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Effectiveness of BNT162b2 and CoronaVac COVID-19 vaccination against asymptomatic and symptomatic infection of SARS-CoV-2 omicron BA.2 in Hong Kong: a prospective cohort study

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Summary

Background

COVID-19 vaccines provide protection against symptomatic infection that might require medical attention and against severe outcomes; however, there is a paucity of evidence regarding the effectiveness of the BNT162b2 and CoronaVac vaccines and their booster regimens against asymptomatic or mild omicron infections in the community. We aimed to measure the effectiveness of BNT162b2 and CoronaVac vaccines against asymptomatic and symptomatic SARS-CoV-2 omicron infections, during a period of omicron BA.2 predominance in Hong Kong.

Methods

In this prospective cohort study in a population that was generally infection-naive before the large omicron BA.2 wave between January and late May, 2022, we established a public health surveillance platform to monitor the evolving activity of SARS-CoV-2 infections in the community. We recruited a cohort of individuals aged 5 years and older between March 1 and March 7, 2022, from the general population. Individuals were enrolled from all 18 districts of Hong Kong, according to a predefined age-stratified quota, primarily by random digit dialing (generating suitable eight-digit local telephone numbers by randomly picking sets of the first four digits from a sampling frame, and randomly generating the last four digits), and supplemented by our existing cohorts (which included cohorts for studying influenza vaccination from school-based vaccination programmes and cohorts for SARS-CoV-2 seroprevalence from the community), to ensure representativeness of the population in Hong Kong. Participants did weekly rapid antigen testing with a self-collected pooled nasal and throat swab, regardless of symptom and exposure status, from March 1 to April 15, 2022. Individuals reporting a history of SARS-CoV-2 infection confirmed by laboratory PCR testing before enrolment were excluded from the vaccine effectiveness analysis to avoid potential bias due to infection-induced immunity. The primary outcomes of the study were the incidence of SARS-CoV-2 infection, including asymptomatic and symptomatic infections, and the vaccine effectiveness of BNT162b2 and CoronaVac vaccines. The effectiveness of one, two, and three doses of vaccination was estimated with a Cox proportional hazards regression model with time-dependent covariates, allowing for changes in vaccination status over time, after adjustment for demographic factors and pre-existing medical conditions.

Findings

Of the 8636 individuals included in the analysis, 7233 (84%) received at least two doses of vaccine, 3993 (46%) received booster doses, and 903 (10%) reported SARS-CoV-2 infection. Among these infections 589 (65·2%) were symptomatic and 314 (34·8%) were asymptomatic at the time of testing. Statistically significant protection against asymptomatic and symptomatic SARS-CoV-2 omicron infection was found only for those who received a BNT162b2 or CoronaVac booster dose, with a vaccine effectiveness of 41·4% (23·2 to 55·2; p=0·0001) and 32·4% (9·0 to 49·8; p=0·0098), respectively. The vaccine effectiveness of BNT162b2 and CoronaVac boosters was further increased to 50·9% (95% CI 31·0–65·0; p<0·0001) and 41·6% (15·0–59·8; p=0·0049), respectively, for symptomatic omicron infections. A similar pattern of vaccine effectiveness (55·8%, 22·9–74·6; p=0·0040) was also conferred after receipt of a BNT162b2 booster by individuals who received a CoronaVac primary vaccination series.

Interpretation

Two doses of either vaccine did not provide significant protection against COVID-19 infection. However, receipt of a BNT162b2 booster or CoronaVac booster was associated with a significantly lower risk of omicron BA.2 infection and symptomatic infection. Our findings confirm the effectiveness of booster doses to protect against mild and asymptomatic infection.

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Funding

Henry Fok Foundation and Hong Kong Health Bureau.

Introduction

With the current global predominance of the omicron variant of SARS-CoV-2, previous understanding of the effectiveness of different COVID-19 vaccines against the ancestral strain and earlier variants is no longer sufficient to inform the way forward during the evolving COVID-19 pandemic.

1

  • Abu-Raddad LJ
  • Chemaitelly H
  • Ayoub HH
  • et al.
Effect of mRNA vaccine boosters against SARS-CoV-2 omicron infection in Qatar.

 

Literature has generally suggested that a primary series plus booster doses of mRNA vaccine shows modest to high effectiveness against severe COVID-19 outcomes, including hospitalisation, mechanical ventilation, and death,

2

  • Lauring AS
  • Tenforde MW
  • Chappell JD
  • et al.
Clinical severity of, and effectiveness of mRNA vaccines against, COVID-19 from omicron, delta, and alpha SARS-CoV-2 variants in the United States: prospective observational study.

 

3

  • McMenamin ME
  • Nealon J
  • Lin Y
  • et al.
Vaccine effectiveness of one, two, and three doses of BNT162b2 and CoronaVac against COVID-19 in Hong Kong: a population-based observational study.

 

4

  • Altarawneh HN
  • Chemaitelly H
  • Ayoub HH
  • et al.
Effects of previous infection and vaccination on symptomatic omicron infections.

 

5

  • Sheikh A
  • Kerr S
  • Woolhouse M
  • et al.
Severity of omicron variant of concern and effectiveness of vaccine boosters against symptomatic disease in Scotland (EAVE II): a national cohort study with nested test-negative design.

 

6

  • Baum U
  • Poukka E
  • Leino T
  • Kilpi T
  • Nohynek H
  • Palmu AA
High vaccine effectiveness against severe COVID-19 in the elderly in Finland before and after the emergence of omicron.

 

7

  • Kirsebom FCM
  • Andrews N
  • Stowe J
  • et al.
COVID-19 vaccine effectiveness against the omicron (BA.2) variant in England.

 

and effectively prevents symptomatic infections.

4

  • Altarawneh HN
  • Chemaitelly H
  • Ayoub HH
  • et al.
Effects of previous infection and vaccination on symptomatic omicron infections.

 

5

  • Sheikh A
  • Kerr S
  • Woolhouse M
  • et al.
Severity of omicron variant of concern and effectiveness of vaccine boosters against symptomatic disease in Scotland (EAVE II): a national cohort study with nested test-negative design.

 

7

  • Kirsebom FCM
  • Andrews N
  • Stowe J
  • et al.
COVID-19 vaccine effectiveness against the omicron (BA.2) variant in England.

 

8

  • Andrews N
  • Stowe J
  • Kirsebom F
  • et al.
Covid-19 vaccine effectiveness against the omicron (B.1.1.529) variant.

 

9

  • Fleming-Dutra KE
  • Britton A
  • Shang N
  • et al.
Association of prior BNT162b2 COVID-19 vaccination with symptomatic SARS-CoV-2 infection in children and adolescents during omicron predominance.

 

However, evidence of the effectiveness of vaccines in preventing mild and asymptomatic infections, which have potential public health implications for seeding downstream secondary transmission, are generally lacking.

 

Research in contextEvidence before this studyWith the evolving omicron variants of SARS-CoV-2, previous understanding of the effectiveness of COVID-19 vaccines against the ancestral strain and earlier variants is becoming increasingly insufficient. Newer omicron-specific vaccine-effectiveness estimates are needed to inform the way forward, especially for individuals who present with asymptomatic infection, who might either have no symptoms or develop symptoms later (pre-symptomatic), because of the potential public health implications for seeding downstream secondary transmission. We searched PubMed and MedRxiv, with no language restrictions, from database inception up to Sept 14, 2022, using the search terms “((vaccine effectiveness) AND (omicron)) AND (((BNT162b2) OR (Comirnaty)) OR (CoronaVac))”, and found 133 published articles and 791 preprints. 118 of these publications reported vaccine effectiveness against omicron outcomes, with 100 studies focused only on symptomatic infection or severe complications. Among the 18 studies that attempted to examine asymptomatic infections, only ten reported aggregated vaccine effectiveness rather than the vaccine effectiveness of specific vaccine types, three used only a risk-based testing approach, which was not optimal in ascertaining asymptomatic infections, and five were of restricted generalisability, as they focused on specific population subgroups (one each on haemodialysis patients, people who were incarcerated, and university students and employees, and two on children). To our knowledge, to date, no study has reported the vaccine effectiveness of the BNT162b2 booster or CoronaVac vaccines and booster regimens against omicron BA.2 asymptomatic infection.Added value of this studyThe population of Hong Kong was generally omicron-infection-naive before a large BA.2 wave extending from January 1 to April 30, 2022, and peaking in early March. Our prospective observational cohort study examined and compared the vaccine effectiveness of BNT162b2 and CoronaVac against asymptomatic and symptomatic SARS-CoV-2 omicron BA.2 infections. The systematic use of weekly SARS-CoV-2 rapid antigen testing for outcome ascertainment, regardless of exposure status and symptoms, allowed for identification of asymptomatic infections, including in those who remained asymptomatic and those who went on to develop symptoms (pre-symptomatic), and improved generalisability to community infections. To our knowledge, our study is the first to report the effectiveness of CoronaVac vaccines against SARS-CoV-2 omicron BA.2 asymptomatic infections. Our results suggest that no significant protection was observed for one or two doses of BNT162b2 and CoronaVac. Significant protection against SARS-CoV-2 asymptomatic and symptomatic omicron infection was shown for those who received a BNT162b2 booster or CoronaVac booster. A similar pattern of vaccine effectiveness was also conferred by administering a BNT162b2 booster dose to individuals who received a CoronaVac primary vaccination series.Implications of all the available evidenceOur results suggest that a booster dose of COVID-19 vaccine is needed to achieve significant protection against omicron infection, by either an inactivated or mRNA vaccine, which highlights the importance of achieving high coverage of booster doses. Our study shows the experimental feasibility for examining vaccine effectiveness against asymptomatic and mild infections using a systematic outcome-ascertainment approach, irrespective of exposures status and symptoms.

However, examination of the effectiveness of vaccines in preventing mild and asymptomatic COVID-19 infections is inherently challenging. Common study designs used for studying vaccine effectiveness, including test-negative design, depend on symptomatic cases presenting in various settings.

9

  • Fleming-Dutra KE
  • Britton A
  • Shang N
  • et al.
Association of prior BNT162b2 COVID-19 vaccination with symptomatic SARS-CoV-2 infection in children and adolescents during omicron predominance.

 

Therefore, such designs can be biased towards the more severe end of the clinical spectrum and might not be generalisable to all cases in the community. Moreover, previous observational vaccine effectiveness studies that do not have a prescribed similar testing schedule might be biased by the potential differential testing frequencies and behaviours among people with different vaccination status.

10

  • Kuitunen I
  • Uimonen M
  • Seppälä SJ
  • Ponkilainen VT
COVID-19 vaccination status and testing rates in Finland—a potential cause for bias in observational vaccine effectiveness analysis.

 

11

  • Glasziou P
  • McCaffery K
  • Cvejic E
  • et al.
Testing behaviour may bias observational studies of vaccine effectiveness.

 

Previous vaccine effectiveness studies against omicron infections have focused mainly on various mRNA vaccine candidates, including BNT162b2 (Pfizer–BioNTech) and the mRNA-1273 (Moderna) vaccine, or adenoviral vector vaccines, such as ChAdOx1 nCoV-19 (AstraZeneca),

4

  • Altarawneh HN
  • Chemaitelly H
  • Ayoub HH
  • et al.
Effects of previous infection and vaccination on symptomatic omicron infections.

 

5

  • Sheikh A
  • Kerr S
  • Woolhouse M
  • et al.
Severity of omicron variant of concern and effectiveness of vaccine boosters against symptomatic disease in Scotland (EAVE II): a national cohort study with nested test-negative design.

 

7

  • Kirsebom FCM
  • Andrews N
  • Stowe J
  • et al.
COVID-19 vaccine effectiveness against the omicron (BA.2) variant in England.

 

8

  • Andrews N
  • Stowe J
  • Kirsebom F
  • et al.
Covid-19 vaccine effectiveness against the omicron (B.1.1.529) variant.

 

9

  • Fleming-Dutra KE
  • Britton A
  • Shang N
  • et al.
Association of prior BNT162b2 COVID-19 vaccination with symptomatic SARS-CoV-2 infection in children and adolescents during omicron predominance.

 

12

  • Tan SHX
  • Cook AR
  • Heng D
  • Ong B
  • Lye DC
  • Tan KB
Effectiveness of BNT162b2 vaccine against omicron in children 5 to 11 years of age.

 

and, to our knowledge, the effectiveness of inactivated vaccine (eg CoronaVac [Sinovac]) against omicron infections has yet to be investigated. Although previous studies have reported the effectiveness of BNT162b2 among children and adolescents,

9

  • Fleming-Dutra KE
  • Britton A
  • Shang N
  • et al.
Association of prior BNT162b2 COVID-19 vaccination with symptomatic SARS-CoV-2 infection in children and adolescents during omicron predominance.

 

12

  • Tan SHX
  • Cook AR
  • Heng D
  • Ong B
  • Lye DC
  • Tan KB
Effectiveness of BNT162b2 vaccine against omicron in children 5 to 11 years of age.

 

the comparative effectiveness of BNT162b2 and CoronaVac vaccines among different age groups remains unclear. We did a study examining the effectiveness of BNT162b2 and CoronaVac vaccines against SARS-CoV-2 infection, using a prospective and systematic approach to outcome ascertainment, regardless of risk or symptoms, and therefore capturing mild and asymptomatic infections, during a period of omicron BA.2 predominance in Hong Kong.

Results

1560 (15·3%) of 10 196 individuals in the cohort had reported themselves to be previously infected with SARS-CoV-2 before enrolment and thus were excluded from the vaccine effectiveness analysis. Among the 8636 individuals included in the vaccine effectiveness analysis, 903 (10·5%) were infected during the surveillance period, with a median of 10 days (IQR 6–17) between enrolment and infection; among these infections 589 (65·2%) were symptomatic and 314 (34·8%) were asymptomatic. 7233 (84%) individuals had received at least two doses of vaccine and 3993 (46%) received booster doses. The distribution of positive and negative cases according to sex, age, and comorbidity status was similar (table 1). Sociodemographic factors associated with test positivity included household size, district, housing type, and TPU level median monthly domestic household rent (appendix p 2). High compliance with weekly testing was maintained in 8419 (97·5%) individuals, with a similar pattern across different characteristics (appendix p 3).

Table 1Characteristics of people tested for SARS-CoV-2 with rapid antigen test, according to test positivity or negativity

Data are n (%) or n/N (%), unless otherwise indicated. Only individuals aged 5 years and older were included.

764 (8·8%) of 8636 individuals were unvaccinated, 639 (7·4%) had only one dose of vaccine, 3240 (37·5%) had two doses, and 3993 (46·2%) had three doses (table 1). Differences in monthly domestic household rent, housing type, and geographical district were observed between vaccination status; in particular, individuals who received three doses of vaccine had a higher likelihood of being male, older, having a chronic illness, having a smaller household size, and being asymptomatic (appendix p 4). 2308 (71·2%) of 3240 individuals who received two doses of vaccine had received the second dose more than 3 months before testing, so vaccine effectiveness was stratified by those who had completed the second dose within 3 months or 3 months or longer before testing. For the primary series of two vaccine doses, 2353 (27·2%) of 8636 individuals received BNT162b2 and 875 (10·1%) individuals received CoronaVac. For the primary series using BNT162b2, 1884 (21·8%) of 8636 individuals completed the two doses 3 months before testing and 469 (5·4%) completed the two doses within 3 months of testing (table 2). For the primary series using CoronaVac, 458 (5·3%) of 8636 individuals completed the two doses 3 months before testing and 417 (4·8%) completed the two doses within 3 months of testing (table 2). As switching of vaccine between the two doses was not allowed in the primary series, only 12 (0·1%) of 8636 individuals had two doses with other vaccine combinations, and were not included in the primary analysis (table 2).

Table 2Vaccination status by age group

Data are n (%), unless otherwise indicated.

For individuals who received three doses of vaccine, 2432 (28·2%) of 8636 received three doses of BNT162b2 and 1050 (12·2%) received CoronaVac. A small proportion of individuals received a combination, either of a primary series of CoronaVac followed by a BNT162b2 booster (463 [5·4%] of 8636 individuals), or a primary series of BNT162b2 followed by a CoronaVac booster (29 [0·3%] individuals). 19 (0·2%) of 8636 individuals received three vaccine doses in other combinations and were not included in the analysis (table 2).
Among the 886 participants aged 5–17 years, 323 (36·5%) received two doses of vaccine and 287 (32·4%) received one dose of vaccine. As only 60 (6·8%) of 886 individuals aged 5–17 years had received three doses of vaccination, the effectiveness of booster vaccination was not examined in this age group. Among the 6014 individuals aged 18–59 years, 2988 (49·7%) received three doses of vaccine and 2404 (40·0%) received two doses of vaccine. Among the 1736 individuals aged 60 years and older, 945 (54·4%) received three doses of vaccine and 513 (29·6%) received two doses of vaccine. The observed differential distribution of vaccination status by age group was largely consistent with the territory-wide figures of vaccine coverage for the population in Hong Kong (table 2).

Table 3 shows the differential risk of SARS-CoV-2 infection stratified according to vaccination status. The lowest positivity rate was observed among individuals who received three doses (5·4%, 95% CI 4·8–6·2), followed by those who received two doses within 3 months (6·8%, 5·3–8·6). Higher positivity rates were observed among individuals who received only one dose (14·7%, 12·2–17·7) or two doses at least 3 months previously (17·6%, 16·1–19·2). Detailed vaccination status by age group is shown in the appendix were shown in the appendix (pp 5–7). For all age groups, the positivity rate was lower for individuals with a more recent primary series of vaccination within 3 months compared with those who completed vaccination at least 3 months ago.

Table 3Vaccination status and risk of infection

Data are n (%), unless otherwise indicated.

A potential attenuation of infection severity was shown in those who received a booster BNT162b2 dose compared with unvaccinated individuals, both in terms of a lower number of symptoms (6·21, SD 3·64 vs 8·09, 4·13; p=0·0040) and a lower mean severity score was found (8·35, 6·31 vs 11·56, 7·93; p=0·0068). No impact on symptom profile was observed for those who received two doses or fewer of BNT162b2 (appendix p 8).

Using unvaccinated people as the reference group in the multivariate model, the first dose of BNT162b2 vaccine provided a vaccine effectiveness of 16·5% (95% CI –19·5 to 41·6; p=0·32) against asymptomatic and symptomatic SARS-CoV-2 omicron infection (table 4). Vaccine effectiveness after two doses (ie, primary series) was not significant (27·6%, –6·3 to 50·7; p=0·10) within 3 months, and point estimates declined to a very low level of 1·1% (–22·4 to 20·1; p=0·92) at 3 months and beyond. A BNT162b2 booster vaccine improved the effectiveness to 41·4% (23·2 to 55·2; p=0·0001; figure; table 4).

Table 4Effectiveness of the BNT162b2 and CoronaVac vaccines against COVID-19 omicron BA.2 infection

Data are n, unless otherwise indicated. Data were adjusted for age group, gender, chronic illness, household size, district, housing type, Hong Kong tertiary planning unit level, and monthly household rent. Symptomatic infections were defined as those with a positive rapid antigen test result after an individuals reported at least one of 19 surveyed symptoms.

FigureCumulative risk of infection with the SARS-CoV-2 omicron variant according to vaccination status in asymptomatic and symptomatic infection (A) and symptomatic infection only (B)

A similar pattern of vaccine effectiveness for any SARS-CoV-2 infection, but with a slightly lower magnitude of protection, was given by the CoronaVac vaccine. The first dose of CoronaVac provided a vaccine effectiveness of –1·6% (95% CI –30·8 to 26·2; p=0·92) against asymptomatic and symptomatic SARS-CoV-2 omicron infection (table 4). Vaccine effectiveness after two doses was not significant within 3 months (5·4%, –25·6 to 28·8; p=0·70) or at 3 months and beyond (22·7%, –15·2 to 48·2; p=0·21). A CoronaVac booster improved the vaccine effectiveness to 32·4% (9·0 to 49·8; p=0·0098; figure; table 4). A similar amount of protection was observed for CoronaVac and BNT162b2, with non-significant relative vaccine effectiveness (appendix p 13).
The vaccine effectiveness against any infection of a booster dose using a switched vaccine type was also examined. For people who received a primary series of CoronaVac, the vaccine effectiveness for a booster dose using BNT162b2 was 31·3% (95% CI –1·0 to 53·3; p=0·056), similar to the values for a booster with the same vaccine (table 4). No significant difference in vaccine effectiveness was found in the estimation of relative effectiveness for the types of booster dose (p=0·86; appendix p 13). The effectiveness of a CoronaVac booster after a primary series of BNT162b2 was not examined because of the small sample size.
For vaccine effectiveness against symptomatic SARS-CoV-2 omicron infection, a booster dose generally showed a similar pattern of effectiveness but conferred a higher level of protection, with vaccine effectiveness of 50·9% (95% CI 31·0–65·0; ptable 4). A BNT162b2 booster for those who received a primary series of CoronaVac also conferred a similar significant vaccine effectiveness of 55·8% (22·9–74·6; p=0·0040) against symptomatic infection (table 4). The relative vaccine effectiveness against symptomatic infection between CoronaVac and BNT162b2 was not significant (appendix p 13).
To address the potential confounding effect of differential vaccine coverage in subpopulations, the age-specific effectiveness of different vaccine types was further examined. For all SARS-CoV-2 omicron infections, a similar non-significant protection of the first dose and primary series within 3 months was observed across all age groups (appendix pp 17, 20, 23). For adults aged 18–59 years, we observed no significant protection for the first dose of BNT162b2 (20·4%, 95% CI –30·9 to 51·6; p=0·37), first dose CoronaVac (–0·6%, –72·2 to 41·3; p=0·98), two BNT162b2 doses within 3 months (35·3%, –4·2 to 59·8; p=0·073), two CoronaVac doses within 3 months (38·2%, –19·5 to 68·0; p=0·15), or a second dose received beyond 3 months (2·5, –29·0 to 26·2; p=0·86 for BNT162b2 and –3·0, –45·9 to 27·3; p=0·87) for CoronaVac; appendix p 17). Significant protection was only observed for those who received a BNT162b2 booster vaccine, with a vaccine effectiveness of 42·1% (19·5 to 58·4; p=0·0012; appendix p 17). For symptomatic SARS-CoV-2 omicron infection, the significant protection of a BNT162b2 booster was also maintained, with a slightly higher vaccine effectiveness of 51·6% (27·7 to 67·6; p=0·0004) for those receiving a BNT162b2 primary series and 60·0% (20·8 to 79·8; p=0·0085) for those receiving a CoronaVac primary series.
For adults aged 60 years and older, no significant protection against SARS-CoV-2 omicron infection was shown after either one dose of BNT162b2 (–69·7%, 95% CI –353·1 to 36·5; p=0·29), one dose of CoronaVac (–65·0%, –219·6 to 14·8; p=0·14), two BNT162b2 doses within 3 months (–39·3%, –236·4 to 42·4; p=0·46), or two CoronaVac doses within 3 months (–65·7%, –228·5 to 16·5; p=0·15; appendix p 20). A booster vaccine of either BNT162b2 or CoronaVac did not provide significant protection against SARS-CoV-2 omicron infection for this older population, with a vaccine effectiveness of –1·5% (–101·0 to 48·7; p=0·97) and 25·2% (–56·0 to 64·1; p=0·44), respectively (appendix p 20). A similarly negligible protection for older people was observed for symptomatic omicron infection (appendix p 20).
For individuals aged 5–17 years, no significant protection against SARS-CoV-2 omicron infection was shown after one dose of BNT162b2 (32·4%, 95% CI –29·0 to 64·6; p=0·24), one dose of CoronaVac (22·7%, –38·3 to 56·8; p=0·39), two BNT162b2 doses within 3 months (3·2%, –220·7 to 70·8; p=0·96), or two CoronaVac doses within 3 months (55·6%, –50·3 to 86·9; p=0·19; appendix p 23). A similarly negligible protection for this population was observed for symptomatic omicron infection (appendix p 23). The age-specific protection conferred by either a BNT162b2 or CoronaVac booster after a primary series was not examined for those aged 5–17 years because of the small sample size.

Discussion

This prospective cohort study adopted a comprehensive non-symptom and risk-based outcome-ascertainment approach by regular rapid antigen testing to evaluate the vaccine effectiveness of the primary series and booster dose of vaccination against SARS-CoV-2 during omicron BA.2 predominance. A representative cohort that covered different population subgroups by age, gender, monthly income, and district was recruited to increase the generalisability of our findings, and stratified analysis provided an age-specific and vaccine-type-specific estimate for different vaccination statuses. Our surveillance initiative, with regular testing regardless of symptom status or exposure history, allowed assessment of vaccine effectiveness against both symptomatic and asymptomatic infection. The provision of free rapid antigen tests to all enrolled participants helped to minimise the potential effect of changing testing policy and capacity on outcome ascertainment. The exclusion of 15·3% of individuals who were previously infected was consistent with the reported local seroprevalence against BA.2 of 7·3% before the fifth wave of SARS-CoV-2 in November to December, 2021,

27

  • Chen L-L
  • Abdullah SMU
  • Chan W-M
  • et al.
Contribution of low population immunity to the severe omicron BA.2 outbreak in Hong Kong.

 

and 23·4% after the peak of the fifth wave of infection in May, 2022,

28

  • Poon RW-S
  • Chan BP-C
  • Chan W-M
  • et al.
SARS-CoV-2 IgG seropositivity after the severe omicron wave of COVID-19 in Hong Kong.

 

and might have helped us avoid wrongly attributing protection to previous infection in the vaccine effectiveness analysis. Understanding the updated effectiveness of available vaccines against infection, including asymptomatic infection, in relation to the evolving omicron variants is essential for guiding vaccination policies and informing future vaccine development.

Our findings showed that a booster dose of vaccination conferred substantial protection against SARS-CoV-2 infection by the omicron variant, including mild and asymptomatic cases. Significant protection against infection was observed only for three doses of vaccine. This finding supports the need for a booster dose for protection against the omicron variant, and fits with the current recommendation for booster doses in Hong Kong,

29

The Government of the Hong Kong Special Administrative Region
COVID-19 vaccination programme.

 

Ontario, Canada,

30

Ministry of Health Ontario
COVID-19 vaccine booster recommendations.

 

Australia,

31

Australian Technical Advisory Group on Immunisation
Clinical recommendations for COVID-19 vaccines.

 

and the USA.

32

US Centers for Disease Control and Prevention
Interim clinical considerations for use of COVID-19 vaccines currently approved or authorized in the United States.

 

We also observed differential vaccine effectiveness for the booster dose for different age groups. Specifically, moderate and statistically significant protection from a BNT162b2 booster dose was only achieved in those aged 18–59 years, whereas no significant protection was conferred in those aged 60 years and older, which is compatible with the general finding of a lower vaccine effectiveness for older individuals in the literature.

33

  • Emani VR
  • Pallipuram VK
  • Goswami KK
  • et al.
Increasing SARS-CoV2 cases, hospitalizations and deaths among the vaccinated elderly populations during the omicron (B.1.1.529) variant surge in UK.

 

34

  • Arregocés-Castillo L
  • Fernández-Niño J
  • Rojas-Botero M
  • et al.
Effectiveness of COVID-19 vaccines in older adults in Colombia: a retrospective, population-based study of the ESPERANZA cohort.

 

35

  • Nanishi E
  • Levy O
  • Ozonoff A
Waning effectiveness of SARS-CoV-2 mRNA vaccines in older adults: a rapid review.

 

36

  • Ranzani OT
  • Hitchings MDT
  • Dorion M
  • et al.
Effectiveness of the CoronaVac vaccine in older adults during a gamma variant associated epidemic of COVID-19 in Brazil: test negative case-control study.

 

This differential vaccine effectiveness highlights the need to explore the potential feasibility and benefit of more targeted vaccination regimens for optimising protection of different subpopulations in the community.

For the primary series of two doses of either BNT162b2 or CoronaVac completed within 3 months or at least 3 months ago, our results showed no significant protection was achieved in all age groups. Compared with a previous study on symptomatic omicron infection, our finding of no significant protection from the primary series of BNT162b2 contrasted with that study’s finding of high vaccine effectiveness (65·5%, 95% CI 63·9–67·0) assessed at 4 weeks,

8

  • Andrews N
  • Stowe J
  • Kirsebom F
  • et al.
Covid-19 vaccine effectiveness against the omicron (B.1.1.529) variant.

 

but was more similar to the study’s finding of much lower vaccine effectiveness (8·8%, 7·0–10·5) at 6 months or more after vaccination.

8

  • Andrews N
  • Stowe J
  • Kirsebom F
  • et al.
Covid-19 vaccine effectiveness against the omicron (B.1.1.529) variant.

 

Although a BNT162b2 primary series completed within 3 months did not show significant vaccine effectiveness, the higher vaccine effectiveness compared with a course completed 3 or more months ago (27·6% vs 1·1%) was compatible with the rapid waning of effectiveness reported in previous studies.

37

  • Higdon MM
  • Baidya A
  • Walter KK
  • et al.
Duration of effectiveness of vaccination against COVID-19 caused by the omicron variant.

 

This observed difference might also have been partly due to our adjustment for immortal time bias to avoid potential wrongful attribution of protective effects to a more recent vaccination event.

Our findings showed that significant vaccine effectiveness against symptomatic or asymptomatic omicron infection was conferred by a third dose of either BNT162b2 or CoronaVac. The protection conferred by a BNT162b2 or CoronaVac booster was further increased when considering only symptomatic omicron infections. Our results were generally much lower than previously reported vaccine effectiveness of booster doses against the more severe outcomes of omicron infection, including an effectiveness of 86% against hospital admission

2

  • Lauring AS
  • Tenforde MW
  • Chappell JD
  • et al.
Clinical severity of, and effectiveness of mRNA vaccines against, COVID-19 from omicron, delta, and alpha SARS-CoV-2 variants in the United States: prospective observational study.

 

and more than 90% effectiveness against severe disease or death,

3

  • McMenamin ME
  • Nealon J
  • Lin Y
  • et al.
Vaccine effectiveness of one, two, and three doses of BNT162b2 and CoronaVac against COVID-19 in Hong Kong: a population-based observational study.

 

38

  • Stowe J
  • Andrews N
  • Kirsebom F
  • Ramsay M
  • Bernal JL
Effectiveness of COVID-19 vaccines against omicron and delta hospitalisation: test negative case-control study.

 

39

  • Chemaitelly H
  • Ayoub HH
  • AlMukdad S
  • et al.
Duration of mRNA vaccine protection against SARS-CoV-2 omicron BA.1 and BA.2 subvariants in Qatar.

 

40

  • Tenforde MW
  • Self WH
  • Gaglani M
  • et al.
Effectiveness of mRNA vaccination in preventing COVID-19-associated invasive mechanical ventilation and death—United States, March 2021–January 2022.

 

but were consistent with the vaccine effectiveness of 52·2% (95% CI 48·1–55·9) of three doses of BNT162b2 against symptomatic omicron BA.2 infection reported in Qatar, where universal testing allowed detection of cases of all severities.

4

  • Altarawneh HN
  • Chemaitelly H
  • Ayoub HH
  • et al.
Effects of previous infection and vaccination on symptomatic omicron infections.

 

Although our results were lower than the reported vaccine effectiveness in a previous study (70·2–73·5% for BNT162b2 and 32·4–51·0 % for CoronaVac) of patients with mild or moderate COVID-19 who were admitted to hospital during the same epidemic wave in Hong Kong using an ecological study design,

3

  • McMenamin ME
  • Nealon J
  • Lin Y
  • et al.
Vaccine effectiveness of one, two, and three doses of BNT162b2 and CoronaVac against COVID-19 in Hong Kong: a population-based observational study.

 

our study might capture the milder end of the spectrum of infection in the community, with most individuals not requiring medical attention. With this understanding, our findings are consistent with the overall picture of a rapidly attenuating vaccine effectiveness effect size when the examined outcomes were shifted from the more severe to the milder end of the clinical spectrum in the published literature.

1

  • Abu-Raddad LJ
  • Chemaitelly H
  • Ayoub HH
  • et al.
Effect of mRNA vaccine boosters against SARS-CoV-2 omicron infection in Qatar.

 

4

  • Altarawneh HN
  • Chemaitelly H
  • Ayoub HH
  • et al.
Effects of previous infection and vaccination on symptomatic omicron infections.

 

39

  • Chemaitelly H
  • Ayoub HH
  • AlMukdad S
  • et al.
Duration of mRNA vaccine protection against SARS-CoV-2 omicron BA.1 and BA.2 subvariants in Qatar.

 

However, as previous studies suggested that vaccination might shorten the viral shedding duration,

41

  • Jung J
  • Kim JY
  • Park H
  • et al.
Transmission and infectious SARS-CoV-2 shedding kinetics in vaccinated and unvaccinated individuals.

 

42

  • Puhach O
  • Adea K
  • Hulo N
  • et al.
Infectious viral load in unvaccinated and vaccinated individuals infected with ancestral, delta or omicron SARS-CoV-2.

 

our study design with regular scheduled testing might help to avoid potential differential outcome ascertainment related to the duration of viral shedding, reducing the likelihood of detecting an infection among vaccinated people, and the resultant bias towards an overestimation of the vaccine effectiveness effect size.

Despite the low level of protection against infections with mild or no symptoms, the high proportion of mild infections might still impose a non-trivial collective clinical burden in the community during a rapid surge of an evolving epidemic, as in the fifth SARS-CoV-2 wave in Hong Kong. However, the high proportion of asymptomatic cases that might have been prevented by booster vaccination, which otherwise might have potentially seeded downstream secondary transmission, might help to prevent further propagation of the epidemic in the community due to the shedding of virus in the absence of awareness, appropriate management, isolation, or quarantine measures. This potential public health implication might become even more important as newer SARS-CoV-2 variants with higher transmissibility and milder clinical symptoms emerge,

43

Evolution of infectious disease.

 

including the new omicron variants.

44

  • Madewell ZJ
  • Yang Y
  • Longini Jr, IM
  • Halloran ME
  • Dean NE
Household secondary attack rates of SARS-CoV-2 by variant and vaccination status: an updated systematic review and meta-analysis.

 

45

  • Del Águila-Mejía J
  • Wallmann R
  • Calvo-Montes J
  • Rodríguez-Lozano J
  • Valle-Madrazo T
  • Aginagalde-Llorente A
Secondary attack rate, transmission and incubation periods, and serial interval of SARS-CoV-2 omicron variant, Spain.

 

Besides the indirect effect on transmission through preventing the incidence of infection, transmission might also be prevented through reduced transmissibility of infection in breakthrough cases in vaccinated people. Although current literature generally regards the vaccine effectiveness of two doses for preventing omicron transmission to be minimal,

44

  • Madewell ZJ
  • Yang Y
  • Longini Jr, IM
  • Halloran ME
  • Dean NE
Household secondary attack rates of SARS-CoV-2 by variant and vaccination status: an updated systematic review and meta-analysis.

 

46

  • Tan ST
  • Kwan AT
  • Rodríguez-Barraquer I
  • et al.
Infectiousness of SARS-CoV-2 breakthrough infections and reinfections during the Omicron wave.

 

some studies have reported modest effectiveness of a booster dose for reducing secondary transmission related to breakthrough cases in vaccinated people in households or institutional settings,

44

  • Madewell ZJ
  • Yang Y
  • Longini Jr, IM
  • Halloran ME
  • Dean NE
Household secondary attack rates of SARS-CoV-2 by variant and vaccination status: an updated systematic review and meta-analysis.

 

46

  • Tan ST
  • Kwan AT
  • Rodríguez-Barraquer I
  • et al.
Infectiousness of SARS-CoV-2 breakthrough infections and reinfections during the Omicron wave.

 

47

  • Lyngse FP
  • Kirkeby CT
  • Denwood M
  • et al.
Transmission of SARS-CoV-2 omicron VOC subvariants BA.1 and BA.2: evidence from Danish households.

 

signifying the value and implications of the vaccine even if effectiveness against mild infection is not high. Although our study did not directly examine the outcome of transmission or viral shedding, our data did reveal a potential attenuation of infection severity in those who received a booster BNT162b2 vaccine compared with unvaccinated individuals, both in terms of a lower number of symptoms and a lower mean severity score. However, similar to the existing literature, no effect on symptom profile was observed for those who received two doses or fewer of vaccine.

The similar magnitude of vaccine effectiveness of the mRNA vaccine (BNT162b2) and inactivated vaccine (CoronaVac) implies that both vaccine types are effective against omicron infection. The similar protection achieved with either the same or different booster regimens also supports the current recommendation of BNT162b2 boosters in Hong Kong and some other countries,

48

The Government of the Hong Kong Special Administrative Region
Recommendation for additional dose(s) of COVID-19 vaccination.

 

49

WHO
Interim recommendations for heterologous COVID-19 vaccine schedules.

 

50

European Medicines Agency
EMA and ECDC recommendations on heterologous vaccination courses against COVID-19: ‘mix-and-match’ approach can be used for both initial courses and boosters.

 

which might give the advantage of facilitating higher booster dose uptake, with the enhanced autonomy of personal preference, and lead to less issues with vaccine availability during an evolving pandemic.

This surveillance initiative is an observational study with some possible biases and should be interpreted with caution. As a history of previous PCR-confirmed infection was ascertained by self-reporting, some under-ascertainment of previous infection might have been present and affected our vaccine effectiveness estimation. However, given the straightforward and official nature of the case definition, and the lack of obvious benefit for untruthful reporting, substantial inaccurate recall might be unlikely. Government mandatory testing orders in relation to community exposure risk, which were instituted independent of vaccination status, might serve to capture some people with no symptoms and to prevent substantial differential under-ascertainment among people with different vaccination statuses.

Imperfect performance in terms of suboptimal sensitivity and specificity of rapid antigen testing might cause misclassification of infection status,

18

  • Chiu RYT
  • Kojima N
  • Mosley GL
  • et al.
Evaluation of the INDICAID COVID-19 rapid antigen test in symptomatic populations and asymptomatic community testing.

 

which is likely to be non-differential, as suggested in a systematic review of 155 studies on rapid antigen test diagnostic performance.

51

  • Dinnes J
  • Sharma P
  • Berhane S
  • et al.
Rapid, point-of-care antigen tests for diagnosis of SARS-CoV-2 infection.

 

This fact might bias the estimation of the HR towards the null, and result in a potentially over-estimated vaccine effectiveness.

52

  • Wacholder S
  • Hartge P
  • Lubin JH
  • Dosemeci M
Non-differential misclassification and bias towards the null: a clarification.

 

Adopting rapid antigen test brands that meet the WHO priority target product profiles for COVID-19 diagnostics

15

WHO
COVID-19 target product profiles for priority diagnostics to support response to the COVID-19 pandemic v.1.0.

 

and FDA Emergency Use Authorization,

16

US Food and Drug Administration
INDICAID COVID-19 rapid antigen at-home test.

 

as in our study, would thus be an important step to minimise potential bias in vaccine effectiveness estimation.

The availability of rapid antigen testing kits for regular self-testing, irrespective of symptom status or exposure risk, should facilitate early identification of both symptomatic and asymptomatic cases.

53

  • Larremore DB
  • Wilder B
  • Lester E
  • et al.
Test sensitivity is secondary to frequency and turnaround time for COVID-19 screening.

 

However, case counting on the basis of PCR testing or voluntary rapid antigen test result reporting might underestimate the risk of infection and case ascertainment, as testing can be affected by any change in testing policy, health seeking behaviour, laboratory testing capacity, or incomplete reporting practices due to the fear of isolation or quarantine order being imposed.

As the changing symptom pattern after rapid antigen test positivity was not continuously monitored in our surveillance platform, classification as either symptomatic or asymptomatic in the current study was based primarily on the data at the time of the positive rapid antigen test. As some people who were asymptomatic on original testing might develop symptoms later (ie, pre-symptomatic), this strategy might affect precise estimation of the vaccine effectiveness against symptomatic infection; however, this should have no effect on the estimation of vaccine effectiveness against both symptomatic and asymptomatic infection.

Although behavioural factors, such as wearing a mask and physical distancing, might affect infection risk and be potential residual confounders in this study, a substantial difference between vaccinated and unvaccinated participants, or between individuals who received two doses of vaccine and those who received three doses, was not expected, as universal mask wearing and stringent social distancing requirements were legally required for the whole community during the study period in Hong Kong, irrespective of vaccination.

54

The Government of the Hong Kong Special Administrative Region
Prevention and control of disease ordinance (cap 599).

 

Another limitation was our inability to estimate vaccine effectiveness for some subgroups, due to the relatively small number of individuals who received some vaccine regimens. As the local population had recently started to receive booster doses, and booster doses had only recently been approved for children, the additional protection achievable by a booster dose in children, and the waning effectiveness of booster doses over time, were not evaluated. A further study examining the effect of booster doses on younger age groups and the waning effectiveness of booster doses is warranted, to inform the assessment of and optimise vaccine policy in the evolving pandemic.

In conclusion, we assessed the vaccine effectiveness of the BNT162b2 and CoronaVac vaccines in different regimens and age groups and found that a BNT162b2 or CoronaVac booster dose achieved significant protection against omicron infection in Hong Kong. These updated vaccine effectiveness estimates allow assessment of the public health impact of COVID-19 vaccines for preventing transmission of symptomatic and asymptomatic infections in the community. We found similar effectiveness for both vaccine types, and a potential association of effectiveness with age. Our findings support the use of different booster vaccination regimens from the primary series during the evolving pandemic.

GML and DKMI conceived and designed the study. NNYT and HCS collected the data. NNYT and DKMI accessed and verified the data. BJC advised on the statistical analysis. NNYT did the statistical analysis. NNYT and DKMI interpreted the data. NNYT and DKMI wrote the first draft of the manuscript, and all authors provided critical review and revision of the text and approved the final version for publication. All authors had full access to all the data in the study and accept final responsibility for the decision to submit for publication.

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GLP-1 Agonists Protected Kidneys in T2D With Advanced DKD – Medscape

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Researchers published the study covered in this summary on Research Square as a preprint that has not yet been peer reviewed.

Key Takeaways

  • In patients with advanced diabetic kidney disease (DKD; estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73m2), treatment with a glucagon-like peptide-1 (GLP-1) agonist had a neutral effect on cardiovascular outcomes but significantly linked with preservation of kidney function and improved survival in a propensity-score matched, retrospective analysis of observational data from more than 2000 people with type 2 diabetes in Taiwan.

Why This Matters

  • Cardiovascular disease is a leading cause of mortality in people with type 2 diabetes and among those with chronic kidney disease.

  • GLP-1 agonists reduce all-cause mortality and cardiovascular death in people with type 2 diabetes, but their role in patients with advanced DKD is controversial.

  • Research on the effect of GLP-1 agonists on cardiovascular outcomes in patients with advanced DKD is limited. Trials that have assessed GLP-1 agonists in people with type 2 diabetes have generally excluded those with advanced DKD and completely excluded those with end-stage kidney disease (eGFR < 30 mL/min/1.73m2).

  • Treatment with GLP-1 agonists has been associated with a significant reduction in composite cardiovascular outcomes in people with type 2 diabetes and relatively fair kidney function (eGFR > 30 mL/min/1.73m2), but among people with type 2 diabetes and lower levels of kidney function, research has shown neutral composite cardiovascular outcomes levels. However, limitations of previous studies include being mainly based on subgroup analysis or including a limited sample of patients.

Study Design

  • Retrospective analysis of observational data from nearly 9000 people in Taiwan with type 2 diabetes and an eGFR < 30 mL/min/1.73m2 who received a first prescription for a GLP-1 agonist or dipeptidyl peptidase 4 (DPP-4) inhibitor in 2012-2021 and had the data necessary for this analysis in their records.

  • The data came from the largest multi-institutional electronic medical record database in Taiwan, which includes two medical centers and five general hospitals and information on more than 11 million patients, from 2001 to 2019.

  • Researchers used propensity scoring to match 602 people treated with a GLP-1 agonist with 1479 people treated with a DPP-4 inhibitor.

Key Results

  • During a mean follow-up of 2.1 years, the rate of the composite cardiovascular outcome (cardiovascular death, myocardial infarction, and ischemic stroke) did not significantly differ between the GLP-1 agonist and DPP-4 inhibitor groups, with incidence rates of 13.0% and 13.8%, respectively, and a nonsignificant hazard ratio of 0.88. Rates of each of the three components of the composite endpoint also did not significantly differ between the two groups.

  • Progression to end-stage kidney disease with dialysis was significantly lower in those treated with a GLP-1 agonist compared with a DPP-4 inhibitor, with incidence rates of 23.4% and 27.5%, respectively, and a significant hazard ratio of 0.72.

  • The incidence of a greater than 50% drop in eGFR from baseline was 32.2% with GLP-1 agonist treatment compared to 35.9% with a DPP-4 inhibitor, with a significant hazard ratio of 0.74.

  • Median time until patients needed new-onset dialysis was 1.9 years with GLP-1 agonist treatment and 1.3 years with DPP-4 inhibitor treatment, which was a significant difference.

  • The rate of all-cause death was 18.4% with GLP-1 agonist treatment compared with 25.1% with DPP-4 inhibitor treatment, a hazard ratio of 0.71 that was significant.  

Limitations

  • Because the study was a retrospective analysis of observational data it cannot prove causality.

  • The study could be subject to residual confounding despite propensity-score matching.

  • The data came from health records that could have included coding errors.

  • Treatment compliance was unknown.

Disclosures

This is a summary of a preprint research study, “The cardiovascular and renal effects of glucagon-like peptide 1 receptor agonists in patients with advanced diabetic kidney disease,” by researchers in Taiwan on Research Square and provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on researchsquare.com.

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Research by UBC professor lays groundwork for life-saving breast cancer treatment – UBC Faculty of Medicine

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A drug originally designed to prevent osteoporosis is now expected to save and improve the lives of millions of people with breast cancer, thanks in part to decades of foundational research by Dr. Josef Penninger, a professor in UBC’s Faculty of Medicine and director of the Life Sciences Institute.

The achievement highlights how UBC scientists are developing effective new treatments — and unlocking the full potential of existing drugs – through research into the fundamental biological principles behind disease. By advancing scientific discoveries from the lab to the clinic, UBC researchers are bringing life-changing treatments to patients everywhere.

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The drug, called Denosumab, was recently shown in a long-term Phase 3 clinical trial to improve survival among postmenopausal women with hormone receptor-positive early breast cancer receiving aromatase inhibitor treatment. Moreover, the drug markedly improved patients’ quality of life by reducing broken bones by 50 per cent, a common side effect of breast cancer treatment. The results of the trial were recently reported in The New England Journal of Medicine.

Denosumab is a monoclonal antibody developed by American biopharmaceutical company Amgen to prevent bone loss. In the early 2000s, research by Dr. Penninger and his team revealed the therapeutic potential of Denosumab, as well as the drug’s surprising connections with breast cancer.

“More than two decades ago we started the experimental groundwork that revealed Donosumab’s potential as a treatment for breast cancer patients,” says Dr. Penninger. “These results are incredibly exciting and will help improve the lives of millions of patients. I am very proud of all the people in my lab over the years who did that work and helped pave the way for this achievement.”

Discovering the link between osteoporosis and breast cancer

Denosumab works by binding to and inhibiting the activity of a protein called RANKL, which plays a key role in bone-resorbing cells called osteoclasts. By blocking RANKL, denosumab reduces the activity of osteoclasts and slows down bone resorption, helping to increase bone density and preventing osteoporosis.

Dr. Josef Penninger

Dr. Josef Penninger

Dr. Penninger and his team began to draw the connection between osteoporosis and HR-positive breast cancer when they generated the first RANKL “knock-out” mice in the late 1990s.

A knockout mouse is a laboratory mouse that has been genetically engineered to have certain genes deactivated, or “knocked-out”. Dr. Penninger’s team engineered mice that lacked the genes necessary to produce the RANKL protein in an effort to study the protein’s essential function in bone metabolism.

However, to the researchers’ surprise, they discovered that the RANKL-deficient mice failed to develop a lactating mammary gland in pregnancy – a process that depends on sex hormones.

“This proved an evolutionary link: showing how bone loss is regulated by sex hormones, and how pregnant mammals activate RANKL to form breast tissue for lactation among other functions,” says Dr. Penninger.

Based on this initial finding, Dr. Penninger’s team went on to show that RANKL played a key role in progestin-driven breast cancer, as well as breast cancer driven by BRCA1 mutations.

“Further researcher revealed how RANKL controls the stem cells in the breast that respond to sex hormones and thereby drives growth of the breast tissue at every menstruation cycle and in particular in pregnancy and lactation,” adds Dr. Penninger.

In the case of breast cancer, RANKL spurs mammary epithelial cells to divide, and helps to maintain the stem cells that give rise to breast tumours.

A dual benefit drug

One in eight Canadian women will be diagnosed with breast cancer in their lifetime according to the Canadian Breast Cancer Network. An estimated 70 to 80 per cent of these breast cancers are hormone receptor-positive (HR-positive), making it the most prevalent breast cancer subtype.

The current standard treatment for HR-positive breast cancer involves surgery and radiation, followed by treatment with aromatase inhibitors for 5 to 7 years. While aromatase inhibitors diminish sex hormones that drive new cancer growth, they can have serious adverse effects on bone health, including increased risk of osteoporosis and fractures.

The now-published clinical trial, led by the Austrian Breast and Colorectal Cancer Study Group, was conducted to see if Denosumab could help in two ways: by reducing these negative effects on bone health, while also improving breast cancer survival outcomes.

“These results are incredibly exciting and will help improve the lives of millions of patients.”
Dr. Josef Penninger

The results reveal that 6 mg of Denosumab every six months — the recommended treatment level for osteoporosis — improved disease-free survival, bone metastasis-free survival, and overall survival among participants. It also effectively reduced bone fractures over the long term.

“Blocking RANKL in breast cancer patients reduces broken bones by 50 per cent, massively improving their quality of life, and even at a very low treatment dose,” says Dr. Penninger. “We now know that RANKL drives breast cancer cell growth, is the critical mechanism behind bone loss, and has also an effect on anti-cancer immunity and immunological rewiring in pregnancy. These clinical results in patients show how blocking RANKL could save the lives of 50,000 women among one million women with the diagnosis of breast cancer.”

Based on the data, the researchers behind the trials are recommending that Denosumab be considered for routine clinical use in postmenopausal breast cancer patients receiving aromatase inhibitor therapy.

These trials were largely based on the foundational research published by the Penninger laboratory, including Kong et al. Nature 1999, Fata et al. Cell 2000, Jones Nature 2006, Schramek et al. Nature 2010, Sigl et al. Cell Research 2016, and Paolino et al. Nature 2021.

Dr. Penninger is now part of a large international prevention trial evaluating Denosumab in young women who carry BRCA1 mutations.

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Respiratory illness peaked in December at Chatham Kent Health Alliance: Suni – Chatham-Kent This Week

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Chatham-Kent Health Alliance officials are reporting a drop in patients visiting the emergency departments with respiratory illnesses between December and January, but admissions from the emergency rooms to the hospitals remain high.

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Caen Suni, the hospital group’s vice president of clinical programs and operations, said patients with illnesses like influenza, COVID-19 and respiratory syncytial virus dropped 50 per cent in January compared to December among children and by one-third among adults.

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“The community is I think essentially working its way through seasonal illness at this point,” he said during a media teleconference Monday.

December also showed a 25 per cent increase over December 2021 for pediatric admissions and of those, 77 per cent were for respiratory illnesses, Suni said.

“That’s impactful and I think that’s what we’ve seen across the health sector in our entire region at this point,” he said.

Suni said the number of people seeking treatment at the emergency departments – which includes patients not admitted – is not “historically high,” but admissions to the hospitals increased in December by three per cent over the previous month.

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This translates to an extra two to three extra patients a day who require a bed. The health alliance also experienced almost 2.5 per cent more admissions in December than any month in the previous year.

However, December also had the lowest daily average of visits to the emergency departments of any month during the Health Alliance’s current fiscal year.

This means a higher proportion of patients require admission to the hospital and patients presenting at the emergency departments are more ill, Suni said.

Since December, the trends are now “pointing towards a decrease,” Suni said, “which we’re thankful for, as the community bounces back from seasonal illness.”

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