Virus World

With six confirmed and two suspected cases, health officials are ramping up a vaccination push amid fears of a wider outbreak.  A polio outbreak centered in Jerusalem has prompted Israel’s return to the World Health Organization’s list of polio “outbreak countries.” Israel now appears along with 28 other countries on the WHO’s Global Polio Eradication Initiative’s list of countries with polio outbreaks, after being declared polio-free in 1988. Nations including Egypt, Iran, Ethiopia and Ukraine are also on the list of outbreak countries — places where the virus was halted but has resurfaced — while Afghanistan and Pakistan are considered endemic countries. Last month, the first case of polio in more than 30 years was confirmed in Jerusalem, spurring deep concerns and a renewed vaccination drive.  According to the latest Health Ministry figures, released last week, there have been six confirmed polio cases, all among unvaccinated patients. In addition, there is a high likelihood of another case in an unvaccinated child, and an eighth potential case that is being investigated. Traces of the disease have also been found in the sewage system in Jerusalem, Beit Shemesh, Tiberias and Modiin Illit.

Over the past month, more than 18,000 children in the Jerusalem area have received a polio vaccine dose as part of the ministry’s push to reach those who were unvaccinated or partially vaccinated. Like much of the world, Israel administers polio vaccines — spread out in multiple doses — to children as part of its standard vaccine regimen. Polio spreads mostly from person to person or through contaminated water. It attacks the nervous system and can sometimes paralyze people within hours. The disease mostly affects children under 5 and has been largely wiped out in wealthy countries. Dr. Sharon Alroy-Preis, the Health Ministry’s public health director, explained last week that during the years 2005-2013, polio vaccinations were scaled back as the disease was vanquished in the country and many babies did not get all the necessary doses. “We are definitely seeing an outbreak of polio in Israel,” Alroy-Preis said. “It reaches unvaccinated pockets and is spreading.” One Jerusalem child who was recently diagnosed with polio has weakness and paralysis on one side, she reported. “That is just the tip of the iceberg, under which there are many other infected children,” she assessed. Disease experts have warned of the real prospect of a resurgence of polio cases — in manageable numbers but enough to leave some children with long-term damage. Traces of the virus have occasionally been found in sewage samples in Israel, but have not resulted in any clinical cases for several decades.

We tested whether COVID-19 incidence and hospitalization rates were inversely related to vaccination coverage among the 112 most populous counties in the United States, each with a population exceeding 600,000, and together with a combined total population of 147 million persons. We measured vaccination coverage as the percent of the total population fully vaccinated as of July 15, 2021, with the exception of 11 Texas counties, where the cutoff date was July 14, 2021. We measured COVID-19 incidence as the number of confirmed cases per 100,000 population during the 14-day period ending August 12, 2021. We measured hospitalization rates as the number of confirmed COVID-19 admissions per 100,000 population during the same 14-day period. COVID-19 incidence was significantly higher among counties in the lower half of the distribution of vaccination coverage (incidence 543.8 per 100,000 among 56 counties with mean coverage 42.61%) than among counties in the upper half of the distribution of coverage (incidence 280.7 per 100,000 among 56 counties with mean coverage 57.37%, p < 0.0001). Hospital admissions were also significantly higher among counties in the lower half of the distribution (55.37 per 100,000) than in the upper half of the distribution (20.48 per 100,000, p < 0.0001). In log-linear regression models, a 10-percentage-point increase in vaccination coverage was associated with a 28.3% decrease in COVID-19 incidence (95% confidence interval, 16.8 - 39.7%), a 44.9 percent decrease in the rate of COVID-19 hospitalization (95% CI, 28.8 - 61.0%), and a 16.6% decrease in COVID-19 hospitalizations per 100 cases (95% CI, 8.4 - 24.8%). Higher vaccination coverage is associated not only with significantly lower COVID-19 incidence, but also significantly less severe cases of the disease.

Available as preprint (August 20, 2021):

https://doi.org/10.1101/2021.08.17.21262195 

• A new Ipsos-World Economic Forum survey shows a notable increase in COVID-19 vaccination intent since December in all 15 countries studied.
• Eighty-nine percent of people in Brazil say they’re ready to be vaccinated, with confidence also very high in Italy, China and Spain.
• Confidence in the vaccines has risen most in Italy – up 36 percentage points since December.

Limited initial supply of SARS-CoV-2 vaccine raises the question of how to prioritize available doses. Here, we used a mathematical model to compare five age-stratified prioritization strategies. A highly effective transmission-blocking vaccine prioritized to adults ages 20-49 years minimized cumulative incidence, but mortality and years of life lost were minimized in most scenarios when the vaccine was prioritized to adults over 60 years old. Use of individual-level serological tests to redirect doses to seronegative individuals improved the marginal impact of each dose while partially addressing existing inequities in COVID-19 impact. While maximum impact prioritization strategies were broadly consistent across countries, transmission rates, vaccination rollout speeds, and estimates of naturally acquired immunity, this framework can be used to compare impacts of prioritization strategies across contexts.

Available in medRxiv (Dec. 7, 2020):

 https://doi.org/10.1101/2020.09.08.20190629

California’s new COVID cases are settling down after this summer’s surge, and a divide has clearly emerged. Although the Golden State as a whole is doing well compared to the rest of the country, some smaller and more rural counties where vaccination rates are among the lowest in the state are only now starting to level off after experiencing their highest ever new case rates in the past few weeks. Every county with a vaccination rate under 50% has a case rate over 25. In the Bay Area where vaccination rates range from 64% to 82%, every county has a case rate under 20. And despite the downward trend in cases, hospitals in some of those places still have more COVID patients than at any other point in the pandemic.  An analysis by the Bay Area News Group shows that every California county with a vaccination rate under 50% had more than 25 new cases in the previous 14 days per 10,000 residents. In the Bay Area, where vaccination rates range from 64% to 82%, there is not a single county with a case rate over 20.  “This demonstrates in a poignant way something we have always known,” said Dr. John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology at UC Berkeley’s school of public health. “The fewer people vaccinated in a community correlates directly with the risk of getting COVID-19.” “If data presented like this will not change peoples’ minds about getting vaccinated,” Swartzberg added, “I don’t know what will.”

A tool to help you track down COVID-19 vaccine appointment openings at your state's pharmacies. Updated every minute. Rather than searching around on each pharmacy's website, we'll automatically scan the pharmacy websites and show you any available appointments we can find on one page.

Finding vaccines seems tough! Hopefully things will become easier soon, but in the meantime, maybe this can help. If you find this useful, feel free to share it around. Get in touch with any questions: vaccine@nickm.org, @nickblah, or GitHub. I'd like to add additional functionality (scanning additional pharmacies and sending e-mail or text notifications when appointments open up) if this proves useful and as time permits. If you're a computer programmer and would like to contribute, the project is open source on GitHub (it's currently very messy and undocumented, though).

The panel says adults aged 75 and older, as well as frontline essential workers, be designated as the second priority group. n expert panel that advises the Centers for Disease Control and Prevention recommended Sunday that adults aged 75 and older, as well as frontline essential workers, be designated as the second priority group to be vaccinated against Covid-19. The Advisory Committee on Immunization Practices also voted to recommend that the third stage of the national vaccination program should focus on adults 65 to 74, people 16 to 64 years old with high-risk medical conditions, and essential workers not included in the second phase of vaccination. The committee defined frontline essential workers as first responders, teachers and other education workers including day care workers, food and agriculture workers, correctional facility staff, postal workers, public transit workers, and people who work in manufacturing and in grocery stores. The vote came after hours of data presentations and debate, and pleas from members of the public to move up individual groups in the priority listing. “I voted for this recommendation because in my opinion, it follows the evidence about the risk from coronavirus and the ethical principles that we have developed on ACIP to maximize the benefits and minimize harms, promote justice, and to minimize health inequities,” said Peter Szilagyi, a pediatrician at UCLA.  “We are trying to thread the needle here.”

Szilagyi and multiple members of the committee said the work to decide who gets priority access to Covid-19 vaccines has been agonizing.   “This is without a doubt the hardest vote that I have taken in my 6 1/2 years on this committee,” said chair Jose Romero, secretary of health for Arkansas.  The committee voted 13 to 1 to approve the groups to be included in Phase 1b and Phase 1c of the vaccination program. Phase 1a, which is currently ongoing, gives top priority to health care workers and residents and staff of nursing homes. The lone dissenter, Henry Bernstein, a pediatrician and professor at the Zucker School of Medicine at Hofstra/Northwell, said he felt that adults aged 65 and older should have been in Phase 1b. The toll the virus takes on people 65 to 74 is not substantially different from its impact on people 75 and older, he argued. The ACIP recommendations now go to CDC Director Robert Redfield, who must sign off on them in order for them to become CDC guidance. However, state and local health authorities make the final decisions on how to roll out vaccination in their locales. At the end of Sunday’s meeting it was announced that more than half a million people in the country have already been vaccinated with the Pfizer Covid-19 vaccine. Moderna’s vaccine, which was given an emergency use authorization Friday evening by the Food and Drug Administration, will begin to be rolled out this week. 

The ACIP’s Covid vaccines work group, which proposed the priority groups, explained it was trying to balance the prevention of illness and death with trying to maintain societal functioning as well as equity. Frontline essential workers are in jobs where they cannot work from home; they may not even be able to practice social distancing because of the demands of their work. Previously the committee had talked about putting all essential workers ahead of seniors — an idea which drew pushback from Health and Human Services Secretary Alex Azar, among others.  But the entire essential workers group, which is based on a list drawn up by a division of the Department of Homeland Security, represents about 87 million people — too big a group at a time when vaccine supplies are scarce. Essential workers who will have to wait for Phase 1c for vaccine include people who maintain water and wastewater systems, people who work in the IT and communications sector, members of the media, and public safety workers.  Operation Warp Speed, the federal government’s program to fast-track vaccine production, estimates there will be enough vaccine to vaccinate 20 million people in December, another 30 million in January, and an additional 50 million by the end of February. Phase 1a of the vaccination effort, which began last week, involves offering vaccine to 24 million people. In Phase 1b, 49 million people will be eligible to receive vaccine. Phase 1c is a much larger group, including roughly 129 million people. In total, the first three priority groups will cover 202 million people — double the number of people the country expects to have vaccine for by the end of February.....

CDC ACIP Meetings Recommendations (Nov. 23, 2020):

https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-11/COVID-04-Dooling.pdf 

CDC Data on Vaccine Administration and Distribution (updated daily):

https://covid.cdc.gov/covid-data-tracker/#vaccinations