{"id":40686,"date":"2021-06-01T07:27:24","date_gmt":"2021-06-01T07:27:24","guid":{"rendered":"https:\/\/i-base.info\/htb\/?p=40686"},"modified":"2021-06-01T08:48:30","modified_gmt":"2021-06-01T08:48:30","slug":"cases-of-covid-19-reported-in-care-home-residents-after-full-course-vaccination","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/40686","title":{"rendered":"Cases of COVID-19 reported including deaths in care home residents after full-course vaccination"},"content":{"rendered":"
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<\/span>Simon Collins, HIV i-Base<\/strong><\/p>\n<\/div>\n

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Several recent studies have reported cases of COVID-19 in residential care homes despite full-course mRNA vaccination, including the B.1.351 variant. [1, 2]<\/span><\/strong><\/p>\n<\/div>\n

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Other studies have also reported significantly lower humoral responses to COVID-19 vaccines in some people with reduced immune function, including those older than 80 years. [3]<\/span><\/p>\n<\/div>\n

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A paper published in CID reported an outbreak of the 501.v2 (B.1.351; South African) variant in an elderly nursing home in France. All non-vaccinated residents (5\/5) became infected compared to half (13\/26) who had been fully vaccinated (two doses) with the Pfizer mRNA vaccine (BNT162b2). COVID-19 was serious in 4\/5 and 2\/13 of these two groups respectively. [1]<\/span><\/p>\n<\/div>\n

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This study included 31 residents and 59 staff. The first case was in a 92 year-old resident, with 17 residents testing positive over the next three weeks. Vaccinated residents had received their second vaccine dose from 4 to 26 February,<\/span><\/p>\n<\/div>\n

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Only 19\/59 staff were fully vaccinated. with 1\/19 becoming infected vs 10\/40 unvaccinated staff. No staff developed serious COVID-19 symptoms but the outcomes for residents who had received two vaccine doses was more serious.<\/p>\n

Although 2\/13 cases were asymptomatic, 9\/13 developed mild to moderate symptoms and 2\/13 2 (15.4%) progressed to severe disease and died, secondary to acute respiratory distress syndrome (ARDS).<\/p>\n<\/div>\n

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A second more optimistic but still cautious study included a retrospective review from 280 care homes in the US reported in a letter to the NEJM. This included more than 18,000 vaccinated (13,000 of which had received both doses) and approximately 4,000 unvaccinated residents. [2]<\/span><\/p>\n<\/div>\n

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The incidence of infections declined significantly over time in all groups. Vaccination were mRNA: 80% Pfizer, 20% Moderna.<\/span><\/p>\n<\/div>\n

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In those receiving one dose there were 822 incident cases (4.5%) within 0 to 14 days and 250 cases (1.4%) at 15 to 28 days. In those who received both doses there were 130 incident cases (1.0%) within 0 to 14 days and 38 cases (0.3%) after 14 days. Cases also decreased in unvaccinated residents from 173 cases (4.3%) within 0 to 14 days after the first vaccination clinic to 12 cases (0.3%) at more than 42 days after the clinic.<\/span><\/p>\n<\/div>\n

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While showing levels of community protection in those who were unvaccinated, the paper showed infections after receiving both doses.<\/span><\/p>\n<\/div>\n

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comment<\/span><\/h3>\n<\/div>\n
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These data should inform individual management of risk for care home residents.<\/span><\/b><\/p>\n<\/div>\n

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They also highlight the continued risk to residents if staff are not vaccinated, including vulnerability to new variants.<\/b><\/p>\n<\/div>\n<\/div>\n

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References<\/span><\/p>\n<\/div>\n

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  1. Bailly B et al, BNT162b2 mRNA vaccination did not prevent an outbreak of SARS COV-2 variant 501Y.V2 in an elderly nursing home but reduced transmission and disease severity. Clinical Infectious Diseases, ciab446. DOI: 10.1093\/cid\/ciab446. (16 May 2021).
    \n<\/span>https:\/\/academic.oup.com\/cid\/advance-article\/doi\/10.1093\/cid\/ciab446\/6276392<\/a><\/li>\n
  2. White EM et al. Incident SARS-CoV-2 Infection among mRNA-Vaccinated and Unvaccinated Nursing Home Residents. NEJM. DOI: 10.1056\/NEJMc2104849. (19 May 2021).
    \n    https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMc2104849<\/a><\/li>\n
  3. Collins S. Low responses to mRNA COVID-19 vaccines in those older than 80 vs <60 years and in recipients of solid organ transplants. HTB (3 May 2021).
    \n    https:\/\/i-base.info\/htb\/40502<\/a><\/li>\n<\/ol>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    Simon Collins, HIV i-Base Several recent studies have reported cases of COVID-19 in residential care homes despite full-course mRNA vaccination, including the B.1.351 variant. [1, 2] Other studies have also reported significantly lower humoral responses to COVID-19 vaccines in some …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[292,278],"tags":[],"class_list":["post-40686","post","type-post","status-publish","format-standard","hentry","category-covid-19-vaccine","category-covid-19"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/40686","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=40686"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/40686\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=40686"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=40686"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=40686"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}