and 0.77 (95% CI: 0.48-1.24) in those less clinically vulnerable to severe COVID-19. Among vaccinated persons, no evidence was found for differences in incidence of death in the primary-infection versus infection-naïve cohorts, even among persons more clinically vulnerable to severe COVID-19.ConclusionsCOVID-19 mortality in Qatar appears primarily driven by forward displacement of deaths of individuals with relatively short life expectancy and more clinically vulnerable to severe COVID-19. Vaccination negated the mortality displacement by preventing early deaths.
Published: 2023
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21. Trends in the Burden and Determinants of Hypertensive Heart Disease in the Eastern Mediterranean Region, 1990-2019: An Analysis of the Global Burden of Disease Study 2019

Author: Asieh Mansouri, Alireza Khosravi, Kamran Mehrabani-Zeinabad, Jacek Kopec, Karam I. I. Adawi, Michelle Lui, Hanan F. Abdul Rahim, Wagida A. Anwar, Ibthihal Fadhil, Kadhim Sulaiman, Nooshin Bazargani, Georges Saade, Hasan A. Farhan, Wael AlMahmeed, Saira Bokhari, Nejat Hassen, Amani A. Alndejani, Shahin Shirani, Amr Abdin, Yosef Manla, Catherine Johnson, Benjamin Stark, Gregory A. Roth, Ali Mokdad, Sheikh Mohammed Shariful Islam, and Nizal Sarrafzadegan
Published: 2023
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22. Following Interprofessional Education: Health Education Students’ Experience in a Primary Interprofessional Care Setting

Author: Sawsan Awada, Ghadir Fakhri Al-Jayyousi, Diana Alsayed Hassan, and Hanan F. Abdul Rahim
Subjects: medicine.medical_specialty, field experience, media_common.quotation_subject, education, interprofessional collaboration, primary care, Health care, medicine, health education, Curriculum, General Nursing, media_common, Original Research, Medical education, Teamwork, business.industry, communication, Public health, Journal of Multidisciplinary Healthcare, Behavior change, public health, General Medicine, Interprofessional education, Health education, business, Psychology, Patient education
Abstract: Ghadir Fakhri Al-Jayyousi, Hanan Abdul Rahim, Diana Alsayed Hassan, Sawsan Mohammed Awada Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, QatarCorrespondence: Ghadir Fakhri Al-JayyousiDepartment of Public Health, College of Health Sciences, QU Health, Qatar University, PO Box 2713, Doha, QatarEmail g.aljayyousi@qu.edu.qaBackground: There is an accelerating need for interprofessional education (IPE) in the Public Health field, as healthcare providers become diverse and multi-disciplinary. Public Health students with health education concentration at Qatar University are required to join training sessions in IPE before the start of their field experience, where students are placed in a variety of community-based and clinical settings including, but not limited to, primary healthcare.Purpose: The goal of this qualitative research study is to understand health education studentsâ experience in interprofessional care during their field experience in a primary healthcare setting and to highlight the successes and challenges.Patients and Methods: Participants were third-year health education students (N = 22) enrolled in the Public Health program at Qatar University who obtained their experiential learning in three different primary health care centers. Studentsâ weekly reports reflecting on primary interprofessional care were included in the analysis for the purpose of this study. Following constant comparative techniques, thematic analysis was conducted on health education studentsâ reports.Results: Interprofessional care was witnessed and practiced by students in teamwork and collaboration for the benefit of the patient, communication among health care professionals and referral process and patient flow. Health education students understood their role in interprofessional care in the fields of behavior change, and patient education and empowerment. However, professionals and patients were not recognizing health educatorsâ role and were not familiar with their contributions to interprofessional care in primary healthcare. Students suggested delivering interprofessional education for health care providers to enhance collaborative teamwork and promote knowledge about the evolving health education field among healthcare providers in Qatar. In addition, they recommended orienting their training supervisors about the goal of IPE-based practice in a primary healthcare setting.Conclusion: Interprofessional care was observed and practiced by health education students through collaborative teamwork, communication among health care professionals and management of patient flow. However, they faced challenges during their practice-based IPE. The findings can be tailored towards planning for interprofessional education workshops to boost collaboration progress among health care providers including health educators and supporting professionals interested to implement practice-based IPE in their placement curriculums.Keywords: interprofessional collaboration, communication, health education, public health, primary care, field experience
Published: 2021

23. Effect of BNT162b2 antigen dosage on protection against SARS-CoV-2 omicron infection

Author: Hiam Chemaitelly, Houssein H. Ayoub, Peter Coyle, Patrick Tang, Hadi M. Yassine, Asmaa A. Al Thani, Hebah A. Al-Khatib, Mohammad R. Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Hamad Eid Al-Romaihi, Adeel A. Butt, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Abstract: BackgroundCoronavirus Disease 2019 (COVID-19) vaccine antigen dosage may affect protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but direct evidence to quantify this effect is lacking.MethodsA matched, retrospective, cohort study that emulated a randomized control trial was conducted in Qatar between February 3, 2022 and November 8, 2022, to provide a head-to-head, controlled comparison of protection induced by two antigen dosages of the BNT162b2 vaccine. The study compared incidence of omicron infection in the national cohort of adolescents 12 years of age who received the two-dose primary-series of the 30-µg BNT162b2 vaccine to that in the national cohort of adolescents 11 years of age who received the two-dose primary-series of the pediatric 10-µg BNT162b2 vaccine. Associations were estimated using Cox proportional-hazard regression models.ResultsAmong adolescents with no record of prior infection, cumulative incidence of infection was 6.0% (95% CI: 4.9-7.3%) for the 30-µg cohort and 7.2% (95% CI: 6.1-8.5%) for the 10-µg cohort, 210 days after the start of follow-up. Incidence during follow-up was dominated by omicron subvariants including, consecutively, BA.1/BA.2, BA.4/BA.5, BA.2.75*, and XBB. The adjusted hazard ratio comparing incidence of infection in the 30-µg cohort to the 10-µg cohort was 0.77 (95% CI: 0.60-0.98). Corresponding relative effectiveness was 23.4% (95% CI: 1.6-40.4%). Relative effectiveness was -3.3% (95% CI: -68.0-27.5%) among adolescents with a record of prior infection.ConclusionsThree-fold higher BNT162b2 dosage was associated with ∼25% higher protection against infection in infection-naïve adolescents of similar age. These findings may inform design of future COVID-19 vaccines and boosters for persons of different age groups.
Published: 2022
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24. 1966. Protection afforded by prior infection, vaccination, and hybrid immunity against symptomatic BA.1 and BA.2 Omicron infections

Author: Heba N Altarawneh, Hiam Chemaitelly, Houssein H Ayoub, Patrick Tang, Mohammad R Hasan, Hadi M Yassine, Hebah A Al-Khatib, Maria K Smatti, Peter Coyle, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F Abdul-Rahim, Gheyath K Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A Butt, Hamad Eid Al-Romaihi, Mohamed H Al-Thani, Abdul Latif Al Khal, Roberto Bertollini, and Laith J Abu-Raddad
Subjects: Infectious Diseases, Oncology
Abstract: Background Protection offered by five different forms of immunity, combining natural and vaccine immunity, was investigated against symptomatic SARS-CoV-2 infection from Omicron BA.1 or BA.2, and severe, critical, or fatal COVID-19 from BA.1 or BA.2, in Qatar, between December 23, 2021 and February 21, 2022. Methods Six national, matched, test-negative case-control studies were conducted on a sample of 272,861 PCR-positive tests and 669,628 PCR-negative tests to estimate effectiveness of BNT162b2 (Pfizer-BioNTech) vaccine, mRNA-1273 (Moderna) vaccine, natural immunity due to prior infection with pre-Omicron variants, and hybrid immunity from prior infection and vaccination. Results Effectiveness of prior infection alone against symptomatic BA.2 infection was 46.1% (95% CI: 39.5-51.9%). Effectiveness of two-dose BNT162b2 vaccination alone was negligible at -1.1% (95% CI: -7.1-4.6), but nearly all individuals received their second dose >6 months earlier. Effectiveness of three-dose BNT162b2 vaccination alone was 52.2% (95% CI: 48.1-55.9%). Effectiveness of hybrid immunity of prior infection and two-dose BNT162b2 vaccination was 55.1% (95% CI: 50.9-58.9%). Effectiveness of hybrid immunity of prior infection and three-dose BNT162b2 vaccination was 77.3% (95% CI: 72.4-81.4%). Meanwhile, prior infection, BNT162b2 vaccination, and hybrid immunity all showed strong effectiveness ( >70%) against severe, critical, or fatal COVID-19 due to BA.2. Similar patterns of effectiveness were observed for BA.1 and for the mRNA-1273 vaccine. Figure 1.Effectiveness of prior infection, vaccination, and hybrid immunity against symptomatic Omicron infection and against severe, critical, or fatal COVID-19 for the BA.1 (panels A and B, respectively) and BA.2 (panels C and D, respectively) subvariants in the BNT162b2-vaccine study.Figure 2.Effectiveness of prior infection, vaccination, and hybrid immunity against symptomatic Omicron infection and against severe, critical, or fatal COVID-19 for the BA.1 (panels A and B, respectively) and BA.2 (panels C and D, respectively) subvariants in the mRNA-1273-vaccine study. Conclusion There are no discernable differences between BA.1 and BA.2 in the effects of prior infection, vaccination, and hybrid immunity. Vaccination enhances the protection of those with a prior infection. Hybrid immunity resulting from prior infection and recent booster vaccination conferred the strongest protection. Disclosures Adeel A. Butt, MBBS, Gilead Sciences: Grant/Research Support.
Published: 2022
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25. Long-term COVID-19 booster effectiveness by infection history and clinical vulnerability and immune imprinting

Author: Hiam Chemaitelly, Houssein H. Ayoub, Patrick Tang, Peter Coyle, Hadi M. Yassine, Asmaa A. Al Thani, Hebah A. Al-Khatib, Mohammad R. Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, Jeremy Samuel Faust, and Laith J. Abu-Raddad
Abstract: BackgroundLong-term effectiveness of COVID-19 mRNA boosters in populations with different prior infection histories and clinical vulnerability profiles is inadequately understood.MethodsA national, matched, retrospective, target trial cohort study was conducted in Qatar to investigate effectiveness of a third mRNA (booster) dose, relative to a primary series of two doses, against SARS-CoV-2 omicron infection and against severe COVID-19. Associations were estimated using Cox proportional-hazards regression models.ResultsBooster effectiveness relative to primary series was 41.1% (95% CI: 40.0-42.1%) against infection and 80.5% (95% CI: 55.7-91.4%) against severe, critical, or fatal COVID-19, over one-year follow-up after the booster. Among persons clinically vulnerable to severe COVID-19, effectiveness was 49.7% (95% CI: 47.8-51.6%) against infection and 84.2% (95% CI: 58.8-93.9%) against severe, critical, or fatal COVID-19. Effectiveness against infection was highest at 57.1% (95% CI: 55.9-58.3%) in the first month after the booster but waned thereafter and was modest at only 14.4% (95% CI: 7.3-20.9%) by the sixth month. In the seventh month and thereafter, coincident with BA.4/BA.5 and BA.2.75* subvariant incidence, effectiveness was progressively negative reaching -20.3% (95% CI: -55.0-29.0%) after one year of follow-up. Similar levels and patterns of protection were observed irrespective of prior infection status, clinical vulnerability, or type of vaccine (BNT162b2 versus mRNA-1273).ConclusionsBoosters reduced infection and severe COVID-19, particularly among those clinically vulnerable to severe COVID-19. However, protection against infection waned after the booster, and eventually suggested an imprinting effect of compromised protection relative to the primary series. However, imprinting effects are unlikely to negate the overall public health value of booster vaccinations.
Published: 2022
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26. Protection against reinfection with SARS-CoV-2 omicron BA.2.75*sublineage

Author: Hiam Chemaitelly, Patrick Tang, Peter Coyle, Hadi M. Yassine, Hebah A. Al-Khatib, Maria K. Smatti, Mohammad R. Hasan, Houssein H. Ayoub, Heba N. Altarawneh, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar H. Kaleeckal, Ali N. Latif, Riyazuddin M. Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed G. Al-Kuwari, Adeel A. Butt, Hamad E. Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Published: 2022
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27. Hepatic and cardiac iron overload quantified by magnetic resonance imaging in patients on hemodialysis: A systematic review and meta-analysis

Author: Abdulqadir J. Nashwan, Mohamed A. Yassin, Alaa Abd‐Alrazaq, Farag Shuweihdi, Muftah Othman, Hanan F. Abdul Rahim, and Mujahed Shraim
Subjects: Iron Overload, Nephrology, Renal Dialysis, Iron, Humans, Kidney Failure, Chronic, Hematology, Magnetic Resonance Imaging
Abstract: Few studies have reported hepatic and cardiac iron overload in patients with end-stage renal disease (ESRD), and the current evidence regarding the prevalence is still scarce.This review aims to estimate the prevalence of hepatic and/or cardiac iron overload quantified by magnetic resonance imaging (MRI) in patients with ESRD who receive hemodialysis (HD), peritoneal dialysis (PD), or have undergone a kidney transplant.A systematic review with meta-analysis was conducted and reported in line with PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. MEDLINE and Embase bibliographic databases were searched using a comprehensive list of controlled vocabulary and keywords to identify relevant studies. All studies reporting the prevalence of hepatic and/or cardiac iron overload quantified by MRI in ESRD patients were considered. The Newcastle-Ottawa scale was used to assess the methodological quality of included studies. To investigate the heterogeneity between studies, random-effect meta-analyses for proportions were used.The review comprised seven studies that included 339 patients. Using meta-analysis, the pooled prevalence of severe and mild to moderate hepatic iron overload quantified by MRI was 0.23 [95% CI: 0.08-0.43] and 0.52 [95% CI: 0.47-0.57], respectively. Only three studies included cardiac iron quantification, and none reported iron overload.This review has revealed a high prevalence of severe hepatic iron overload in patients with ESRD treated by HD. Further studies with a larger sample size are needed to determine the impact of iron overload on vital organs in patients with ESRD and guide future research in this understudied field. Proper use of iron chelation and continuous monitoring will help in the early detection of unsolicited complications; however, the low renal clearance of most iron chelators limits the options for treating iron excess in patients with ESRD.
Published: 2022

28. Protective Effect of Previous SARS-CoV-2 Infection against Omicron BA.4 and BA.5 Subvariants

Author: Heba N. Altarawneh, Hiam Chemaitelly, Houssein H. Ayoub, Mohammad R. Hasan, Peter Coyle, Hadi M. Yassine, Hebah A. Al-Khatib, Maria K. Smatti, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar H. Kaleeckal, Ali N. Latif, Riyazuddin M. Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed G. Al-Kuwari, Adeel A. Butt, Hamad E. Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, Patrick Tang, and Laith J. Abu-Raddad
Subjects: Neutralization Tests, SARS-CoV-2, Spike Glycoprotein, Coronavirus, Humans, COVID-19, General Medicine
Published: 2022

29. Protection against the Omicron Variant from Previous SARS-CoV-2 Infection

Author: Heba N. Altarawneh, Hiam Chemaitelly, Mohammad R. Hasan, Houssein H. Ayoub, Suelen Qassim, Sawsan AlMukdad, Peter Coyle, Hadi M. Yassine, Hebah A. Al-Khatib, Fatiha M. Benslimane, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar H. Kaleeckal, Ali N. Latif, Riyazuddin M. Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed G. Al-Kuwari, Adeel A. Butt, Hamad E. Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, Patrick Tang, and Laith J. Abu-Raddad
Subjects: General Medicine
Published: 2022
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30. BNT162b2 antigen dose and SARS-CoV-2 omicron infection in adolescents

Author: Hiam Chemaitelly, Houssein H Ayoub, Peter Coyle, Patrick Tang, Hadi M Yassine, Asmaa A Al Thani, Hebah A Al-Khatib, Mohammad R Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F Abdul-Rahim, Gheyath K Nasrallah, Mohamed Ghaith Al-Kuwari, Hamad Eid Al-Romaihi, Adeel A Butt, Mohamed H Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J Abu-Raddad
Subjects: Infectious Diseases
Published: 2023
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31. Immune protection against SARS-CoV-2 re-reinfection and immune imprinting

Author: Hiam Chemaitelly, Houssein H. Ayoub, Patrick Tang, Mohammad R. Hasan, Peter Coyle, Hadi M. Yassine, Hebah A. Al-Khatib, Maria K Smatti, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Abstract: We investigated epidemiological evidence for immune imprinting by comparing incidence of re-reinfection in the national cohort of individuals with a documented Omicron (BA.1/BA.2) reinfection after a pre-Omicron primary infection (designated as the reinfection cohort), to incidence of reinfection in the national cohort of individuals with a documented Omicron (BA.1/BA.2) primary infection (designated as the primary-infection cohort). This was done using a matched, retrospective cohort study that emulated a randomized “target trial”. Vaccinated individuals were excluded. Associations were estimated using Cox proportional-hazard regression models. Cumulative incidence of infection was 1.1% (95% CI: 0.8-1.4%) for the reinfection cohort and 2.1% (95% CI: 1.8-2.3%) for the primary-infection cohort, 135 days after the start of follow-up. The adjusted hazard ratio (aHR) for infection was 0.52 (95% CI: 0.40-0.68), comparing incidence in the reinfection cohort to that in the primary-infection cohort. The aHR was 0.59 (95% CI: 0.40-0.85) in a subgroup analysis in which primary infection in the reinfection cohort was restricted to only the index virus or Alpha variant. In the first 70 days of follow-up, when incidence was dominated by BA.2, the aHR was 0.92 (95% CI: 0.51-1.65). However, cumulative incidence curves diverged when BA.4/BA.5 subvariants dominated incidence (aHR, 0.46 (95% CI: 0.34-0.62)). There was no evidence that immune imprinting compromises protection against Omicron subvariants. However, there was evidence that having two infections, one with a pre-Omicron variant followed by one with an Omicron subvariant, elicits stronger protection against future Omicron-subvariant reinfection than having had only one infection with an Omicron subvariant.
Published: 2022
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32. Duration of immune protection of SARS-CoV-2 natural infection against reinfection

Author: Hiam Chemaitelly, Nico Nagelkerke, Houssein H Ayoub, Peter Coyle, Patrick Tang, Hadi M Yassine, Hebah A Al-Khatib, Maria K Smatti, Mohammad R Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F Abdul-Rahim, Gheyath K Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A Butt, Hamad Eid Al-Romaihi, Mohamed H Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J Abu-Raddad
Subjects: severe disease, Omicron, cohort study, COVID-19, epidemiology, General Medicine, immunity, reinfection
Abstract: Background The future of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic hinges on virus evolution and duration of immune protection of natural infection against reinfection. We investigated the duration of protection afforded by natural infection, the effect of viral immune evasion on duration of protection and protection against severe reinfection, in Qatar, between 28 February 2020 and 5 June 2022. Methods Three national, matched, retrospective cohort studies were conducted to compare the incidence of SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) severity among unvaccinated persons with a documented SARS-CoV-2 primary infection, to incidence among those infection-naïve and unvaccinated. Associations were estimated using Cox proportional hazard regression models. Results Effectiveness of pre-Omicron primary infection against pre-Omicron reinfection was 85.5% [95% confidence interval (CI): 84.8–86.2%]. Effectiveness peaked at 90.5% (95% CI: 88.4–92.3%) in the 7th month after the primary infection, but waned to ~ 70% by the 16th month. Extrapolating this waning trend using a Gompertz curve suggested an effectiveness of 50% in the 22nd month and Conclusions Protection of natural infection against reinfection wanes and may diminish within a few years. Viral immune evasion accelerates this waning. Protection against severe reinfection remains very strong, with no evidence for waning, irrespective of variant, for over 14 months after primary infection.
Published: 2022
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33. Effectiveness of the BNT162b2 vaccine against SARS-CoV-2 infection among children and adolescents in Qatar

Author: Hiam Chemaitelly, Sawsan AlMukdad, Houssein H. Ayoub, Heba N. Altarawneh, Peter Coyle, Patrick Tang, Hadi M. Yassine, Hebah A. Al-Khatib, Maria K. Smatti, Mohammad R. Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Hamad Eid Al-Romaihi, Adeel A. Butt, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Abstract: BackgroundThe BNT162b2 COVID-19 vaccine is authorized for children 5-11 years of age and adolescents 12-17 years of age, but in different dose sizes. We assessed BNT162b2 real-world effectiveness against SARS-CoV-2 infection among children and adolescents in Qatar.MethodsThree matched, retrospective, target-trial, cohort studies were conducted to compare incidence of SARS-CoV-2 infection in the national cohort of vaccinated individuals to incidence in the national cohort of unvaccinated individuals. Associations were estimated using Cox proportional-hazards regression models.ResultsEffectiveness of the 10 µg dose for children against Omicron infection was 25.7% (95% CI: 10.0-38.6%). It was highest at 49.6% (95% CI: 28.5-64.5%) right after the second dose, but waned rapidly thereafter and was negligible after 3 months. Effectiveness was 46.3% (95% CI: 21.5-63.3%) among those aged 5-7 years and 16.6% (−4.2-33.2%) among those aged 8-11 years. Effectiveness of the 30 µg dose for adolescents against Omicron infection was 30.6% (95% CI: 26.9-34.1%), but many adolescents were vaccinated months earlier. Effectiveness waned with time after the second dose. Effectiveness was 35.6% (95% CI: 31.2-39.6%) among those aged 12-14 years and 20.9% (13.8-27.4%) among those aged 15-17 years. Effectiveness of the 30 µg dose for adolescents against pre-Omicron infection was 87.6% (95% CI: 84.0-90.4%) and waned relatively slowly after the second dose.ConclusionsPediatric vaccination is associated with modest and rapidly waning protection against Omicron infection. Adolescent vaccination is associated with stronger and more durable protection, perhaps because of the larger dose size. Age at such young age appears to play a role in determining vaccine protection, with greater protection observed in younger than older children or adolescents.
Published: 2022
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34. Duration of immune protection of SARS-CoV-2 natural infection against reinfection in Qatar

Author: Hiam Chemaitelly, Nico Nagelkerke, Houssein H. Ayoub, Peter Coyle, Patrick Tang, Hadi M. Yassine, Hebah A. Al-Khatib, Maria K. Smatti, Mohammad R. Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Abstract: BACKGROUNDThe future of the SARS-CoV-2 pandemic hinges on virus evolution and duration of immune protection of natural infection against reinfection. We investigated duration of protection afforded by natural infection, the effect of viral immune evasion on duration of protection, and protection against severe reinfection, in Qatar, between February 28, 2020 and June 5, 2022.METHODSThree national, matched, retrospective cohort studies were conducted to compare incidence of SARS-CoV-2 infection and COVID-19 severity among unvaccinated persons with a documented SARS-CoV-2 primary infection, to incidence among those infection-naïve and unvaccinated. Associations were estimated using Cox proportional-hazard regression models.RESULTSEffectiveness of pre-Omicron primary infection against pre-Omicron reinfection was 85.5% (95% CI: 84.8-86.2%). Effectiveness peaked at 90.5% (95% CI: 88.4-92.3%) in the 7th month after the primary infection, but waned to ∼70% by the 16th month. Extrapolating this waning trend using a Gompertz curve suggested an effectiveness of 50% in the 22nd month and nd month. Effectiveness of pre-Omicron primary infection against Omicron reinfection was 38.1% (95% CI: 36.3-39.8%) and declined with time since primary infection. A Gompertz curve suggested an effectiveness of th month. Effectiveness of primary infection against severe, critical, or fatal COVID-19 reinfection was 97.3% (95% CI: 94.9- 98.6%), irrespective of the variant of primary infection or reinfection, and with no evidence for waning. Similar results were found in sub-group analyses for those ≥50 years of age.CONCLUSIONSProtection of natural infection against reinfection wanes and may diminish within a few years. Viral immune evasion accelerates this waning. Protection against severe reinfection remains very strong, with no evidence for waning, irrespective of variant, for over 14 months after primary infection.
Published: 2022
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35. Herd Immunity against Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 10 Communities, Qatar

Author: Abdullatif Al Khal, Mohamed Ghaith Al Kuwari, Reham Awni El Kahlout, Naseer Ahmad Masoodi, Adeel A. Butt, Riyazuddin Mohammad Shaik, Anil George Thomas, Anvar Hassan Kaleeckal, Hiam Chemaitelly, Hanaa Nafady-Hego, Nourah Younes, Mohamed H. Al-Thani, Ahmed Al-Mohammed, Moza Alishaq, Huda Mohamad Al Naomi, Ali Nizar Latif, Abdul-Badi Abou-Samra, Einas Al Kuwari, Naema Hassan Abdulla Al Molawi, Jameela Ali A.A. Al Ajmi, Zaina Al Kanaani, Laith J. Abu-Raddad, Peter Coyle, Houssein H. Ayoub, Andrew Jeremijenko, Hadi M. Yassine, Hamad Eid Al Romaihi, Roberto Bertollini, Imtiaz Gillani, Hanan F. Abdul Rahim, and Nasser Ali Asad Al Ansari
Subjects: Immunity, Herd, Microbiology (medical), medicine.medical_specialty, craft and manual workers, Epidemiology, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 030231 tropical medicine, Population, coronavirus, Infectious and parasitic diseases, RC109-216, medicine.disease_cause, Herd immunity, respiratory infections, 03 medical and health sciences, 0302 clinical medicine, Immunity, Internal medicine, medicine, Humans, herd immunity, Seroprevalence, viruses, 030212 general & internal medicine, education, Qatar, CMWs, Coronavirus, education.field_of_study, Herd Immunity against Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 10 Communities, Qatar, seroprevalence, biology, SARS-CoV-2, business.industry, Research, COVID-19, immunity, infection, zoonoses, communities, Infectious Diseases, coronavirus disease, biology.protein, Medicine, Antibody, business, severe acute respiratory syndrome coronavirus 2
Abstract: We investigated what proportion of the population acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and whether the herd immunity threshold has been reached in 10 communities in Qatar. The study included 4,970 participants during June 21–September 9, 2020. Antibodies against SARS-CoV-2 were detected by using an electrochemiluminescence immunoassay. Seropositivity ranged from 54.9% (95% CI 50.2%–59.4%) to 83.8% (95% CI 79.1%–87.7%) across communities and showed a pooled mean of 66.1% (95% CI 61.5%–70.6%). A range of other epidemiologic measures indicated that active infection is rare, with limited if any sustainable infection transmission for clusters to occur. Only 5 infections were ever severe and 1 was critical in these young communities; infection severity rate of 0.2% (95% CI 0.1%–0.4%). Specific communities in Qatar have or nearly reached herd immunity for SARS-CoV-2 infection: 65%–70% of the population has been infected.
Published: 2021
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36. Effects of Previous Infection and Vaccination on Symptomatic Omicron Infections

Author: Heba N. Altarawneh, Hiam Chemaitelly, Houssein H. Ayoub, Patrick Tang, Mohammad R. Hasan, Hadi M. Yassine, Hebah A. Al-Khatib, Maria K. Smatti, Peter Coyle, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar H. Kaleeckal, Ali N. Latif, Riyazuddin M. Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed G. Al-Kuwari, Adeel A. Butt, Hamad E. Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Subjects: Recurrence, SARS-CoV-2, Case-Control Studies, Vaccination, Immunization, Secondary, COVID-19, Humans, Immunization, Omicron Infections, General Medicine, BNT162 Vaccine, Immunity, Innate, 2019-nCoV Vaccine mRNA-1273
Abstract: The protection conferred by natural immunity, vaccination, and both against symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with the BA.1 or BA.2 sublineages of the omicron (B.1.1.529) variant is unclear. We conducted a national, matched, test-negative, case-control study in Qatar from December 23, 2021, through February 21, 2022, to evaluate the effectiveness of vaccination with BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna), natural immunity due to previous infection with variants other than omicron, and hybrid immunity (previous infection and vaccination) against symptomatic omicron infection and against severe, critical, or fatal coronavirus disease 2019 (Covid-19). The effectiveness of previous infection alone against symptomatic BA.2 infection was 46.1% (95% confidence interval [CI], 39.5 to 51.9). The effectiveness of vaccination with two doses of BNT162b2 and no previous infection was negligible (-1.1%; 95% CI, -7.1 to 4.6), but nearly all persons had received their second dose more than 6 months earlier. The effectiveness of three doses of BNT162b2 and no previous infection was 52.2% (95% CI, 48.1 to 55.9). The effectiveness of previous infection and two doses of BNT162b2 was 55.1% (95% CI, 50.9 to 58.9), and the effectiveness of previous infection and three doses of BNT162b2 was 77.3% (95% CI, 72.4 to 81.4). Previous infection alone, BNT162b2 vaccination alone, and hybrid immunity all showed strong effectiveness (>70%) against severe, critical, or fatal Covid-19 due to BA.2 infection. Similar results were observed in analyses of effectiveness against BA.1 infection and of vaccination with mRNA-1273. No discernable differences in protection against symptomatic BA.1 and BA.2 infection were seen with previous infection, vaccination, and hybrid immunity. Vaccination enhanced protection among persons who had had a previous infection. Hybrid immunity resulting from previous infection and recent booster vaccination conferred the strongest protection. (Funded by Weill Cornell Medicine-Qatar and others.).
Published: 2022

37. Effects of BA.1/BA.2 subvariant, vaccination and prior infection on infectiousness of SARS-CoV-2 omicron infections

Author: Suelen H. Qassim, Hiam Chemaitelly, Houssein H. Ayoub, Sawsan AlMukdad, Patrick Tang, Mohammad R. Hasan, Hadi M. Yassine, Hebah A. Al-Khatib, Maria K. Smatti, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Abdullatif Al-Khal, Peter Coyle, Anvar Hassan Kaleeckal, Riyazuddin Mohammad Shaik, Ali Nizar Latif, Einas Al-Kuwari, Andrew Jeremijenko, Adeel A. Butt, Roberto Bertollini, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, and Laith J. Abu-Raddad
Subjects: sub-lineage, Omicron, SARS-CoV-2, breakthrough infection, Vaccination, COVID-19, General Medicine, Antibodies, Viral, immunity, SDG 3 - Good Health and Well-being, vaccine, cohort study, Humans, epidemiology, subvariant
Abstract: BACKGROUNDQatar experienced a large SARS-CoV-2 Omicron (B.1.1.529) wave that started on December 19, 2021 and peaked in mid-January, 2022. We investigated effects of Omicron subvariant (BA.1 and BA.2), previous vaccination, and prior infection on infectiousness of Omicron infections, between December 23, 2021 and February 20, 2022.METHODSUnivariable and multivariable regression analyses were conducted to estimate the association between the RT-qPCR cycle threshold (Ct) value of PCR tests (a proxy for SARS-CoV-2 infectiousness) and each of the Omicron subvariants, mRNA vaccination, prior infection, reason for RT-qPCR testing, calendar week of RT-qPCR testing (to account for phases of the rapidly evolving Omicron wave), and demographic factors.RESULTSCompared to BA.1, BA.2 was associated with 3.53 fewer cycles (95% CI: 3.46-3.60), signifying higher infectiousness. Ct value decreased with time since second and third vaccinations. Ct values were highest for those who received their boosters in the month preceding the RT-qPCR test—0.86 cycles (95% CI: 0.72-1.00) higher than for unvaccinated persons. Ct value was 1.30 (95% CI: 1.20-1.39) cycles higher for those with a prior infection compared to those without prior infection, signifying lower infectiousness. Ct value declined gradually with age. Ct value was lowest for those who were tested because of symptoms and was highest for those who were tested for travel-related purposes. Ct value was lowest during the exponential-growth phase of the Omicron wave and was highest after the wave peaked and was declining.CONCLUSIONSThe BA.2 subvariant appears substantially more infectious than the BA.1 subvariant. This may reflect higher viral load and/or longer duration of infection, thereby explaining the rapid expansion of this subvariant in Qatar.
Published: 2022
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38. Reporting of RT-PCR cycle threshold (Ct) values during the first wave of COVID-19 in Qatar improved result interpretation in clinical and public health settings

Author: Peter V. Coyle, Naema Hassan Al Molawi, Mohamed Ali Ben Hadj Kacem, Reham Awni El Kahlout, Einas Al Kuwari, Abdullatif Al Khal, Imtiaz Gillani, Andrew Jeremijenko, Hatoun Saeb, Mohammad Al Thani, Roberto Bertollini, Hanan F. Abdul Rahim, Hiam Chemaitelly, Patrick Tang, Ali Nizar Latif, Saad Al Kaabi, Muna A. Rahman S. Al Maslamani, Brendan David Morris, Nasser Al-Ansari, Anvar Hassan Kaleeckal, and Laith J. Abu Raddad
Subjects: Microbiology (medical), SDG 3 - Good Health and Well-being, Reverse Transcriptase Polymerase Chain Reaction, SARS-CoV-2, COVID-19, Humans, Public Health, General Medicine, Viral Load, Real-Time Polymerase Chain Reaction, Qatar, Microbiology
Abstract: Introduction. The cycle threshold (Ct) value in real-time PCR (RT-PCR) is where a target-specific amplification signal becomes detectable and can infer viral load, risk of transmission and recovery. Use of Ct values in routine practice is uncommon. Gap Statement. There is a lack of routine use of Ct values when reporting RT-PCR results in routine practice. Aim. To automatically insert Ct values and interpretive comments when reporting SARS-CoV-2 RT-PCR to improve patient management. Methodology. Routine Ct values across three different RT-PCR platforms were reviewed for concordance at presentation and clearance in patients with COVID-19. An indicative threshold (IT) linked to viral clearance kinetics was defined at Ct30 to categorize Ct values as low and high, reflecting high and low viral loads respectively. Results. The different gene targets of each platform showed high correlation and kappa score agreement (PCt30 as reactive; interpretive comments were added to all reports. The new reporting algorithm impacted on: physician interpretation of SARS-CoV-2 results; patient management and transfer; staff surveillance; length of stay in quarantine; and redefinition of patient recovery. Conclusion. Incorporation of Ct values into routine practice is possible across different RT-PCR platforms and adds useful information for patient management. The use of an IT with interpretive comments improves clinical interpretation and could be a model for reporting other respiratory infections. Withholding Ct values wastes useful clinical data and should be reviewed by the profession, accreditation bodies and regulators.
Published: 2022
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39. Supporting Public Health Research Capacity, Quality, and Productivity in a Diverse Region (Preprint)

Author: Rana AlHamawi, Randa K Saad, Hanan F. Abdul Rahim, Khwaja Mir Islam SAEED, Abdullatif Husseini, Yousef Khader, and Mohannad Al Nsour
Subjects: General Medicine
Abstract: UNSTRUCTURED Public health research plays a critical role in strengthening health systems and improving their performance and impact. However, scholarly production in public health coming from the Eastern Mediterranean Region (EMR) remains well below the world average and lacks a tangible growth trend over time. During the 7th Eastern Mediterranean Public Health Network (EMPHNET) Regional Conference, a roundtable session brought together a panel of public health experts representing Global Health Development| EMPHNET affiliates, universities/academia, and research institutions from the region, where they shared insights on the current situation of public health research, challenges and barriers of research facing the different countries in the EMR and the region in general, and how research agenda, productivity and quality can be supported through strengthening research capacity in the region. Although the region is diverse in terms of health system capacity and socioeconomic development, several common challenges were identified, including a lack of strategic prioritization to guide health research, insufficient funding, ineffective transfer of knowledge to policy and practice, limited availability of research facilities, and limited national and international research collaboration. Occupied countries and countries in a state of conflict, such as Palestine, face additional barriers, such as personal and social security, lack of control on borders and natural resources, travel and movement restrictions, and confidentiality challenges because of the continuing war conditions and occupation. However, there have been success stories in the EMR regarding research publications and their positive and effective impact on policy and decision-makers. To improve research resilience and public health care in the region a collaborative approach involving institutions, policymakers, and relevant stakeholders is critical.
Published: 2022
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40. The Reproductive Agency Scale (RAS-17): development and validation in a cross-sectional study of pregnant Qatari and non-Qatari Arab Women

Author: Hanan F. Abdul Rahim, Kathryn M. Yount, and Laurie James-Hawkins
Subjects: Adult, Scale validation, women’s empowerment, medicine.medical_specialty, Cross-sectional study, media_common.quotation_subject, Reproductive medicine, Prenatal care, Scale validation, women's empowerment, lcsh:Gynecology and obstetrics, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Pregnancy, medicine, Humans, Measurement invariance, 030212 general & internal medicine, Empowerment, Maternal Behavior, Qatar, lcsh:RG1-991, media_common, Freedom of movement, 030219 obstetrics & reproductive medicine, business.industry, Obstetrics and Gynecology, Factor analysis, measurement invariance, Middle Aged, medicine.disease, Arabs, Cross-Sectional Studies, women’s agency, Perinatal period, Female, Pregnant Women, Self Report, business, Demography, Qualitative research, Research Article
Abstract: BackgroundSustainable Development Goal (SDG) 5 prioritizes women’s empowerment and gender equality, alone and as drivers of other SDGs. Efforts to validate universal measures of women’s empowerment have eclipsed efforts to develop refined measures in local contexts and lifecycle stages. Measures of women’s empowerment across the reproductive lifecycle remain limited, including in the Arab Middle East.MethodsIn this sequential, mixed-methods study, we developed and validated the Reproductive Agency Scale 17 (RAS-17) in 684 women having a normal pregnancy and receiving prenatal care at Hamad Medical Corporation in Doha, Qatar. Participants varied in age (19–46 years), trimester, gravidity (M3.3[SD2.1], range 1–14), and parity (M2.1[SD1.5], range 0–7). Using qualitative research and questionnaire reviews, we developed 44 pregnancy-specific and non-pregnancy-specific agency items. We performed exploratory then confirmatory factor analyses (EFA/CFA) in random split-half samples and multiple-group CFA to assess measurement invariance of the scale across Qatari (n = 260) and non-Qatari Arab (n = 342) women.ResultsNon-Qatari women agreed more strongly than Qatari women that every woman should have university education, and working outside home benefitted women. Qatari women agreed more strongly than non-Qatari women that a woman should be free to sell her property. Qatari women reported more influence than non-Qatari women in decisions about spending their money (M4.6 versus M4.4), food they can eat (M4.4 versus M4.2), and rest during pregnancy (M4.5 versus M4.2). Qatari and non-Qatari women typically reported going most places with permission if accompanied. A 17-item, three-factor model measuring women’s intrinsic agency or awareness of economic rights (5 items) and instrumental agency in decision-making (5 items) and freedom of movement (7 items) had good fit and was partially invariant across groups.ConclusionsThe RAS-17 is a contextual, multidimensional measure of women’s reproductive agency validated in pregnant Qatari and non-Qatari Arab women. This scale integrates pregnancy-specific and non-pregnancy-specific items in dimensions of intrinsic agency and instrumental agency relevant to Arab women of reproductive age. The RAS-17 may be useful to screen for low reproductive agency as a predictor of maternal and perinatal outcomes. The RAS-17 should be validated in other samples to assess its full applicability across the reproductive life cycle.
Published: 2020
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41. Effect of prior infection, vaccination, and hybrid immunity against symptomatic BA.1 and BA.2 Omicron infections and severe COVID-19 in Qatar

Author: Heba N. Altarawneh, Hiam Chemaitelly, Houssein Ayoub, Patrick Tang, Mohammad R. Hasan, HADI M. YASSINE, Hebah A. Al-Khatib, Maria K. Smatti, Peter Coyle, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J Abu-Raddad
Abstract: BACKGROUND: Protection offered by five different forms of immunity, combining natural and vaccine immunity, was investigated against SARS-CoV-2 Omicron symptomatic BA.1 infection, symptomatic BA.2 infection, BA.1 hospitalization and death, and BA.2 hospitalization and death, in Qatar, between December 23, 2021 and February 21, 2022. METHODS: Six national, matched, test-negative case-control studies were conducted to estimate effectiveness of BNT162b2 (Pfizer-BioNTech) vaccine, mRNA-1273 (Moderna) vaccine, natural immunity due to prior infection with pre-Omicron variants, and hybrid immunity from prior infection and vaccination. RESULTS: Effectiveness of only prior infection against symptomatic BA.2 infection was 46.1% (95% CI: 39.5-51.9%). Effectiveness of only two-dose BNT162b2 vaccination was negligible at -1.1% (95% CI: -7.1-4.6), but nearly all individuals had received their second dose several months earlier. Effectiveness of only three-dose BNT162b2 vaccination was 52.2% (95% CI: 48.1-55.9%). Effectiveness of hybrid immunity of prior infection and two-dose BNT162b2 vaccination was 55.1% (95% CI: 50.9-58.9%). Effectiveness of hybrid immunity of prior infection and three-dose BNT162b2 vaccination was 77.3% (95% CI: 72.4-81.4%). Meanwhile, prior infection, BNT162b2 vaccination, and hybrid immunity all showed strong effectiveness >70% against any severe, critical, or fatal COVID-19 due to BA.2 infection. Similar levels and patterns of effectiveness were observed for BA.1 and for the mRNA-1273 vaccine. CONCLUSIONS: There are no discernable differences in the effects of prior infection, vaccination, and hybrid immunity against BA.1 versus BA.2. Hybrid immunity resulting from prior infection and recent booster vaccination confers the strongest protection against either subvariant. Vaccination enhances protection of those with a prior infection.
Published: 2022
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42. Protection of prior natural infection compared to mRNA vaccination against SARS-CoV-2 infection and severe COVID-19 in Qatar

Author: Hiam Chemaitelly, Houssein H. Ayoub, Sawsan AlMukdad, Peter Coyle, Patrick Tang, Hadi M. Yassine, Hebah A. Al-Khatib, Maria K. Smatti, Mohammad R. Hasan, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Abstract: BACKGROUNDProtection conferred by natural SARS-CoV-2 infection versus COVID-19 vaccination has not been investigated in rigorously controlled studies. We compared head-to-head protection conferred by natural infection to that from the BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) vaccines in Qatar, between February 28, 2020 and March 6, 2022.METHODSTwo national matched retrospective target-trial cohort studies were conducted to compare incidence of SARS-CoV-2 infection and COVID-19 hospitalization and death among those with a documented primary infection to incidence among those with a two-dose primary-series vaccination. Associations were estimated using Cox proportional-hazards regression models.RESULTSThe overall adjusted hazard ratio (AHR) for infection was 0.46 (95% CI: 0.45-0.48) comparing those with a prior infection to those vaccinated with BNT162b2, and 0.51 (95% CI: 0.48-0.53) comparing those with a prior infection to those vaccinated with mRNA-1273. For BNT162b2, the AHR decreased gradually from 0.55 (95% CI: 0.46-0.65) in the fourth month after primary infection/vaccination to 0.31 (95% CI: 0.27-0.37) in the eighth month, while for mRNA-1273, it decreased from 0.80 (95% CI: 0.59-1.07) to 0.35 (95% CI: 0.29-0.41) over the same time period. During the Omicron wave, the AHR was ∼0.50 for BNT162b2 and ∼0.60 for mRNA-1273. The overall AHR for any severe, critical, or fatal COVID-19 (against all variants) was 0.32 (95% CI: 0.10-1.00) for BNT162b2, and 0.58 (95% CI: 0.14-2.43) for mRNA-1273.CONCLUSIONSNatural infection was associated with stronger and more durable protection against infection, regardless of the variant, than mRNA primary-series vaccination. Nonetheless, vaccination remains the safest and optimal tool of protection against infection and COVID-19 hospitalization and death.
Published: 2022
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43. Duration of protection of BNT162b2 and mRNA-1273 COVID-19 vaccines against symptomatic SARS-CoV-2 Omicron infection in Qatar

Author: Hiam Chemaitelly, Houssein H. Ayoub, Sawsan AlMukdad, Patrick Tang, Mohammad R. Hasan, Hadi M. Yassine, Hebah A. Al Khatib, Maria K. Smatti, Peter Coyle, Zaina Al Kanaani, Einas Al Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al Kuwari, Adeel A. Butt, Hamad Eid Al Romaihi, Mohamed H. Al-Thani, Abdullatif Al Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Abstract: BACKGROUNDQatar has been experiencing a large SARS-CoV-2 Omicron (B.1.1.529) wave that started on December 19, 2021. We assessed duration of protection of BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines after second dose and after third/booster dose against symptomatic Omicron infection and against COVID-19 hospitalization and death, between December 23, 2021 and February 2, 2022.METHODSVaccine effectiveness was estimated using the test-negative, case-control study design, applying the same methodology used earlier to assess waning of BNT162b2 and mRNA-1273 effectiveness in the same population during earlier infection waves.RESULTSBNT162b2 effectiveness against symptomatic Omicron infection was highest at 61.9% (95% CI: 49.9-71.1%) in the first month after the second dose, but then gradually declined and was at 10% or less starting from the 5th month after the second dose. After the booster, effectiveness rapidly rebounded to peak at about 55% between 2-5 weeks after the booster, but then started to decline again thereafter. Effectiveness against severe, critical, or fatal COVID-19 was maintained at >70% after the second dose and at >90% after the booster with no evidence for declining effectiveness over time. mRNA-1273 effectiveness against symptomatic Omicron infection was highest at 44.8% (95% CI: 16.0-63.8%) in the first three months after the second dose, before gradually declining to negligible levels thereafter. After the booster, effectiveness rapidly rebounded to peak at about 55% between 2-5 weeks after the booster, but then declined again thereafter. Effectiveness against severe, critical, or fatal COVID-19 was high at >60% after the second dose and at >80% after the booster, but the confidence intervals were wide owing to the small number of cases.CONCLUSIONSBNT162b2 and mRNA-1273 vaccines show a similar level and pattern of protection against symptomatic Omicron infection. Protection against Omicron is lower than that against Alpha, Beta, and Delta variants, and wanes more rapidly than against earlier variants after the second and booster doses. Meanwhile, protection against hospitalization and death appears robust and durable after both the second and booster doses.
Published: 2022
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44. Assessing the performance of a serological point-of-care test in measuring detectable antibodies against SARS-CoV-2

Author: Peter V. Coyle, Reham Awni El Kahlout, Soha R. Dargham, Hiam Chemaitelly, Mohamed Ali Ben Hadj Kacem, Naema Hassan Abdulla Al-Mawlawi, Imtiaz Gilliani, Nourah Younes, Zaina Al Kanaani, Abdullatif Al Khal, Einas Al Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul Rahim, Gheyath K. Nasrallah, Hadi M. Yassine, Mohamed G. Al Kuwari, Hamad Eid Al Romaihi, Patrick Tang, Roberto Bertollini, Mohamed H. Al-Thani, Laith J. Abu-Raddad, and Elhadi, Muhammed
Subjects: Male, RNA viruses, Viral Diseases, Physiology, Coronaviruses, Artificial Gene Amplification and Extension, Biochemistry, Polymerase Chain Reaction, Geographical Locations, Medical Conditions, Seroepidemiologic Studies, Immune Physiology, Medicine and Health Sciences, Public and Occupational Health, Pathology and laboratory medicine, Virus Testing, Multidisciplinary, Immune System Proteins, Middle Aged, Medical microbiology, Vaccination and Immunization, Infectious Diseases, Serology, Point-of-Care Testing, Spike Glycoprotein, Coronavirus, Viruses, Medicine, Female, SARS CoV 2, Pathogens, Research Article, Adult, Asia, SARS coronavirus, Science, Immunology, Research and Analysis Methods, Microbiology, Antibodies, COVID-19 Serological Testing, Young Adult, SDG 3 - Good Health and Well-being, Diagnostic Medicine, Humans, Molecular Biology Techniques, Qatar, Molecular Biology, Medicine and health sciences, Biology and life sciences, SARS-CoV-2, Organisms, Viral pathogens, COVID-19, Biology and Life Sciences, Proteins, Covid 19, Reverse Transcriptase-Polymerase Chain Reaction, Microbial pathogens, Research and analysis methods, Immunoglobulin M, Immunoglobulin G, People and Places, Preventive Medicine, People and places
Abstract: This study investigated the performance of a rapid point-of-care antibody test, the BioMedomics COVID-19 IgM/IgG Rapid Test, in comparison with a high-quality, validated, laboratory-based platform, the Roche Elecsys Anti-SARS-CoV-2 assay. Serological testing was conducted on 709 individuals. Concordance metrics were estimated. Logistic regression was used to assess associations with seropositivity. SARS-CoV-2 seroprevalence was 63.5% (450/709; 95% CI 59.8%-67.0%) using the BioMedomics assay and 71.9% (510/709; 95% CI 68.5%-75.2%) using the Elecsys assay. There were 60 discordant results between the two assays, all of which were seropositive in the Elecsys assay, but seronegative in the BioMedomics assay. Overall, positive, and negative percent agreements between the two assays were 91.5% (95% CI 89.2%-93.5%), 88.2% (95% CI 85.1%-90.9%), and 100% (95% CI 98.2%-100%), respectively, with a Cohen’s kappa of 0.81 (95% CI 0.78–0.84). Excluding specimens with lower (Elecsys) antibody titers, the agreement improved with overall, positive, and negative percent concordance of 94.4% (95% CI 92.3%-96.1%), 91.8% (95% CI 88.8%-94.3%), and 100% (95% CI 98.2%-100%), respectively, and a Cohen’s kappa of 0.88 (95% CI 0.85–0.90). Logistic regression confirmed better agreement with higher antibody titers. The BioMedomics COVID-19 IgM/IgG Rapid Test demonstrated good performance in measuring detectable antibodies against SARS-CoV-2, supporting the utility of such rapid point-of-care serological testing to guide the public health responses and vaccine prioritization.
Published: 2022
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45. Effectiveness of BNT162b2 and mRNA-1273 COVID-19 boosters against SARS-CoV-2 Omicron (B.1.1.529) infection in Qatar

Author: Laith J. Abu-Raddad, Hiam Chemaitelly, Houssein H. Ayoub, Sawsan AlMukdad, Patrick Tang, Mohammad R. Hasan, Peter Coyle, Hadi M. Yassine, Hebah A. Al-Khatib, Maria K. Smatti, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul-Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A. Butt, Hamad Eid Al-Romaihi, Mohamed H. Al-Thani, Abdullatif Al-Khal, and Roberto Bertollini
Abstract: BACKGROUNDWaning of COVID-19 vaccine protection and emergence of SARS-CoV-2 Omicron (B.1.1.529) variant have expedited efforts to scale up booster vaccination. This study compared protection afforded by booster doses of the BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) vaccines, compared to the primary series of only two doses in Qatar, during a large, rapidly growing Omicron wave.METHODSIn a population of 2,232,224 vaccinated persons with at least two doses, two matched, retrospective cohort studies were implemented to investigate effectiveness of booster vaccination against symptomatic SARS-CoV-2 infection and against COVID-19 hospitalization and death, up to January 9, 2022. Association of booster status with infection was estimated using Cox proportional-hazards regression models.RESULTSFor BNT162b2, cumulative symptomatic infection incidence was 2.9% (95% CI: 2.8-3.1%) in the booster-dose cohort and 5.5% (95% CI: 5.3-5.7%) in the primary-series cohort, after 49 days of follow-up. Adjusted hazard ratio for symptomatic infection was 0.50 (95% CI: 0.47-0.53). Booster effectiveness relative to primary series was 50.1% (95% CI: 47.3-52.8%). For mRNA-1273, cumulative symptomatic infection incidence was 1.9% (95% CI: 1.7-2.2%) in the booster-dose cohort and 3.5% (95% CI: 3.2-3.9%) in the primary-series cohort, after 35 days of follow-up. The adjusted hazard ratio for symptomatic infection was 0.49 (95% CI: 0.43-0.57). Booster effectiveness relative to primary series was 50.8% (95% CI: 43.4-57.3%). There were fewer cases of severe COVID-19 in booster-dose cohorts than in primary-series cohorts, but cases of severe COVID-19 were rare in all cohorts.CONCLUSIONSmRNA booster vaccination is associated with modest effectiveness against symptomatic infection with Omicron. The development of a new generation of vaccines targeting a broad range of variants may be warranted.
Published: 2022
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46. Protection afforded by prior infection against SARS-CoV-2 reinfection with the Omicron variant

Author: Heba Altarawneh, Hiam Chemaitelly, Patrick Tang, Mohammad R. Hasan, Suelen Qassim, Houssein H. Ayoub, Sawsan AlMukdad, Hadi M. Yassine, Fatiha M. Benslimane, Hebah A. Al Khatib, Peter Coyle, Zaina Al Kanaani, Einas Al Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul Rahim, Gheyath K. Nasrallah, Mohamed Ghaith Al Kuwari, Adeel A. Butt, Hamad Eid Al Romaihi, Mohamed H. Al-Thani, Abdullatif Al Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Abstract: BACKGROUNDNatural SARS-CoV-2 infection elicits strong protection against reinfection with the Alpha (B.1.1.7), Beta (B.1.351), and Delta (B.1.617.2) variants. However, the Omicron (B.1.1.529) variant harbors multiple mutations that can mediate immune evasion. We estimated effectiveness of prior infection in preventing reinfection (PES) with Omicron and other SARS-CoV-2 variants in Qatar.METHODSPES was estimated using the test-negative, case-control study design, employing a methodology that was recently investigated and validated for derivation of robust estimates for PES. Cases (PCR-positive persons with a variant infection) and controls (PCR-negative persons) were exact-matched by sex, 10-year age group, nationality, and calendar time of PCR test, to control for known differences in the risk of exposure to SARS-CoV-2 infection in Qatar.RESULTSPES against symptomatic reinfection was estimated at 90.2% (95% CI: 60.2-97.6) for Alpha, 84.8% (95% CI: 74.5-91.0) for Beta, 92.0% (95% CI: 87.9-94.7) for Delta, and 56.0% (95% CI: 50.6-60.9) for Omicron. Only 1 Alpha, 2 Beta, 0 Delta, and 2 Omicron reinfections progressed to severe COVID-19. None progressed to critical or fatal COVID-19. PES against hospitalization or death due to reinfection was estimated at 69.4% (95% CI: −143.6-96.2) for Alpha, 88.0% (95% CI: 50.7-97.1) for Beta, 100% (95% CI: 43.3-99.8) for Delta, and 87.8% (95% CI: 47.5-97.1) for Omicron.CONCLUSIONSProtection afforded by prior infection in preventing symptomatic reinfection with Alpha, Beta, or Delta is robust, at about 90%. While such protection against reinfection with Omicron is lower, it is still considerable at nearly 60%. Prior-infection protection against hospitalization or death at reinfection appears robust, regardless of variant.
Published: 2022
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47. Estimating protection afforded by prior infection in preventing reinfection: Applying the test-negative study design

Author: Houssein H. Ayoub, Milan Tomy, Hiam Chemaitelly, Heba N. Altarawneh, Peter Coyle, Patrick Tang, Mohammad R. Hasan, Zaina Al Kanaani, Einas Al Kuwari, Adeel A. Butt, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Gheyath K. Nasrallah, Fatiha M. Benslimane, Hebah A. Al Khatib, Hadi M. Yassine, Mohamed G. Al Kuwari, Hamad Eid Al Romaihi, Hanan F. Abdul-Rahim, Mohamed H. Al-Thani, Abdullatif Al Khal, Roberto Bertollini, and Laith J. Abu-Raddad
Abstract: BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic has highlighted an urgent need to use infection testing databases to rapidly estimate effectiveness of prior infection in preventing reinfection (PES) by novel variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).MethodsMathematical modeling was used to demonstrate the applicability of the test-negative, case-control study design to derive PES. Modeling was also used to investigate effects of bias in PES estimation. The test-negative design was applied to national-level testing data in Qatar to estimate PES for SARS-CoV-2 infection and to validate this design.ResultsApart from the very early phase of an epidemic, the difference between the test-negative estimate for PES and the true value of PES was minimal and became negligible as the epidemic progressed. The test-negative design provided robust estimation of PES even when PES began to wane after prior infection. Assuming that only 25% of prior infections are documented, misclassification of prior infection status underestimated PES, but the underestimate was considerable only when >50% of the population was ever infected. Misclassification of latent infection, misclassification of current active infection, and scale-up of vaccination all resulted in negligible bias in estimated PES. PES against SARS-CoV-2 Alpha and Beta variants was estimated at 97.0% (95% CI: 93.6-98.6) and 85.5% (95% CI: 82.4-88.1), respectively. These estimates were validated using a cohort study design.ConclusionsThe test-negative design offers a feasible, robust method to estimate protection from prior infection in preventing reinfection.
Published: 2022
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48. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author: Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Luxia Zhang, Young-Ho Khang, Ellina Rakhimova, Kairit Mikkel, Tiina Vlasoff, Eruke E. Egbagbe, Sidsel Graff-Iversen, Ilona Nenko, Magdalena Klimek, Mathilde Savy, Sanjib Kumar Sharma, Alfonso Siani, Luís Lopes, Vanina Bongard, Gregor Jurak, Jacqueline F. Price, Christina-Paulina Lambrinou, Maria Lc Iurilli, Rainford J. Wilks, Bontha V. Babu, Fereidoun Azizi, Harunobu Nakamura, Marialaura Bonaccio, Angela Döring, Zhenyu Zhang, Naser Ahmadi, Jolanta Słowikowska-Hilczer, Ana Paula Carlos Cândido, Clive Osmond, Thirunavukkarasu Sathish, Robert J. Adams, Themistoklis Tzotzas, Reina Engle-Stone, Atul Trivedi, Shoichiro Tsugane, Niels Møller, Jorge Bezerra, Dénes Molnár, Muhammad Fadhli Mohd Yusoff, Badreya Al-Lahou, J. Jaime Miranda, Bahram Mohajer, Sigmund A. Anderssen, Lital Keinan Boker, Eero Kajantie, Martin Gulliford, Maties Torrent, Sumit Bharadwaj, Toshiharu Ninomiya, Zbigniew Gaciong, Nayu Ikeda, Li Juan Wu, Adrian Richter, Licia Iacoviello, Marc J. Gunter, Wenbin Wei, Norsyamlina Che Abdul Rahim, Eman Aly, Ambady Ramachandran, Nils Lehmann, Soile E. Puhakka, Giovanni Veronesi, Hongsheng Bi, Eiji Oda, Jia Li Duan, Per Tynelius, José María Huerta, Janne Schurmann Tolstrup, Rodrigo M. Carrillo-Larco, Rosangela Fernandes Lucena Batista, Victoria E Soto-Rojas, Hanno Ulmer, Shukri F. Mohamed, Anthony Kafatos, Suyeon Park, Mohsen Ibrahim, Hamed Pouraram, Bin Zhou, May Soe Aung, Lars Bo Andersen, Erfan Ghasemi, René Charles Sylva, Himanshu K. Chaturvedi, Luc Dauchet, Ahmad Ali Zainuddin, Angela Chetrit, Dan Zhu, Valérie Deschamps, Ko Ko Zaw, Peter Vollenweider, Tomas Vega, Yves Martin-Prével, Mahfuzar Rahman, Dorja Vočanec, Roman Topor-Madry, Vinay Nangia, Herculina S. Kruger, Asher Fawwad, Emily Sonestedt, Elena Pahomova, Aleksander Giwercman, Elżbieta Dziankowska-Zaborszczyk, Cecilia Björkelund, Tatjana Hejgaard, Maria Puiu, Maria Benedetta Donati, Andrew Wong, Carlos P. Boissonnet, Santosh K. Bhargava, Patrick Kolsteren, Dermot O'Reilly, Bahareh Kheiri, Wolfgang Kratzer, Susanne R. de Rooij, H. Bas Bueno-de-Mesquita, Günther Fink, José R. Banegas, Michele Monroy-Valle, Drude Molbo, Mahmudur Rahman, Hynek Pikhart, Rafael N. Pichardo, Massimo Salvetti, Hui Cai, Sarah Filippi, Georg Posch, Hung-Kwan So, Yonghua Hu, Katsuyasu Kouda, Joana Carvalho, Gailute Bernotiene, Hannu Uusitalo, Thein Thein Htay, Felix Kaducu, Maigeng Zhou, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Michel Joffres, Sabina Zambon, Ronald D. Gregor, Vayia Rarra, Seyed Mohammad Hashemi-Shahri, Loreto Santa Marina, Galina Obreja, Rudolf Kaaks, Aya Mostafa, Maria do Carmo Franco, Beata Gurzkowska, Chien-Jen Chen, Marie Moitry, Nizal Sarrafzadegan, Xiangjun Wang, Diego Giulliano Destro Christofaro, Imperia Brajkovich, Fangfang Chen, Francesco Panza, Ling Yang, Holly E. Syddall, Cecily Kelleher, Michael Tornaritis, Ningli Wang, Lutgarde Thijs, Marjolein Visser, Angelika Schaffrath Rosario, María José Tormo, Jostein Steene-Johannessen, Norbert Amougou, Emmanuella Magriplis, Mar Alvarez-Pedrerol, Jingli Gao, Stig E. Bojesen, Giuseppe Grosso, Seongjun Ha, Lauren Lissner, Mikhail Benet, Anastasia Markaki, Sanjay Rampal, Antônio Augusto Moura da Silva, Maria Lorenza Muiesan, Angelique Chan, Yvonne T. van der Schouw, Annamari Lundqvist, Philippe Amouyel, Kristyna Zejglicova, Charalambos Hadjigeorgiou, João Breda, Jørgen Meisfjord, Fatima Zahra Laamiri, Carl Lachat, Kai-Uwe Saum, Vilma Irazola, Leng Huat Foo, Óscar Lopes, Dickman Gareta, Flavio Nervi, Imre Janszky, Ruzena Kubinova, Terho Lehtimäki, Mario V. Capanzana, Moyses Szklo, Ramfis Nieto-Martínez, Viswanathan Mohan, Shuohua Chen, Arvind Pandey, Luigi Palmieri, Roya Kelishadi, Srinivasan Kannan, Jie Mi, Robert Beaglehole, Liliana Dacica, Jyrki K. Virtanen, Mohan Deepa, Peter Ueda, Isti Ilmiati Fujiati, Hermann Pohlabeln, Morten Sodemann, Jytte Halkjær, Zbigniew Kułaga, Sophie Visvikis-Siest, Farshad Farzadfar, Mohsen Azimi-Nezhad, Henry Völzke, Karolina Milkowska, Zahra Mohammadi, Belgin Ünal, Magda Gasull, George S. Stergiou, Marshall K. Tulloch-Reid, Seppo Koskinen, James E. Bennett, Marcela González-Gross, Virginija Dulskiene, Idris Guessous, Assembekov Batyrbek, Kamarul Imran Musa, Jeannette Lee, Josep Redon, Bihungum Bista, Luisa M Macieira, Johan Sundström, Andres Metspalu, Lariane M Ono, Flora A. Ukoli, Salar Rahimikazerooni, Andrea Gualtieri, Trevor S. Ferguson, Félicité Tchibindat, Eliza Cinteza, Ha Tp Do, Tajana Zeljkovic Vrkic, Tuyen D Le, Alison J. Hayes, Abdul Basit, Chandini Nekkantti, Teresa Norat, Eunice Ugel, Gulmira Aitmurzaeva, Mariachiara Di Cesare, Abdul Hamid Zargar, Vincenzo Solfrizzi, Garry L. Jennings, Aline Meirhaeghe, Kaare Christensen, Päivi Mäki, Xu Lin, Ali Esmaeili, Joanna Baran, Aneta Grajda, Renata Cifkova, Alexandre C. Pereira, Martin Bobak, Iuliia A Rusakova, Keiu Nelis, Damian K Francis, Guansheng Ma, Axel C. Carlsson, Alejandro Diaz, Alireza Ansari-Moghaddam, N Capkova, Zumin Shi, Maria Turley, Imelda A. Agdeppa, Helena I. S. 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Patel, Reynaldo Martorell, Ching-Yu Cheng, Stine Schramm, Hana Shimizu-Furusawa, Jacek Jóźwiak, Radwan Qasrawi, Herman Borghs, Zhanna Kalmatayeva, Heidi Klakk, Akram Pourshams, Naomi S. Levitt, Son Thai Pham, Simona Giampaoli, Dong Zhao, Indah Suci Widyahening, Merete Osler, Paula Margozzini, Silvia Bel-Serrat, Dora Romaguera, Monira Alarouj, Winsome R. Parnell, Marloes Cardol, Giota Touloumi, Janice Luisa Lukrafka, Adela Chirita-Emandi, Maryam Kavousi, Sanja Musić Milanović, Jean-Michel Gaspoz, Jalila El Ati, Sauli Herrala, Liang Xu, Pilar Guallar-Castillón, Bee Koon Poh, Luis Serra-Majem, Jonathan E. Shaw, Belong Cho, Daphne Mirkopoulou, Salvador Villalpando, Yuki Fujita, Tiffany K. Gill, Nish Chaturvedi, Erkin M. Mirrakhimov, Günay Can, Mark Woodward, Esther Lopez-Garcia, Mauro Virgílio Gomes de Barros, Ahmed A. Madar, Shoaib Afzal, Melanie J. Cowan, Gareth Stratton, Eduardo Salazar Martinez, Sameer Narake, Norie Sawada, Deepak Amarapurkar, Deepa Weerasekera, Diana A. Santos, Marjeta Majer, Herman Schargrodsky, Bruna Gonçalves Cordeiro da Silva, Ebrahim Eftekhar, Jesús Vioque, Marisa K. Sophiea, Teresa Shamah-Levy, María Dolores Chirlaque, Mohd Azahadi Omar, Stefan Söderberg, Isabel O. Oliveira, Joanne Katz, Xingwang Ye, Christophe Tzourio, Marie Zins, Aneta Weres, Ulrich Keil, Haiquan Xu, Akihiro Yoshihara, Rachel Dankner, Gabriella Gruden, Maroje Sorić, Hanspeter Stamm, Kim Overvad, Yanping Li, Carsten Oliver Schmidt, Christa L. Lilly, Veikko Salomaa, Gilad Twig, Senthil K Vasan, Qian Wang, Liufu Cui, Andrzej Galbarczyk, Sylvain Sebert, Wilma M. Hopman, Karl-Heinz Jöckel, Ari Voutilainen, Peter Schnohr, Jerzy Chudek, Katia Vergetti Bloch, Vincenzo Capuano, Jyh Eiin Wong, Torben Jørgensen, Anja Schienkiewitz, Nader Saki, Carolina Tarqui-Mamani, Maria Cecília Formoso Assunção, Kazi M. Jamil, Juraci Almeida Cesar, Pedro J Ortiz, Delphine De Smedt, Luciana Zaccagni, Lynne M. 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Günay Can , Ana Paula C Cândido , Felicia Cañete , Mario V Capanzana , Nadežda Capková , Eduardo Capuano , Vincenzo Capuano , Marloes Cardol , Viviane C Cardoso , Axel C Carlsson , Esteban Carmuega , Joana Carvalho , José A Casajús , Felipe F Casanueva , Ertugrul Celikcan , Laura Censi , Marvin Cervantes-Loaiza , Juraci A Cesar , Snehalatha Chamukuttan , Angelique W Chan , Queenie Chan , Himanshu K Chaturvedi , Nish Chaturvedi , Norsyamlina Che Abdul Rahim , Miao Li Chee , Chien-Jen Chen , Fangfang Chen , Huashuai Chen , Shuohua Chen , Zhengming Chen , Ching-Yu Cheng , Bahman Cheraghian , Angela Chetrit , Ekaterina Chikova-Iscener , Arnaud Chiolero , Shu-Ti Chiou , María-Dolores Chirlaque , Belong Cho , Kaare Christensen , Diego G Christofaro , Jerzy Chudek , Renata Cifkova , Michelle Cilia , Eliza Cinteza , Frank Claessens , Janine Clarke , Els Clays , Emmanuel Cohen , Hans Concin , Susana C Confortin , Cyrus Cooper , Tara C Coppinger , Eva Corpeleijn , Simona Costanzo , Dominique Cottel , Chris Cowell , Cora L Craig , Amelia C Crampin , Ana B Crujeiras , Semánová Csilla , Alexandra M Cucu , Liufu Cui , Felipe V Cureau , Ewelina Czenczek-Lewandowska , Graziella D'Arrigo , Eleonora d'Orsi , Liliana Dacica , María Ángeles Dal Re Saavedra , Jean Dallongeville , Camilla T Damsgaard , Rachel Dankner , Thomas M Dantoft , Parasmani Dasgupta , Saeed Dastgiri , Luc Dauchet , Kairat Davletov , Guy De Backer , Dirk De Bacquer , Giovanni de Gaetano , Stefaan De Henauw , Paula Duarte de Oliveira , David De Ridder , Karin De Ridder , Susanne R de Rooij , Delphine De Smedt , Mohan Deepa , Alexander D Deev , Vincent Jr DeGennaro , Abbas Dehghan , Hélène Delisle , Francis Delpeuch , Stefaan Demarest , Elaine Dennison , Katarzyna Dereń , Valérie Deschamps , Meghnath Dhimal , Augusto F Di Castelnuovo , Juvenal Soares Dias-da-Costa , María Elena Díaz-Sánchez , Alejandro Diaz , Zivka Dika , Shirin Djalalinia , Visnja Djordjic , Ha Tp Do , Annette J Dobson , Maria Benedetta Donati , 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, Daniel Fernández-Bergés , Daniel Ferrante , Thomas Ferrao , Marika Ferrari , Marco M Ferrario , Catterina Ferreccio , Eldridge Ferrer , Jean Ferrieres , Thamara Hubler Figueiró , Anna Fijalkowska , Günther Fink , Krista Fischer , Leng Huat Foo , Maria Forsner , Heba M Fouad , Damian K Francis , Maria do Carmo Franco , Ruth Frikke-Schmidt , Guillermo Frontera , Flavio D Fuchs , Sandra C Fuchs , Isti I Fujiati , Yuki Fujita , Matsuda Fumihiko , Takuro Furusawa , Zbigniew Gaciong , Mihai Gafencu , Andrzej Galbarczyk , Henrike Galenkamp , Daniela Galeone , Myriam Galfo , Fabio Galvano , Jingli Gao , Manoli Garcia-de-la-Hera , Marta García-Solano , Dickman Gareta , Sarah P Garnett , Jean-Michel Gaspoz , Magda Gasull , Adroaldo Cesar Araujo Gaya , Anelise Reis Gaya , Andrea Gazzinelli , Ulrike Gehring , Harald Geiger , Johanna M Geleijnse , Ali Ghanbari , Erfan Ghasemi , Oana-Florentina Gheorghe-Fronea , Simona Giampaoli , Francesco Gianfagna , Tiffany K Gill , Jonathan Giovannelli , Glen 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, Zhanna Kalmatayeva , Ofra Kalter-Leibovici , Yves Kameli , Freja B Kampmann , Kodanda R Kanala , Srinivasan Kannan , Efthymios Kapantais , Argyro Karakosta , Line L Kårhus , Khem B Karki , Marzieh Katibeh , Joanne Katz , Peter T Katzmarzyk , Jussi Kauhanen , Prabhdeep Kaur , Maryam Kavousi , Gyulli M Kazakbaeva , Ulrich Keil , Lital Keinan Boker , Sirkka Keinänen-Kiukaanniemi , Roya Kelishadi , Cecily Kelleher , Han Cg Kemper , Andre P Kengne , Maryam Keramati , Alina Kerimkulova , Mathilde Kersting , Timothy Key , Yousef Saleh Khader , Davood Khalili , Kay-Tee Khaw , Bahareh Kheiri , Motahareh Kheradmand , Alireza Khosravi , Ilse Msl Khouw , Ursula Kiechl-Kohlendorfer , Stefan Kiechl , Japhet Killewo , Dong Wook Kim , Hyeon Chang Kim , Jeongseon Kim , Jenny M Kindblom , Heidi Klakk , Magdalena Klimek , Jeannette Klimont , Jurate Klumbiene , Michael Knoflach , Bhawesh Koirala , Elin Kolle , Patrick Kolsteren , Jürgen König , Raija Korpelainen , Paul Korrovits , Magdalena Korzycka , 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Van Schoor , Irene Gm van Valkengoed , Dirk Vanderschueren , Diego Vanuzzo , Anette Varbo , Gregorio Varela-Moreiras , Patricia Varona-Pérez , Senthil K Vasan , Tomas Vega , Toomas Veidebaum , Gustavo Velasquez-Melendez , Biruta Velika , Giovanni Veronesi , Wm Monique Verschuren , Cesar G Victora , Giovanni Viegi , Lucie Viet , Salvador Villalpando , Paolo Vineis , Jesus Vioque , Jyrki K Virtanen , Marjolein Visser , Sophie Visvikis-Siest , Bharathi Viswanathan , Mihaela Vladulescu , Tiina Vlasoff , Dorja Vocanec , Peter Vollenweider , Henry Völzke , Ari Voutilainen , Sari Voutilainen , Martine Vrijheid , Tanja Gm Vrijkotte , Alisha N Wade , Aline Wagner , Thomas Waldhör , Janette Walton , Elvis Oa Wambiya , Wan Mohamad Wan Bebakar , Wan Nazaimoon Wan Mohamud , Rildo de Souza Wanderley Júnior , Ming-Dong Wang , Ningli Wang , Qian Wang , Xiangjun Wang , Ya Xing Wang , Ying-Wei Wang , S Goya Wannamethee , Nicholas Wareham , Adelheid Weber , Niels Wedderkopp , Deepa Weerasekera , Daniel Weghuber , Wenbin Wei , Aneta Weres , Bo Werner , Peter H Whincup , Kurt Widhalm , Indah S Widyahening , Andrzej Wiecek , Rainford J Wilks , Johann Willeit , Peter Willeit , Julianne Williams , Tom Wilsgaard , Bogdan Wojtyniak , Roy A Wong-McClure , Andrew Wong , Jyh Eiin Wong , Tien Yin Wong , Jean Woo , Mark Woodward , Frederick C Wu , Jianfeng Wu , Li Juan Wu , Shouling Wu , Haiquan Xu , Liang Xu , Nor Azwany Yaacob , Uruwan Yamborisut , Weili Yan , Ling Yang , Xiaoguang Yang , Yang Yang , Nazan Yardim , Mehdi Yaseri , Tabara Yasuharu , Xingwang Ye , Panayiotis K Yiallouros , Moein Yoosefi , Akihiro Yoshihara , Qi Sheng You , San-Lin You , Novie O Younger-Coleman , Safiah Md Yusof , Ahmad Faudzi Yusoff , Luciana Zaccagni , Vassilis Zafiropulos , Ahmad A Zainuddin , Seyed Rasoul Zakavi , Farhad Zamani , Sabina Zambon , Antonis Zampelas , Hana Zamrazilová , Maria Elisa Zapata , Abdul Hamid Zargar , Ko Ko Zaw , Tomasz Zdrojewski , Kristyna Zejglicova , Tajana Zeljkovic Vrkic , Yi Zeng 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Cynthia, Roccaldo, Romana, Rodrigues, Daniela, Rodríguez-Artalejo, Fernando, del Cristo Rodriguez-Perez, María, Rodríguez-Villamizar, Laura A, Roggenbuck, Ulla, Rojas-Martinez, Rosalba, Rojroongwasinkul, Nipa, Romaguera, Dora, Romeo, Elisabetta L, Rosario, Rafaela V, Rosengren, Annika, Rouse, Ian, Roy, Joel GR, Rubinstein, Adolfo, Rühli, Frank J, Ruidavets, Jean-Bernard, Ruiz-Betancourt, Blanca Sandra, Ruiz-Castell, Maria, Moreno, Emma Ruiz, Rusakova, Iuliia A, Jonsson, Kenisha Russell, Russo, Paola, Rust, Petra, Rutkowski, Marcin, Sabanayagam, Charumathi, Sacchini, Elena, Sachdev, Harshpal S, Sadjadi, Alireza, Safarpour, Ali Reza, Safiri, Saeid, Saki, Nader, Salanave, Benoit, Martinez, Eduardo Salazar, Salmerón, Diego, Salomaa, Veikko, Salonen, Jukka T, Salvetti, Massimo, Samoutian, Margarita, Sánchez-Abanto, Jose, Sandjaja, null, Sans, Susana, Marina, Loreto Santa, Santos, Diana A, Santos, Ina S, Santos, Lèlita C, Santos, Maria Paula, Santos, Osvaldo, Santos, Rute, Sanz, Sara Santo, Saramies, Jouko L, Sardinha, Luis B, Sarrafzadegan, Nizal, Sathish, Thirunavukkarasu, Saum, Kai-Uwe, Savva, Savva, Savy, Mathilde, Sawada, Norie, Sbaraini, Mariana, Scazufca, Marcia, Schaan, Beatriz D, Rosario, Angelika Schaffrath, Schargrodsky, Herman, Schienkiewitz, Anja, Schipf, Sabine, Schmidt, Carsten O, Schmidt, Ida Maria, Schnohr, Peter, Schöttker, Ben, Schramm, Sara, Schramm, Stine, Schröder, Helmut, Schultsz, Constance, Schutte, Aletta E, Sein, Aye Aye, Selamat, Rusidah, Sember, Vedrana, Sen, Abhijit, Senbanjo, Idowu O, Sepanlou, Sadaf G, Sequera, Victor, Serra-Majem, Lui, Servais, Jennifer, Ševcíková, Ludmila, Shalnova, Svetlana A, Shamah-Levy, Teresa, Shamshirgaran, Morteza, Shanthirani, Coimbatore Subramaniam, Sharafkhah, Maryam, Sharma, Sanjib K, Shaw, Jonathan E, Shayanrad, Amaneh, Shayesteh, Ali Akbar, Shengelia, Lela, Shi, Zumin, Shibuya, Kenji, Shimizu-Furusawa, Hana, Shin, Dong Wook, Shirani, Majid, Shiri, Rahman, Shrestha, Namuna, Si-Ramlee, Khairil, Siani, Alfonso, Siantar, Rosalynn, Sibai, Abla M, Silva, Antonio M, Silva, Diego Augusto Santo, Simon, Mary, Simons, Judith, Simons, Leon A, Sjöberg, Agneta, Sjöström, Michael, Skodje, Gry, Slowikowska-Hilczer, Jolanta, Slusarczyk, Przemyslaw, Smeeth, Liam, So, Hung-Kwan, Soares, Fernanda Cunha, Sobek, Grzegorz, Sobngwi, Eugène, Sodemann, Morten, Söderberg, Stefan, Soekatri, Moesijanti YE, Soemantri, Agustinu, Sofat, Reecha, Solfrizzi, Vincenzo, Somi, Mohammad Hossein, Sonestedt, Emily, Song, Yi, Sørensen, Thorkild IA, Sørgjerd, Elin P, Jérome, Charles Sossa, Soto-Rojas, Victoria E, Soumaré, Aïcha, Sovic, Slavica, Sparboe-Nilsen, Bente, Sparrenberger, Karen, Spinelli, Angela, Spiroski, Igor, Staessen, Jan A, Stamm, Hanspeter, Stathopoulou, Maria G, Staub, Kaspar, Stavreski, Bill, Steene-Johannessen, Jostein, Stehle, Peter, Stein, Aryeh D, Stergiou, George S, Stessman, Jochanan, Stevanovic, Ranko, Stieber, Jutta, Stöckl, Dori, Stocks, Tanja, Stokwiszewski, Jakub, Stoyanova, Ekaterina, Stratton, Gareth, Stronks, Karien, Strufaldi, Maria Wany, Sturua, Lela, Suárez-Medina, Ramón, Suka, Machi, Sun, Chien-An, Sundström, Johan, Sung, Yn-Tz, Sunyer, Jordi, Suriyawongpaisal, Paibul, Swinburn, Boyd A, Sy, Rody G, Syddall, Holly E, Sylva, René Charle, Szklo, Moyse, Szponar, Lucjan, Tai, E Shyong, Tammesoo, Mari-Lii, Tamosiunas, Abdona, Tan, Eng Joo, Tang, Xun, Tanrygulyyeva, Maya, Tanser, Frank, Tao, Yong, Tarawneh, Mohammed Rasoul, Tarp, Jakob, Tarqui-Mamani, Carolina B, Braunerová, Radka Taxová, Taylor, Anne, Taylor, Julie, Tchibindat, Félicité, Tebar, William R, Tell, Grethe S, Tello, Tania, Tham, Yih Chung, Thankappan, KR, Theobald, Holger, Theodoridis, Xenophon, Thijs, Lutgarde, Thomas, Nihal, Thuesen, Betina H, Tichá, Lubica, Timmermans, Erik J, Tjonneland, Anne, Tolonen, Hanna K, Tolstrup, Janne S, Topbas, Murat, Topór-Madry, Roman, Torheim, Liv Elin, Tormo, María José, Tornaritis, Michael J, Torrent, Matie, Torres-Collado, Laura, Toselli, Stefania, Touloumi, Giota, Traissac, Pierre, Tran, Thi Tuyet-Hanh, Trichopoulos, Dimitrio, Trichopoulou, Antonia, Trinh, Oanh TH, Trivedi, Atul, Tshepo, Lechaba, Tsigga, Maria, Tsugane, Shoichiro, Tuliakova, Azaliia M, Tulloch-Reid, Marshall K, Tullu, Fikru, Tuomainen, Tomi-Pekka, Tuomilehto, Jaakko, Turley, Maria L, Twig, Gilad, Tynelius, Per, Tzotzas, Themistokli, Tzourio, Christophe, Ueda, Peter, Ugel, Eunice, Ukoli, Flora AM, Ulmer, Hanno, Unal, Belgin, Usupova, Zhamyila, Uusitalo, Hannu MT, Uysal, Nalan, Vaitkeviciute, Justina, Valdivia, Gonzalo, Vale, Susana, Valvi, Damaskini, van Dam, Rob M, Van der Heyden, Johan, van der Schouw, Yvonne T, Van Herck, Koen, Van Minh, Hoang, Van Schoor, Natasja M, van Valkengoed, Irene GM, Vanderschueren, Dirk, Vanuzzo, Diego, Varbo, Anette, Varela-Moreiras, Gregorio, Varona-Pérez, Patricia, Vasan, Senthil K, Vega, Toma, Veidebaum, Tooma, Velasquez-Melendez, Gustavo, Velika, Biruta, Veronesi, Giovanni, Verschuren, WM Monique, Victora, Cesar G, Viegi, Giovanni, Viet, Lucie, Villalpando, Salvador, Vineis, Paolo, Vioque, Jesu, Virtanen, Jyrki K, Visser, Marjolein, Visvikis-Siest, Sophie, Viswanathan, Bharathi, Vladulescu, Mihaela, Vlasoff, Tiina, Vocanec, Dorja, Vollenweider, Peter, Völzke, Henry, Voutilainen, Ari, Voutilainen, Sari, Vrijheid, Martine, Vrijkotte, Tanja GM, Wade, Alisha N, Wagner, Aline, Waldhör, Thoma, Walton, Janette, Wambiya, Elvis OA, Bebakar, Wan Mohamad Wan, Mohamud, Wan Nazaimoon Wan, de Souza Wanderley Júnior, Rildo, Wang, Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S Goya, Wareham, Nichola, Weber, Adelheid, Wedderkopp, Niel, Weerasekera, Deepa, Weghuber, Daniel, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H, Widhalm, Kurt, Widyahening, Indah S, Wiecek, Andrzej, Wilks, Rainford J, Willeit, Johann, Willeit, Peter, Williams, Julianne, Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A, Wong, Andrew, Wong, Jyh Eiin, Wong, Tien Yin, Woo, Jean, Woodward, Mark, Wu, Frederick C, Wu, Jianfeng, Wu, Li Juan, Wu, Shouling, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yamborisut, Uruwan, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yardim, Nazan, Yaseri, Mehdi, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K, Yoosefi, Moein, Yoshihara, Akihiro, You, Qi Sheng, You, San-Lin, Younger-Coleman, Novie O, Md Yusof, Safiah, Yusoff, Ahmad Faudzi, Zaccagni, Luciana, Zafiropulos, Vassili, Zainuddin, Ahmad A, Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antoni, Zamrazilová, Hana, Zapata, Maria Elisa, Zargar, Abdul Hamid, Ko Zaw, Ko, Zdrojewski, Tomasz, Zejglicova, Kristyna, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhang, Zhen-Yu, Zhao, Dong, Zhao, Ming-Hui, Zhao, Wenhua, Zhen, Shiqi, Zheng, Wei, Zheng, Yingfeng, Zholdin, Bekbolat, Zhou, Maigeng, Zhu, Dan, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Cisneros, Julio Zuñiga, Zuziak, Monika, Ezzati, Majid, Filippi, Sarah, Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), Université Paris Cité (UPCité), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut Agro - Montpellier SupAgro, and Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)
Subjects: Population -- Health aspects, Leanness, Baixo peso/Underweight, none, Double burden, alipainoisuus, tulotaso, global health, systematic analysis, Sedentary behaviors, RC1200, Prospective associations, 0302 clinical medicine, underweight, nälänhätä, Biology (General), skin and connective tissue diseases, Children, ComputingMilieux_MISCELLANEOUS, Body mass index, Human Nutrition & Health, education.field_of_study, Humane Voeding & Gezondheid, ylipaino, General Medicine, kansainvälinen vertailu, 3. Good health, World health, Medicine, A100 Pre-clinical Medicine, Population distribution, medicine.medical_specialty, QH301-705.5, Science, Socio-culturale, Nursing, Social sciences, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Thinness, SDG 3 - Good Health and Well-being, BMI, epidemiology, obesity, None, Humans, Obesidade/Obesity, SDG 2 - Zero Hunger, education, VLAG, US adults, Omvårdnad, body mass index, malnutrition, obesity, underweight, nutritional and metabolic diseases, medicine.disease, terveellisyys, Obesity, Faculdade de Ciências Sociais, Body Mass Index, Prevalence, Risk Factors, General Biochemistry, WIAS, lihavuus, RA, Demography, N.A, double burden, Settore MED/09 - Medicina Interna, alueelliset erot, Nutrition and Disease, Animal Nutrition, [SDV]Life Sciences [q-bio], Medizin, 030204 cardiovascular system & hematology, 0601 Biochemistry and Cell Biology, Change distribution of body mass index, RA0421, Voeding en Ziekte, Epidemiology, Medicine and Health Sciences, Global health, Índice de massa corporal/Body Mass Index, 030212 general & internal medicine, Underweight, painoindeksi, 2. Zero hunger, General Neuroscience, aliravitsemus, elintarvikkeet, health, Public Health, Global Health, Social Medicine and Epidemiology, Diervoeding, 3142 Public health care science, environmental and occupational health, purl.org/pe-repo/ocde/ford#3.01.03 [https], Chinese adults, pooled analysis, medicine.symptom, Diet quality, B120 Physiology, Research Article, trends, purl.org/pe-repo/ocde/ford#1.06.03 [https], prevalence, Population, Mothers, Genetics and Molecular Biology, 3121 Internal medicine, medicine, Life Science, ddc:610, 3125 Otorhinolaryngology, ophthalmology, kehonkoostumus, Nutrition, Australian adults, General Immunology and Microbiology, purl.org/pe-repo/ocde/ford#3.01.04 [https], Ciências sociais, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Malnutrition, Epidemiology and Global Health, sense organs, Estilos de Vida e Impacto na Saúde
Abstract: From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions., Wellcome Trust, Medical Research Council, peer-reviewed
Published: 2021
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49. Comparison of antibody immune responses between BNT162b2 and mRNA-1273 SARS-CoV-2 vaccines in naïve and previously infected individuals

Author: Duaa W Al-Sadeq, Farah M Shurrab, Ahmed Ismail, Fathima Humaira Amanullah, Swapna Thomas, Nader Aldewik, Hadi M Yassine, Hanan F Abdul Rahim, Laith Abu-Raddad, and Gheyath K Nasrallah
Subjects: Vaccines, COVID-19 Vaccines, SARS-CoV-2, Immunity, COVID-19, General Medicine, Antibodies, Viral, immune response, S-RBD IgA, Antibody Formation, Pfizer-BNT162b2, Humans, Original Article, mRNA Vaccines, AcademicSubjects/MED00295, BNT162 Vaccine, Moderna-mRNA-1273, 2019-nCoV Vaccine mRNA-1273, S-RBD IgG
Abstract: Background Two mRNA vaccines, Pfizer-BNT162b2 and Moderna-mRNA-1273, obtained the Emergency Use Listing by WHO for preventing COVID-19. However, little is known about the difference in antibody responses induced by these two mRNA vaccines in naïve and previously infected (PI) individuals. Method We investigated the levels of anti-S-RBD (total, IgG and IgA) levels in naïve and PI individuals, 1–13 (median = 6) weeks following the second dose of either vaccine. Results in the naïve-vaccinated group, the mRNA-1273 vaccine induced significantly higher levels of anti-S-RBD total antibodies (3.5-fold; P Conclusion Our results showed that the PI-vaccinated group produces a higher level of antibodies than the naïve vaccinated group, particularly for those vaccinated with BNT162b2.
Published: 2021

50. Introduction and expansion of the SARS-CoV-2 B.1.1.7 variant and reinfections in Qatar: A nationally representative cohort study

Author: Laith J. Abu-Raddad, Hiam Chemaitelly, Houssein H. Ayoub, Peter Coyle, Joel A. Malek, Ayeda A. Ahmed, Yasmin A. Mohamoud, Shameem Younuskunju, Patrick Tang, Zaina Al Kanaani, Einas Al Kuwari, Adeel A. Butt, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F. Abdul Rahim, Gheyath K. Nasrallah, Hadi M. Yassine, Mohamed Ghaith Al Kuwari, Hamad Eid Al Romaihi, Mohamed H. Al-Thani, Abdullatif Al Khal, Roberto Bertollini, and Kretzschmar, Mirjam E. E.
Subjects: RNA viruses, Male, Viral Diseases, Time Factors, Pulmonology, Coronaviruses, Epidemiology, Basic Reproduction Number, Polymerase Chain Reaction, Geographical Locations, Medical Conditions, Child, Pathology and laboratory medicine, Virus Testing, Aged, 80 and over, General Medicine, Medical microbiology, Middle Aged, Infectious Diseases, Viruses, Medicine, Female, SARS CoV 2, Pathogens, Research Article, Adult, Asia, SARS coronavirus, Adolescent, Microbiology, Infectious Disease Epidemiology, Respiratory Disorders, Young Adult, Diagnostic Medicine, Humans, Qatar, Aged, Retrospective Studies, Medicine and health sciences, Biology and life sciences, SARS-CoV-2, Organisms, Viral pathogens, COVID-19, Covid 19, Models, Theoretical, Immunity, Innate, Microbial pathogens, Medical Risk Factors, Reinfection, People and Places, Respiratory Infections, People and places
Abstract: Background The epidemiology of the SARS-CoV-2 B.1.1.7 (or Alpha) variant is insufficiently understood. This study’s objective was to describe the introduction and expansion of this variant in Qatar and to estimate the efficacy of natural infection against reinfection with this variant. Methods and findings Reinfections with the B.1.1.7 variant and variants of unknown status were investigated in a national cohort of 158,608 individuals with prior PCR-confirmed infections and a national cohort of 42,848 antibody-positive individuals. Infections with B.1.1.7 and variants of unknown status were also investigated in a national comparator cohort of 132,701 antibody-negative individuals. B.1.1.7 was first identified in Qatar on 25 December 2020. Sudden, large B.1.1.7 epidemic expansion was observed starting on 18 January 2021, triggering the onset of epidemic’s second wave, 7 months after the first wave. B.1.1.7 was about 60% more infectious than the original (wild-type) circulating variants. Among persons with a prior PCR-confirmed infection, the efficacy of natural infection against reinfection was estimated to be 97.5% (95% CI: 95.7% to 98.6%) for B.1.1.7 and 92.2% (95% CI: 90.6% to 93.5%) for variants of unknown status. Among antibody-positive persons, the efficacy of natural infection against reinfection was estimated to be 97.0% (95% CI: 92.5% to 98.7%) for B.1.1.7 and 94.2% (95% CI: 91.8% to 96.0%) for variants of unknown status. A main limitation of this study is assessment of reinfections based on documented PCR-confirmed reinfections, but other reinfections could have occurred and gone undocumented. Conclusions In this study, we observed that introduction of B.1.1.7 into a naïve population can create a major epidemic wave, but natural immunity in those previously infected was strongly associated with limited incidence of reinfection by B.1.1.7 or other variants., Laith Abu-Raddad and colleagues describe the introduction and expansion of the SARS-CoV-2 B.1.1.7 variant in a national cohort in Qatar., Author summary Why was this study done? A novel SARS-CoV-2 variant emerged in the United Kingdom, B.1.1.7 (known also as Alpha), but the consequences of the introduction of this variant into a new national population are insufficiently understood. The first study objective was to characterize the epidemiology of B.1.1.7 immediately after its introduction into a naïve population for this variant. The second study objective was to investigate reinfections with B.1.1.7 and to estimate the efficacy of natural infection against reinfection with this variant. What did the researchers do and find? We investigated the epidemiology of B.1.1.7 using 2 national retrospective cohort studies, mathematical modeling, and other statistical analyses to answer the study’s research questions. A sudden, large, and rapidly growing epidemic wave of B.1.1.7 cases commenced shortly after introduction of this variant into Qatar, and findings suggest that B.1.1.7 was approximately 60% more infectious than the original wild-type circulating variants. The efficacy of natural infection against reinfection with B.1.1.7 was estimated at 97.5% (95% CI: 95.7% to 98.6%) among those with a prior PCR-confirmed infection and at 97.0% (95% CI: 92.5% to 98.7%) among those with a prior antibody-positive result. What do these findings mean? Given its infectiousness, the B.1.1.7 variant can spark an epidemic wave once introduced into a naïve population, even in the presence of public health restrictions and high levels of natural immunity. Prior infection with a wild-type SARS-CoV-2 variant is associated with strong protection against infection with B.1.1.7, a variant that does not appear to be associated with serious immune evasion.
Published: 2021
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