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Background: Healthcare workers are vulnerable to burnout, especially during the COVID-19 pandemic in the low resource settings. Belize is a small Central American developing country known for its chronic healthcare worker shortage and this is the first study to assess burnout prevalence and its associated factors among healthcare workers in Belize. Aim: To evaluate the prevalence of burnout and its associated factors in HCWs in Belize covering multiple domains (mental health, physical symptoms, and coping behaviors) during the COVID-19 pandemic. Methods: A cross-sectional survey that was developed and validated by a panel of experts was delivered online to all the healthcare workers in Belize from September to November 2021. Burnout was assessed using Copenhagen Burnout Inventory. Depression and anxiety screening was carried out using the Patient Health Questionnaire – 2 (PHQ-2) and Generalized Anxiety Disorder 2-item (GAD-2). Burnout associated factors were estimated using logistic regression models. Findings: Of the total of 263 participants, 27.76% had overall burnout: 56.65% had personal, 54.37% had work-related, and 19.39% had patient-related burnout. Burnout was positively associated with anxiety (OR: 3.14 [1.67, 5.92]), depression (OR: 4.45 [2.30, 8.61]), intentions of quitting their jobs (OR: 2.59 [1.49, 4.51]), health status worsening (OR: 2.21 [1.26, 3.87]), multiple physical symptom presentation (OR: 1.19, [1.10, 1.29]), and use of multiple maladaptive coping behaviors (OR: 1.66, [1.30, 2.12]). Interpretation: Healthcare workers in Belize showed substantial levels of burnout which were significantly associated with using maladaptive coping behaviors, presenting multiple physical symptoms, quitting their jobs, health status worsening, and other mental health issues. These findings should be used to develop and implement programs such as regular health check-ups, health promotion awareness campaigns, and worker recruitment strategies which would improve the working conditions, quality of life, and psychological well-being of our healthcare workers.

Background: Data from previous studies of the MVC-COV1901 vaccine, a subunit vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on the stable prefusion spike protein (S-2P) adjuvanted with CpG 1018 adjuvant and aluminum hydroxide, suggest that the vaccine is generally safe and elicits a good immune response in healthy adult and adolescents. By comparing with the active control, AZD1222, this study adds to the findings from previous trials and further evaluates the breadth of protection offered by MVC-COV1901. Methods: In this phase 3, parallel group, randomized, double-blind, active-controlled trial conducted in 2 sites in Paraguay, we assigned adults aged 18 to 91 years in a 1:1 ratio to receive intramuscular doses of MVC-COV1901 or AZD1222 administered as scheduled in the clinical trial. Serum samples were collected on the day of vaccination, Day 1, and 14 days after the second dose (Day 43 after first dose). Primary and secondary safety and immunogenicity endpoints were assessed. In addition, other outcomes investigated were cross-reactive immunity against the Omicron strain and non-neutralizing antibody immune effector mechanisms particularly the induction of IgG subclasses. Results: A total of 1,030 participants underwent randomization. Safety data was derived from this set while primary immunogenicity data involved a per-protocol immunogenicity (PPI) subset including 225 participants. Among the participants, 58% are seropositive at baseline. The mean age was 32.1 years and approximately 60% were males. An estimated 35.3% of participants had coexisiting medical conditions. When compared against AZD1222, MVC-COV1901 exhibited superiority in terms of neutralizing antibody titers geometric mean titer ratio (GMTR) [GMTR seronegative: 4.8 (95% CI 3.0-7.7); GMTR seropositive: 1.7 (95% CI 1.2-2.2)] and non-inferiority in terms of seroconversion rates. Reactogenicity was generally mild. The incidence of serious adverse events was low in both groups. Both vaccines have a Th1-biased response that is predominated by the production of IgG1 and IgG3 subclasses-with MVC-COV1901 exhibiting a stronger antibody response. In the pseudovirus assay, Omicron-neutralizing titers were 44.5 times lower compared to wildtype-neutralizing titers among seronegative individuals at baseline. This fold-reduction was reduced to 3.0 times among the seropositive. Conclusion: Safety and immunogenicity data presented here demonstrate the safe and robust immunogenicity from MVC-COV1901. Previous infection coupled with vaccination of this vaccine may offer protection against the Omicron strain though its durability is still unknown.