Vaccine effectiveness against referral to hospital after SARS-CoV-2 infection in St. Petersburg, Russia, during the Delta variant surge: a test-negative case-control study.

BACKGROUND: The results of a randomised trial showed the safety and efficacy of Gam-COVID-Vac against COVID-19. However, compared to other vaccines used across the globe, the real-world data on the effectiveness of Gam-COVID-Vac, especially against the disease caused by the Delta variant of concern, was limited. We aimed to assess the effectiveness of vaccination mainly conducted with Gam-COVID-Vac in St. Petersburg, Russia. METHODS: We designed a case-control study to assess the vaccine effectiveness (VE) against referral to hospital. Self-reported vaccination status was collected for individuals with confirmed SARS-CoV-2 infection who were referred for initial low-dose computed tomography (LDCT) triage in two outpatient centres in July 3-August 9, 2021, in St. Petersburg, Russia. We used logistic regression models to estimate the adjusted (for age, sex, and triage centre) VE for complete (14 days or more after the second dose) vaccination. We estimated the VE against referral for hospital admission, COVID-19-related lung injury assessed with LDCT, and decline in oxygen saturation. RESULTS: In the final analysis, 13,893 patients were included, 1291 (9.3%) patients met our criteria for complete vaccination status, and 495 (3.6%) were referred to hospital. In the primary analysis, the adjusted VE against referral to hospital was 81% (95% confidence interval: 68-88) for complete vaccination. The VE against referral to hospital was more pronounced in women (84%, 95% CI: 66-92) compared to men (76%, 95% CI: 51-88). Vaccine protective effect increased with increasing lung injury categories, from 54% (95% CI: 48-60) against any sign of lung injury to 76% (95% CI: 59-86) against more than 50% lung involvement. A sharp increase was observed in the probability of hospital admission with age for non-vaccinated patients in relation to an almost flat relationship for the completely vaccinated group. CONCLUSIONS: COVID-19 vaccination was effective against referral to hospital in patients with symptomatic SARS-CoV-2 infection in St. Petersburg, Russia. This protection is probably mediated through VE against lung injury associated with COVID-19.

Gam-COVID-Vac, EpiVacCorona, and CoviVac effectiveness against lung injury during Delta and Omicron variant surges in St. Petersburg, Russia: a test-negative case-control study.

BACKGROUND: Monitoring vaccine effectiveness (VE) remains a priority for epidemiological research throughout the COVID-19 pandemic. VE against infection declines with the emergence of new SARS-CoV-2 variants of concern (VOC), but VE against the severe disease remains high. Therefore, we aimed to estimate the effectiveness of COVID-19 vaccines used in Russia against lung injury during Delta and Omicron VOC surges. METHODS: We designed a case-control study (test-negative design) to estimate VE against any (any volume of involved lung parenchyma) and severe (>50% of involved parenchyma) lung injury detected on computer tomography and associated with COVID-19 between October 1, 2021-April 28, 2022 (Delta VOC dominance period followed by Omicron dominance period). We included the data of patients with symptomatic confirmed SARS-CoV-2 infection referred to the low-dose computer tomography triage centres. RESULTS: Among 23996 patients in the primary analysis, 13372 (55.7%) had any lung injury, and 338 (1.4%) had severe lung injury. The adjusted for age, sex and triage centre VE estimates against any lung injury were 56% (95% confidence interval 54-59) for two-dose Gam-COVID-Vac (Sputnik V), 71% (68-74) for three-dose Gam-COVID-Vac (booster), 2% (-27 to 24) for EpiVacCorona, and 46% (37-53) for CoviVac. VE estimates against severe lung injury were 76% (67-82) for two-dose Gam-COVID-Vac (Sputnik V), 87% (76-93) for three-dose Gam-COVID-Vac, 36% (-63 to 75) for EpiVacCorona, and 80% (45-92) for CoviVac. CONCLUSIONS: Gam-COVID-Vac remained effective against lung injury associated with COVID-19 during Delta and Omicron VOC surges, and one Gam-COVID-Vac booster could be seen as an appropriate option after a two-dose regimen. CoviVac was also effective against lung injury. EpiVacCorona use in population-based vaccination should be halted until effectiveness and efficacy evidence is provided. Trial registration The joint study of COVID-19 vaccine effectiveness in St. Petersburg was registered at ClinicalTrials.gov (NCT04981405, date of registration-August 4, 2021).

COVID-19 vaccines effectiveness against symptomatic SARS-CoV-2 during Delta variant surge: a preliminary assessment from a case-control study in St. Petersburg, Russia.

BACKGROUND: Studies of mRNA and vector-based vaccines used in different countries report acceptable levels of effectiveness against SARS-CoV-2 infection caused by the Delta variants of SARS-CoV-2. No studies estimated vaccine effectiveness (VE) of Gam-COVID-Vac and other vaccines used in Russia against symptomatic infection with Delta variant. In this population-based case-control study, we aimed to estimate the effectiveness of the Russian COVID-19 vaccines against symptomatic SARS-CoV-2 during the recent outbreak caused by the Delta VOC in October 2021 in St. Petersburg, Russia. METHODS: Cases were symptomatic patients with confirmed SARS-CoV-2 (using polymerase chain reaction (PCR) test) referred to low-dose computed tomography (LDCT) triage in two outpatient centres between October 6 and 14, 2021 during the Delta variant outbreak. We recruited the controls during the representative survey of the seroprevalence study conducted during the same period in St. Petersburg using random digit dialling. In the primary analysis, we used logistic regression models to estimate the adjusted (age, sex, and history of confirmed COVID-19) VE against symptomatic SARS-CoV-2 resulted in a referral to triage centre for three vaccines used in Russia: Gam-COVID-Vac, EpiVacCorona, and CoviVac. RESULTS: We included 1,254 cases and 2,747 controls recruited between the 6th and 14th of October in the final analysis. VE was 56% (95% CI: 48 to 63) for Gam-COVID-Vac (Sputnik V), 49% (95% CI: 29 to 63) for 1-dose Gam-COVID-Vac (Sputnik V) or Sputnik Light, -58% (95% CI: -225 to 23) for EpiVacCorona and 40% (95% CI: 3 to 63) for CoviVac. Without adjustment for the history of confirmed COVID-19 VE for all vaccines was lower, except for one-dose Gam-COVID-Vac (Sputnik Light). The adjusted VE was slightly lower in women - 51% (95% CI: 39 to 60) than men - 65% (95% CI: 5 to 73). CONCLUSIONS: Our preliminary results show that in contrast to other Russian vaccines, Gam-COVID-Vac is effective against symptomatic SARS-CoV-2 infection caused by Delta VOC. Effectiveness is likely higher than the estimated 56% due to bias arising from high prevalence of the past COVID-19 in St. Petersburg.

Access to radiotherapy among circumpolar Inuit populations.

Cancer is a substantial health burden for Inuit populations, an Indigenous peoples who primarily inhabit the circumpolar regions of Alaska, Canada, Greenland, and Russia. Access to radiotherapy is lacking or absent in many of these regions, despite it being an essential component of cancer treatment. This Review presents an overview of factors influencing radiotherapy delivery in each of the four circumpolar Inuit regions, which include population and geography, health-systems infrastructure, and cancer epidemiology. This Review also provides insight into the complex patient pathways needed to access radiotherapy, and on radiotherapy use. The unique challenges in delivering radiotherapy to circumpolar Inuit populations are discussed, which, notably, include geographical and cultural barriers. Recommendations include models of care that have successfully addressed these barriers, and highlight the need for increased collaboration between circumpolar referral centres in Alaska, Canada, Greenland, and Russia to ultimately allow for better delivery of cancer treatment.

Chemotherapy in combination with stereotactic body radiation therapy (SBRT) for oligometastatic pancreatic cancer.

Metastatic pancreatic cancer is characterised by poor prognosis. High toxicity of chemotherapy limits its use in elderly patients with severe comorbidities. Meanwhile, in metastatic disease, local treatment did not show the positive effect on life expectancy. We present a clinical case of a 72-year-old woman with metastatic pancreatic adenocarcinoma tumour, node, metastases (T3N0M1) (according to the seventh TNM classification of the International Union Against Cancer). Chemotherapy led to partial response, but later was stopped due to severe toxicity. Thereafter, consolidating radiosurgical treatment was performed. Dose to pancreatic and liver lesions was 35 Gy in five fractions. After 9 months, only one liver lesion and primary pancreatic tumour, stable in size were determined by MRI. At present time, the patient is alive and in good condition, the disease is stable 50 months after stereotactic body radiation therapy (SBRT). SBRT provides a high level of local control and in combination with systemic treatment can potentially increase survival.

Femoral Access for Central Venous Port System Implantation.

Totally implanted venous access port (TIVAP) systems provide adequate quality of care and life, especially for oncology patients. Long-term vascular access is very important and easy to perform, but in some clinical situations, if patients have a superior caval system occlusion, femoral insertion may be the only option. We present a case of a 70-year-old colorectal adenocarcinoma patient diagnosed with subclavian vein hypoplasia. Her care team decided intraoperatively to implant a port system by the right femoral access. The patient was included in an active surveillance program with regular follow-ups and has had no complications by the end of 2017. This uncommon surgical approach provided this cancer patient with an opportunity to realize a chemotherapy program with optimal quality of life.