Course and Lethality of SARS-CoV-2 Epidemic in Nursing Homes after Vaccination in Florence, Italy

Rivasi, Giulia; Bulgaresi, Matteo; Mossello, Enrico; Buscemi, Primo; Lorini, Chiara; Balzi, Daniela; Barucci, Riccardo; Lungo, I. Del; Gangemi, Sebastiano; Giardini, S.; Piga, Cecilia; Barghini, Eleonora; Boni, Serena; Bulli, Giulia; Carrai, Paolo; Crociani, Andrea; Faraone, Antonio; Forte, Aldo Lo; Martella, Letizia; Pupo, Simone; Fortini, Giacomo; Marozzi, Irene; Bandini, Giulia; Cosma, Claudia; Stacchini, Lorenzo; Vaccaro, Gabriele; Baggiani, Lorenzo; Landini, Giancarlo; Bonaccorsi, Guglielmo; Ungar, Andrea; Benvenuti, Enrico

doi:10.3390/vaccines9101174

Cited by 16 publications

(44 citation statements)

References 23 publications

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“…Yet, hospitalization rate (8%) significantly increased as compared to the early post‐vaccination period (3%), 15 getting closer to that reported in unvaccinated residents during the second wave (10%) 17 . Lethality rate (8%) was significant, but lower than previously reported in unvaccinated residents of the study area (23%) 17 and similar to that observed in the early post‐vaccination period (6%) 15 . Lethality was consistent with what was recently described in a smaller sample of NH residents during a Spanish post‐vaccination outbreak, 20 while hospitalization rate was lower, possibly due to the “hospital‐at‐nursing home” model of care that has been adopted by the Florence Health District during COVID‐19 epidemic 17 …”

Section: Discussionmentioning

confidence: 97%

“…This primary vaccination course, together with strict prevention measures, was associated with a sharp decline in SARS-CoV-2 new cases among NH residents over the following 2 months, with infection rate falling to zero by March 2021, as described in a previous paper. 15 In the present study, we enrolled residents living in Florence NHs as of April 1st 2021, and we calculated the weekly breakthrough infection rates for 7 months, until…”

Section: Methodsmentioning

confidence: 99%

“…This primary vaccination course, together with strict prevention measures, was associated with a sharp decline in SARS‐CoV‐2 new cases among NH residents over the following 2 months, with infection rate falling to zero by March 2021, as described in a previous paper. 15 …”

Section: Methodsmentioning

confidence: 99%

“…4,[6][7][8] The issue is even more relevant to nursing home (NH) residents, a vulnerable population characterized by higher risk for severe COVID-19 outcomes [9][10][11] and blunted immune response to the BNT162b2 vaccine. 12,13 Studies have clearly demonstrated that SARS-CoV-2 vaccination had a positive impact on the epidemic course, hospital admissions and death risk among NH residents 11,[14][15][16] although a decline of effectiveness against SARS-CoV-2 infection has been observed in this population after Delta variant diffusion. 7 Understanding the long-term effectiveness of vaccination is a necessary prerequisite to develop appropriate preventive healthcare strategies, particularly in subgroups at higher risk of COVID-19-related adverse outcomes such as NH residents.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term effects of SARS‐CoV‐2 vaccination in the nursing home setting

Rivasi

Bulgaresi

Bandinelli

et al. 2022

J American Geriatrics Society

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Background SARS‐CoV‐2 vaccination has significantly reduced infection, hospitalization, and lethality rates among nursing home (NH) residents, but durability of vaccine effects remains unknown. This study investigated the long‐term impact of BNT162b2 SARS‐CoV‐2 vaccine on breakthrough infection rates in the NHs of Florence, Italy. Methods Participants included residents living in Florence NHs as of April 1st, 2021, who had completed the primary SARS‐CoV2 vaccination course by February 15th, 2021. Weekly rates of breakthrough infection were calculated between April 1st and October 31st 2021, with 7‐day incidence defined as the number of new confirmed SARS‐CoV‐2‐positive residents over the vaccinated resident census. Hospital admissions and deaths were recorded from local administrative and clinical sources. Patients admitted to NHs after April 1st were excluded to avoid confounding effect of different vaccination timing. Results Among 2271 vaccinated residents (mean age 86.6, 74% female), we recorded 105 cases of breakthrough infections. Rates of breakthrough infection remained very low in the 6 months after vaccination, but started to rise over the following months, peaking at 0.94%, and then became stable around 0.2%–0.3%. Over the study period, infection rates remained low as compared to the incidence of SARS‐CoV‐2 infection during pre‐vaccination period. Overall hospitalization and lethality rates were 8%. Conclusions Among vaccinated NH residents, rates of breakthrough SARS‐CoV‐2 infection, hospitalization and lethality remained low up to 9 months following primary vaccination course. A mild resurgence of SARS‐CoV‐2 infection, after 6 months from vaccination, suggests a decline of vaccine effectiveness in preventing transmission.

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Long‐term effects of SARS‐CoV‐2 vaccination in the nursing home setting

Rivasi

Bulgaresi

Bandinelli

et al. 2022

J American Geriatrics Society

Self Cite

View full text Add to dashboard Cite

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“…Importantly, the extent of vaccination coverage, local prevalence of infection, and necessity of the contact should be carefully considered before allowing any gathering of individuals. Even in high-risk individuals such as those in care homes, SARS-CoV-2 vaccination has been associated with significant reductions in infection rates, and significantly lower risk of morbidity and mortality following SARS-CoV-2 infection compared with those seen pre-vaccination [ 119 , 120 ].…”

Section: Different Testing Settingsmentioning

confidence: 99%

Choice of SARS-CoV-2 diagnostic test: challenges and key considerations for the future

Baldanti

Ganguly

Wang

et al. 2022

Critical Reviews in Clinical Laboratory Sciences

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A plethora of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic tests are available, each with different performance specifications, detection methods, and targets. This narrative review aims to summarize the diagnostic technologies available and how they are best selected to tackle SARS-CoV-2 infection as the pandemic evolves. Seven key settings have been identified where diagnostic tests are being deployed: symptomatic individuals presenting for diagnostic testing and/or treatment of COVID-19 symptoms; asymptomatic individuals accessing healthcare for planned non-COVID-19-related reasons; patients needing to access emergency care (symptom status unknown); patients being discharged from healthcare following hospitalization for COVID-19; healthy individuals in both single event settings (e.g. airports, restaurants, hotels, concerts, and sporting events) and repeat access settings (e.g. workplaces, schools, and universities); and vaccinated individuals. While molecular diagnostics remain central to SARS-CoV-2 testing strategies, we have offered some discussion on the considerations for when other tools and technologies may be useful, when centralized/point-of-care testing is appropriate, and how the various additional diagnostics can be deployed in differently resourced settings. As the pandemic evolves, molecular testing remains important for definitive diagnosis, but increasingly widespread point-of-care testing is essential to the re-opening of society.

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The Efficacy of SARS-CoV-2 Vaccination in the Elderly: A Systemic Review and Meta-analysis

et al. 2023

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Background Given the reduced immune response to vaccines in older populations, this study aimed to evaluate the efficacy of COVID-19 vaccinations and its impact on breakthrough infection, hospital admission, and mortality in the elderly. Methods We carried out a systemic review and meta-analysis where MEDLINE, Web of Science, EMBASE, ClinicalTrials.gov, and Cochrane Central Register for Controlled Trials were queried to identify relevant literature. We included randomized controlled trials (RCTs), non-randomized trials, prospective, observational cohort, and case–control studies assessing breakthrough infection, hospital admission, and mortality after coronavirus 2 (SARS-CoV-2) vaccination in the elderly (≥ 60 years old). Results Overall, 26 studies were included in this meta-analysis. Compared with the unvaccinated group, the vaccinated group showed a decreased risk of SARS-CoV-2 infection after 28–34 (relative risk [RR] = 0.42, 95% confidence interval [CI] 0.37–0.49) and 35–60 days (RR = 0.49, 95% CI 0.37–0.62). There was a step-wise increase in efficacy with additional doses with the two-dose group experiencing decreased risk of breakthrough infection (RR = 0.37, 95% CI 0.32–0.42), hospital admissions (RR = 0.25, 95% CI 0.14–0.45), disease severity (RR = 0.38, 95% CI 0.20–0.70), and mortality (RR = 0.21, 95% CI 0.14–0.32) compared with those receiving one or no doses. Similarly three-dose and four-dose vaccine groups also showed a decreased risk of breakthrough infection (3-dose: RR = 0.14, 95% CI 0.10–0.20; 4-dose RR = 0.46, 95% CI 0.4–0.53), hospital admissions (3-dose: RR = 0.11, 95% CI 0.07–0.17; 4-dose: RR = 0.42, 95% CI 0.32–0.55), and all-cause mortality (3-dose: RR = 0.10, 95% CI 0.02–0.48; 4-dose: RR = 0.48, 95% CI 0.28–0.84) Subgroup analysis found that protection against mortality for vaccinated vs. unvaccinated groups was similar by age (60–79 years: RR = 0.59; 95% CI, 0.47–0.74; ≥ 80 years: RR = 0.76; 95% CI, 0.59–0.98) and gender (female: RR = 0.66; 95% CI, 0.50–0.87, male: (RR = 0.58; 95% CI, 0.44–0.76), and comorbid cardiovascular disease (CVD) (RR = 0.69; 95% CI, 0.52–0.92) or diabetes (DM) (RR = 0.59; 95% CI, 0.39–0.89. Conclusions Our pooled results showed that SARS-CoV-2 vaccines administered to the elderly is effective in preventing prevent breakthrough infection, hospitalization, severity, and death. What’s more, increasing number of vaccine doses is becoming increasingly effective. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-023-08254-9.

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Course and Lethality of SARS-CoV-2 Epidemic in Nursing Homes after Vaccination in Florence, Italy

Cited by 16 publications

References 23 publications

Long‐term effects of SARS‐CoV‐2 vaccination in the nursing home setting

Long‐term effects of SARS‐CoV‐2 vaccination in the nursing home setting

Choice of SARS-CoV-2 diagnostic test: challenges and key considerations for the future

The Efficacy of SARS-CoV-2 Vaccination in the Elderly: A Systemic Review and Meta-analysis

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