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1.
Prev Med Rep ; 31: 102097, 2023 Feb.
Article in English | MEDLINE | ID: mdl-36567743

ABSTRACT

To determine if people infected with SARS-CoV-2 were at higher risk of developing selected medical conditions post-recovery, data were extracted from the database of a large health maintenance organization (HMO) in Israel between March 2020 and May 2021. For each condition, a condition-naïve group prior to COVID-19 (PCR-positive) infection were compared to a condition-naïve, non-COVID-19 infected group, matched by gender, age, socioeconomic status, minority group status and number of months visited primary care physician (PCP) in previous year. Diagnosis and recuperation dates for each COVID-19 infected participant were applied to their matched comparison participant (1:1 ratio). Incidence of each condition was measured between date of recuperation and end of study period for each group and Cox regression models developed to determine hazard ratios by group status, controlling for demographic and health variables. Crude and adjusted incidence rates were higher for the COVID-19 infected group than those not infected with COVID-19 for treatment for depression/anxiety, sleep disturbance, diagnosis of deep venous thrombosis, lung disease and fibromyalgia. Differences in incidence were no longer observed between the two groups for treatment of sleep disturbance, and diagnosis of lung disease when those hospitalized during the acute-phase of illness (any reason) were excluded. No difference was found by COVID-19 infection status for post-acute incidence of diabetes, cerebrovascular accident, myocardial infarction, acute kidney disease, hypertension and ischemic heart disease. Patients post-COVID-19 infection should be evaluated for depression, anxiety, sleep disturbance, DVT, lung disease and fibromyalgia.

2.
Preprint in English | medRxiv | ID: ppmedrxiv-22268809

ABSTRACT

ImportanceAdolescents mental health and well-being were severely compromised during the COVID-19 pandemic. Longitudinal follow-up studies, based on real-world data, assessing the changes in mental health of adolescents during the later phase of the COVID-19 pandemic are needed. ObjectiveTo quantify the effect of COVID-19 on the incidence of Israeli adolescents mental health outcomes from electronic health record (EHR) data. Design, Setting and ParticipantsRetrospective cohort study analyzing EHR data of Maccabi Healthcare Services members, the second largest Health Maintenance Organization in Israel. Eligible subjects were 12-17 years old, during 2017-2021 with no previous diagnosis or psychiatric drug dispensation of those analyzed in this study. This resulted in over 200,000 eligible participants each year. ExposureCOVID-19 pandemic and the measures taken to mitigate it. Main Outcomes and MeasuresIncidence rates of mental health diagnoses (depression; anxiety; obsessive-compulsive disorder; stress; eating disorders; ADHD), and psychiatric drugs dispensation (antidepressants; anxiolytics; antipsychotics; ADHD agents) were measured, and relative risks were computed between the years. Subgroup analyses were performed for age, gender, population sector and socioeconomic status. Interrupted time series (ITS) analysis evaluated changes in monthly incidence rates of psychiatric outcomes. ResultsDuring the COVID-19 period a 36% increase was observed in the incidence of depression (95%CI: 25-47), 31% in anxiety (95%CI: 23-39), 20% in stress (95%CI: 13-27), 50% in eating disorders (95%CI: 35-67), 25% in antidepressants (95%CI: 25-33) and 28% in antipsychotics dispensation (95%CI: 18-40). Decreased rate of 26% (95% CI: 0.80-0.88) was observed in ADHD diagnoses and 10% (95% CI: 0.86-0.93) in prescriptions of ADHD agents. The increase was mostly attributed to females in the general Israeli population; nevertheless, a 24% increase in anxiety was seen in males (95%CI: 13-37), 64% in Israeli Arabs (95%CI: 12-140) and 31% in ultra-orthodox (95%CI: 3-67). ITS analysis revealed a significantly higher growth in the incidence of psychiatric outcomes during the COVID-19 period, compared to previous years. Conclusions and RelevanceEHR data of adolescents shows increased incidence rates of mental health diagnoses and medications during the COVID-19 pandemic, specifically identified females as those with the highest mental health burden. Our study highlights that the deteriorating mental health of children should be considered by decision-makers when actions and policies are put in place entering the third year of the pandemic. Key PointsO_ST_ABSQuestionC_ST_ABSHas the COVID-19 pandemic and the strategies to contain it affected adolescents mental health? FindingsIn this retrospective cohort study of over 200,000 adolescents 12-17 years old, the incidence rates of several measured mental health diagnoses and psychiatric medications increased significantly during the COVID-19 pandemic compared to the period before. This increase was mostly attributed to females. MeaningThis real-world study highlights the deterioration of adolescents mental health during the COVID-19 pandemic and suggests that the mental health of this young population should be considered during management and health policy decision making.

3.
Preprint in English | medRxiv | ID: ppmedrxiv-21262957

ABSTRACT

Israel is currently experiencing a new wave of CoVid-19 infection, six months after implementing a national vaccination campaign. We carried out three discrete analyses using data from a large Israeli HMO to determine whether IgG levels of those fully vaccinated drop over time, the relationship between IgG titer and subsequent PCR-confirmed infection, and compare PCR-confirmed infection rates by period of vaccination. We found that mean IgG antibody levels steadily decreased over the six-month period in the total tested population, and in all age groups. An inverse relationship was found between IgG titer and subsequent CoVid-19 infection (PCR-positive). Those participants vaccinated in the first two months of the campaign were more likely to become infected than those subsequently vaccinated. The 60+ vaccinated had lower initial IgG levels, and were at greater risk of infection. The findings support the decision to add a booster vaccine for those aged 60 and over. Article Summary LineThe BNT162b2 vaccine was found to be less effective in protecting against Covid-19 infection after six months, and vaccination with a third dose is indicated.

4.
Preprint in English | medRxiv | ID: ppmedrxiv-21259579

ABSTRACT

ImportanceWhile the mRNA BNT162b2 vaccine effectivness was demonstrated in general population, the question of effectiveness given confirmed exposure has yet been answered, though it has policy implications, as the need for self-quarantine when exposed and protective measures for vaccinated in high-risk areas. ObjectiveAssessing the BNT162b2 vaccine effectiveness in preventing SARS-CoV-2 infection given high-risk exposure, through analysis of household members of confirmed cases. DesignRetrospective cohort study. Data of household members of confirmed SARS-CoV-2 cases between 20/12/2020 and 17/03/2021 were collected. SettingNationally centralized database of Maccabi Healthcare Services (MHS), the second largest Healthcare Maintenance Organization in Israel. Participants2.5 million MHS members were considered, of which we included only households with two adult members, given possible lower transmission and susceptibility among children. Households with no prior confirmed infections and a confirmed index case during the study period were included. ExposureParticipants were classified into three vaccination groups in time of the index case (the confirmed exposure)-Unvaccinated; Fully Vaccinated(7 or more days post second dose) and a reference control group of Recently Vaccinated Once(0-7 days from the first dose, presumably still unprotected). Main Outcomes and MeasuresAssessing the probability of an additional SARS-CoV-2 infection in the household occurring within 10 days of an index case, calculated separately for the three vaccination groups. Main outcome was vaccine effectiveness given confirmed exposure. High testing rates among household members enabled us to estimate with a high degree of confidence effectiveness against asymptomatic SARS-CoV-2 infection as well. ResultsA total of 173,569 households were included, out of which 6,351 households had an index infection (mean [SD] age, 58.9 [13.5] years; 50% were women). Vaccine effectiveness of Fully Vaccinated compared to Unvaccinated participants was 80.0% [95% CI, 73.0-85.1] and 82.0% [95% CI, 75.5-86.7] compared to those Recently Vaccinated Once. Conclusion and RelevanceThe BNT162b2 vaccine is effective in a high-risk, real life, exposure scenario, but the protection rates afforded in these settings are lower than those previously described. Household members of COVID-19 patients and any individual with a confirmed exposure to COVID-19 are still at a considerable risk of being infected even if fully vaccinated.

5.
Preprint in English | medRxiv | ID: ppmedrxiv-21255304

ABSTRACT

Following the widespread vaccination program for COVID-19 carried out in Israel, a survey was conducted to preliminarily assess behavior changes in the vaccinated population, prior to the expected upcoming policy change as to mask wearing and social distancing regulation in Israel. 200 people answered at least one question pertaining to preventive behaviour. Among the respondents, 21.1% reported a decrease in mask wearing compared to 47.3% who reported a decrease in social distancing. There was no difference in these measures between the sexes. However, people under the age of 50 were more likely to decrease mask wearing (28.1%) and decrease social distancing (56.1%), as compared with people over the age of 50 (17.2% and 41.8%, respectively). Among health care workers, there was a minimal decrease in mask wearing (1/23 people) compared to a more widespread decrease in social distancing (10/23). These data suggest that preventive attitudes change following COVID-19 vaccination, with less adherence to social distancing as compared to mask wearing, and should be taken into account when planning public policy in the future.

6.
Preprint in English | medRxiv | ID: ppmedrxiv-21253051

ABSTRACT

With more than 100 million confirmed COVID-19 cases as of March 2021, reinfection is still considered to be rare. In light of increasing reports of reinfected COVID-19 patients, the need to better understand the real risk for reinfection is critical, with potential effects on public health policies aimed at containing the spread of SARS-CoV-2. In this descriptive preliminary report, we conducted a large-scale assessment on the country level of the possible occurrence of COVID-19 reinfection within the members of a large healthcare provider in Israel. Out of 149,735 individuals with a documented positive PCR test between March 2020 and January 2021, 154 had two positive PCR tests at least 100 days apart, reflecting a reinfection proportion of 1 per 1000. Given our strict inclusion criteria, we believe these numbers represent true reinfection incidence in MHS and should be clinically regarded as such.

7.
Preprint in English | medRxiv | ID: ppmedrxiv-21252844

ABSTRACT

Deployment of the BNT162b2 mRNA Covid-19 Vaccine in Israel began in December 2020. This is a retrospective analysis of serological data, describing SARS-CoV-2 anti-S IgG kinetics in 116 Israeli healthcare workers administrated the BNT162b2 vaccine. Seroconversion occurred by day 14 in all individuals, with IgG levels peaking approximately 30 days post inoculation. This study demonstrated the kinetics of the antibody response post vaccination with BNT162b2. The robustness of seroconversion was observed, alongside a statistically significant difference in IgG levels between employees over and younger 50 years of afge. Further research is required in order to examine the antibody kinetics overtime, as well as whether the age-dependent difference persists.

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