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1.
N Engl J Med ; 385(4): 320-329, 2021 07 22.
Artigo em Inglês | MEDLINE | ID: mdl-34192428

RESUMO

BACKGROUND: Information is limited regarding the effectiveness of the two-dose messenger RNA (mRNA) vaccines BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) in preventing infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and in attenuating coronavirus disease 2019 (Covid-19) when administered in real-world conditions. METHODS: We conducted a prospective cohort study involving 3975 health care personnel, first responders, and other essential and frontline workers. From December 14, 2020, to April 10, 2021, the participants completed weekly SARS-CoV-2 testing by providing mid-turbinate nasal swabs for qualitative and quantitative reverse-transcriptase-polymerase-chain-reaction (RT-PCR) analysis. The formula for calculating vaccine effectiveness was 100% × (1 - hazard ratio for SARS-CoV-2 infection in vaccinated vs. unvaccinated participants), with adjustments for the propensity to be vaccinated, study site, occupation, and local viral circulation. RESULTS: SARS-CoV-2 was detected in 204 participants (5%), of whom 5 were fully vaccinated (≥14 days after dose 2), 11 partially vaccinated (≥14 days after dose 1 and <14 days after dose 2), and 156 unvaccinated; the 32 participants with indeterminate vaccination status (<14 days after dose 1) were excluded. Adjusted vaccine effectiveness was 91% (95% confidence interval [CI], 76 to 97) with full vaccination and 81% (95% CI, 64 to 90) with partial vaccination. Among participants with SARS-CoV-2 infection, the mean viral RNA load was 40% lower (95% CI, 16 to 57) in partially or fully vaccinated participants than in unvaccinated participants. In addition, the risk of febrile symptoms was 58% lower (relative risk, 0.42; 95% CI, 0.18 to 0.98) and the duration of illness was shorter, with 2.3 fewer days spent sick in bed (95% CI, 0.8 to 3.7). CONCLUSIONS: Authorized mRNA vaccines were highly effective among working-age adults in preventing SARS-CoV-2 infection when administered in real-world conditions, and the vaccines attenuated the viral RNA load, risk of febrile symptoms, and duration of illness among those who had breakthrough infection despite vaccination. (Funded by the National Center for Immunization and Respiratory Diseases and the Centers for Disease Control and Prevention.).


Assuntos
Vacinas contra COVID-19 , COVID-19/prevenção & controle , Carga Viral , Vacina de mRNA-1273 contra 2019-nCoV , Adolescente , Adulto , Vacina BNT162 , COVID-19/diagnóstico , COVID-19/virologia , Teste de Ácido Nucleico para COVID-19 , Vacinas contra COVID-19/imunologia , Portador Sadio/diagnóstico , Portador Sadio/prevenção & controle , Socorristas , Feminino , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Gravidade do Paciente , Estudos Prospectivos , SARS-CoV-2/isolamento & purificação , Resultado do Tratamento , Adulto Jovem
2.
J Org Chem ; 89(7): 4595-4606, 2024 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-38452367

RESUMO

Immunomodulatory imide drugs form the core of many pharmaceutically relevant structures, but Csp2-Csp2 bond formation via metal-catalyzed cross coupling is difficult due to the sensitivity of the glutarimide ring ubiquitous in these structures. We report that replacement of the traditional alkali base with a fluoride source enhances a previously challenging Suzuki-Miyaura coupling on glutarimide-containing compounds with trifluoroborates. These enabling conditions are reactive enough to generate these derivatives in high yields but mild enough to preserve both the glutarimide and its sensitive stereocenter. Experimental and computational data suggest a mechanistically distinct process of π-coordination of the trifluoroborate enabled by these conditions.


Assuntos
Fluoretos , Paládio , Estrutura Molecular , Catálise , Paládio/química
3.
Epidemiol Infect ; 152: e32, 2024 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-38329089

RESUMO

Extreme precipitation events are occurring more intensely in Canada. This can contaminate water sources with enteric pathogens, potentially increasing the risk of acute gastrointestinal illness. This study aimed to investigate the relationship between extreme precipitation and emergency department (ED) visits for acute gastrointestinal illness in Toronto from 2012 to 2022. Distributed lag non-linear models were constructed on ED visit counts with a Quasi Poisson distribution. Extreme precipitation was modelled as a 21-day lag variable, with a linear relationship assumed at levels ≧95th percentile. Separate models were also conducted on season-specific data sets. Daily precipitation and gastrointestinal illness ED visits ranged between 0 to 126 mm, and 12 to 180 visits respectively. Overall, a 10-mm increase in precipitation >95th percentile had no significant relationship with the risk of ED visits. However, stratification by seasons revealed significant relationships during spring (lags 1-19, peak at lag 14 RR = 1.04; 95% CI: 1.03, 1.06); the overall cumulative effect across the 21-day lag was also significant (RR = 1.94; 95% CI: 1.47, 2.57). Extreme precipitation has a seasonal effect on gastrointestinal health outcomes in Toronto city, suggesting varying levels of enteric pathogen exposures through drinking water or other environmental pathway during different seasons.


Assuntos
Água Potável , Ontário/epidemiologia , Serviço Hospitalar de Emergência , Cidades , Estações do Ano
4.
JAMA ; 331(5): 408-416, 2024 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-38319331

RESUMO

Importance: Bivalent mRNA COVID-19 vaccines were recommended in the US for children and adolescents aged 12 years or older on September 1, 2022, and for children aged 5 to 11 years on October 12, 2022; however, data demonstrating the effectiveness of bivalent COVID-19 vaccines are limited. Objective: To assess the effectiveness of bivalent COVID-19 vaccines against SARS-CoV-2 infection and symptomatic COVID-19 among children and adolescents. Design, Setting, and Participants: Data for the period September 4, 2022, to January 31, 2023, were combined from 3 prospective US cohort studies (6 sites total) and used to estimate COVID-19 vaccine effectiveness among children and adolescents aged 5 to 17 years. A total of 2959 participants completed periodic surveys (demographics, household characteristics, chronic medical conditions, and COVID-19 symptoms) and submitted weekly self-collected nasal swabs (irrespective of symptoms); participants submitted additional nasal swabs at the onset of any symptoms. Exposure: Vaccination status was captured from the periodic surveys and supplemented with data from state immunization information systems and electronic medical records. Main Outcome and Measures: Respiratory swabs were tested for the presence of the SARS-CoV-2 virus using reverse transcriptase-polymerase chain reaction. SARS-CoV-2 infection was defined as a positive test regardless of symptoms. Symptomatic COVID-19 was defined as a positive test and 2 or more COVID-19 symptoms within 7 days of specimen collection. Cox proportional hazards models were used to estimate hazard ratios for SARS-CoV-2 infection and symptomatic COVID-19 among participants who received a bivalent COVID-19 vaccine dose vs participants who received no vaccine or monovalent vaccine doses only. Models were adjusted for age, sex, race, ethnicity, underlying health conditions, prior SARS-CoV-2 infection status, geographic site, proportion of circulating variants by site, and local virus prevalence. Results: Of the 2959 participants (47.8% were female; median age, 10.6 years [IQR, 8.0-13.2 years]; 64.6% were non-Hispanic White) included in this analysis, 25.4% received a bivalent COVID-19 vaccine dose. During the study period, 426 participants (14.4%) had laboratory-confirmed SARS-CoV-2 infection. Among these 426 participants, 184 (43.2%) had symptomatic COVID-19, 383 (89.9%) were not vaccinated or had received only monovalent COVID-19 vaccine doses (1.38 SARS-CoV-2 infections per 1000 person-days), and 43 (10.1%) had received a bivalent COVID-19 vaccine dose (0.84 SARS-CoV-2 infections per 1000 person-days). Bivalent vaccine effectiveness against SARS-CoV-2 infection was 54.0% (95% CI, 36.6%-69.1%) and vaccine effectiveness against symptomatic COVID-19 was 49.4% (95% CI, 22.2%-70.7%). The median observation time after vaccination was 276 days (IQR, 142-350 days) for participants who received only monovalent COVID-19 vaccine doses vs 50 days (IQR, 27-74 days) for those who received a bivalent COVID-19 vaccine dose. Conclusion and Relevance: The bivalent COVID-19 vaccines protected children and adolescents against SARS-CoV-2 infection and symptomatic COVID-19. These data demonstrate the benefit of COVID-19 vaccine in children and adolescents. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Adolescente , Criança , Feminino , Humanos , Masculino , COVID-19/diagnóstico , COVID-19/prevenção & controle , Vacinas contra COVID-19/uso terapêutico , Estudos Prospectivos , SARS-CoV-2 , Vacinas de mRNA/uso terapêutico , Vacinas Combinadas/uso terapêutico , Pré-Escolar , Eficácia de Vacinas , Estados Unidos
5.
Angew Chem Int Ed Engl ; : e202404601, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38619509

RESUMO

The nitrido-ate complex [(PN)2Ti(N){µ2-K(OEt2)}]2 (1) (PN-=(N-(2-PiPr2-4-methylphenyl)-2,4,6-Me3C6H2) reductively couples CO and isocyanides in the presence of DME or cryptand (Kryptofix222), to form rare, five-coordinate TiII complexes having a linear cumulene motif, [K(L)][(PN)2Ti(NCE)] (E=O, L=Kryptofix222, (2); E=NAd, L=3 DME, (3); E=NtBu, L=3 DME, (4); E=NAd, L=Kryptofix222, (5)). Oxidation of 2-5 with [Fc][OTf] afforded an isostructural TiIII center containing a neutral cumulene, [(PN)2Ti(NCE)] (E=O, (6); E=NAd (7), NtBu (8)) and characterization by CW X-band EPR spectroscopy, revealed unpaired electron to be metal centric. Moreover, 1e- reduction of 6 and 7 in the presence of Kryptofix222cleanly reformed corresponding discrete TiII complexes 2 and 5, which were further characterized by solution magnetization measurements and high-frequency and -field EPR (HFEPR) spectroscopy. Furthermore, oxidation of 7 with [Fc*][B(C6F5)4] resulted in a ligand disproportionated TiIV complex having transoid carbodiimides, [(PN)2Ti(NCNAd)2] (9). Comparison of spectroscopic, structural, and computational data for the divalent, trivalent, and tetravalent systems, including their 15N enriched isotopomers demonstrate these cumulenes to decrease in order of backbonding as TiII→TiIII→TiIV and increasing order of π-donation as TiII→TiIII→TiIV, thus displaying more covalency in TiIII species. Lastly, we show a synthetic cycle whereby complex 1 can deliver an N-atom to CO and CNAd.

6.
Clin Infect Dis ; 76(3): e1168-e1176, 2023 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-36031405

RESUMO

BACKGROUND: Antibody responses to non-egg-based standard-dose cell-culture influenza vaccine (containing 15 µg hemagglutinin [HA]/component) and recombinant vaccine (containing 45 µg HA/component) during consecutive seasons have not been studied in the United States. METHODS: In a randomized trial of immunogenicity of quadrivalent influenza vaccines among healthcare personnel (HCP) aged 18-64 years over 2 consecutive seasons, HCP who received recombinant-HA influenza vaccine (RIV) or cell culture-based inactivated influenza vaccine (ccIIV) during the first season (year 1) were re-randomized the second season of 2019-2020 (year 2 [Y2]) to receive ccIIV or RIV, resulting in 4 ccIIV/RIV combinations. In Y2, hemagglutination inhibition antibody titers against reference cell-grown vaccine viruses were compared in each ccIIV/RIV group with titers among HCP randomized both seasons to receive egg-based, standard-dose inactivated influenza vaccine (IIV) using geometric mean titer (GMT) ratios of Y2 post-vaccination titers. RESULTS: Y2 data from 414 HCP were analyzed per protocol. Compared with 60 IIV/IIV recipients, 74 RIV/RIV and 106 ccIIV/RIV recipients showed significantly elevated GMT ratios (Bonferroni corrected P < .007) against all components except A(H3N2). Post-vaccination GMT ratios for ccIIV/ccIIV and RIV/ccIIV were not significantly elevated compared with IIV/IIV except for RIV/ccIIV against A(H1N1)pdm09. CONCLUSIONS: In adult HCP, receipt of RIV in 2 consecutive seasons or the second season was more immunogenic than consecutive egg-based IIV for 3 of the 4 components of quadrivalent vaccine. Immunogenicity of ccIIV/ccIIV was similar to that of IIV/IIV. Differences in HA antigen content may play a role in immunogenicity of influenza vaccination in consecutive seasons. CLINICAL TRIALS REGISTRATION: NCT03722589.


Assuntos
Vírus da Influenza A Subtipo H1N1 , Vacinas contra Influenza , Influenza Humana , Vacina Antivariólica , Adulto , Humanos , Anticorpos Antivirais , Técnicas de Cultura de Células , Atenção à Saúde , Testes de Inibição da Hemaglutinação , Vírus da Influenza A Subtipo H3N2 , Estados Unidos , Vacinação , Vacinas Combinadas , Vacinas de Produtos Inativados , Vacinas Sintéticas
7.
Clin Infect Dis ; 76(10): 1822-1831, 2023 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-36578137

RESUMO

BACKGROUND: Data on antibody kinetics are limited among individuals previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). From a cohort of healthcare personnel and other frontline workers in 6 US states, we assessed antibody waning after messenger RNA (mRNA) dose 2 and response to dose 3 according to SARS-CoV-2 infection history. METHODS: Participants submitted sera every 3 months, after SARS-CoV-2 infection, and after each mRNA vaccine dose. Sera were tested for antibodies and reported as area under the serial dilution curve (AUC). Changes in AUC values over time were compared using a linear mixed model. RESULTS: Analysis included 388 participants who received dose 3 by November 2021. There were 3 comparison groups: vaccine only with no known prior SARS-CoV-2 infection (n = 224); infection prior to dose 1 (n = 123); and infection after dose 2 and before dose 3 (n = 41). The interval from dose 2 and dose 3 was approximately 8 months. After dose 3, antibody levels rose 2.5-fold (95% confidence interval [CI] = 2.2-3.0) in group 2 and 2.9-fold (95% CI = 2.6-3.3) in group 1. Those infected within 90 days before dose 3 (and median 233 days [interquartile range, 213-246] after dose 2) did not increase significantly after dose 3. CONCLUSIONS: A third dose of mRNA vaccine typically elicited a robust humoral immune response among those with primary vaccination regardless of SARS-CoV-2 infection >3 months prior to boosting. Those with infection <3 months prior to boosting did not have a significant increase in antibody concentrations in response to a booster.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Humanos , COVID-19/prevenção & controle , Formação de Anticorpos , SARS-CoV-2 , RNA Mensageiro , Vacinas de mRNA , Anticorpos Antivirais
8.
J Am Chem Soc ; 145(28): 15088-15093, 2023 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-37399078

RESUMO

The first practical, fully stereoselective P(V)-radical hydrophosphorylation is presented herein by using simple, limonene-derived reagent systems. A set of reagents have been developed that upon radical initiation react smoothly with olefins and other radical acceptors to generate P-chiral products, which can be further diversified (with conventional 2e- chemistry) to a range of underexplored bioisosteric building blocks. The reactions have a wide scope with excellent chemoselectivity, and the unexpected stereochemical outcome has been supported computationally and experimentally. Initial ADME studies are suggestive of the promising properties of this rarely explored chemical space.

9.
Emerg Infect Dis ; 29(3): 599-604, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36703252

RESUMO

In a cohort of essential workers in the United States previously infected with SARS-CoV-2, risk factors for reinfection included being unvaccinated, infrequent mask use, time since first infection, and being non-Hispanic Black. Protecting workers from reinfection requires a multipronged approach including up-to-date vaccination, mask use as recommended, and reduction in underlying health disparities.


Assuntos
COVID-19 , Reinfecção , Humanos , SARS-CoV-2 , Fatores de Risco
10.
BMC Public Health ; 23(1): 2240, 2023 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-37957658

RESUMO

Competencies ensure public health students and professionals have the necessary knowledge, skills, values, and behaviours to do their jobs effectively. Public health is a dynamic and complex field requiring robust competency statements and frameworks that are regularly renewed. Many countries have public health competencies, but there has been no evidence synthesis on how these are developed. Our research aim was to synthesize the extent and nature of the literature on approaches and best practices for competencies statement and framework development in the context of public health, including identifying the relevant literature on approaches for developing competency statements and frameworks for public health students and professionals using a scoping review; and, synthesizing and describing approaches and best practices for developing public health competency statements and frameworks using a thematic analysis of the literature identified by the scoping review. We conducted a scoping review and thematic analysis of the academic and grey literature to synthesize and describe approaches and best practices for developing public health competency statements and frameworks. A systematic search of six databases uncovered 13 articles for inclusion. To scope the literature, articles were assessed for characteristics including study aim, design, methods, key results, gaps, and future research recommendations. Most included articles were peer-reviewed journal articles, used qualitative or mixed method design, and were focused on general, rather than specialist, public health practitioners. Thematic analysis resulted in the generation of six analytical themes that describe the multi-method approaches utilized in developing competency statements and frameworks including literature reviews, expert consultation, and consensus-building. There was variability in the transparency of competency framework development, with challenges balancing foundational and discipline-specific competencies. Governance, and intersectoral and interdisciplinary competency, are needed to address complex public health issues. Understanding approaches and best practices for competency statement and framework development will support future evidence-informed iterations of public health competencies.


Assuntos
Competência Profissional , Saúde Pública , Humanos , Revisão por Pares , Bases de Dados Factuais
11.
Clin Infect Dis ; 75(1): e827-e837, 2022 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-34928334

RESUMO

BACKGROUND: Data on the development of neutralizing antibodies (nAbs) against SARS-CoV-2 after SARS-CoV-2 infection and after vaccination with mRNA COVID-19 vaccines are limited. METHODS: From a prospective cohort of 3975 adult essential and frontline workers tested weekly from August 2020 to March 2021 for SARS-CoV-2 infection by reverse transcription-polymerase chain reaction assay irrespective of symptoms, 497 participants had sera drawn after infection (170), vaccination (327), and after both infection and vaccination (50 from the infection population). Serum was collected after infection and each vaccine dose. Serum-neutralizing antibody titers against USA-WA1/2020-spike pseudotype virus were determined by the 50% inhibitory dilution. Geometric mean titers (GMTs) and corresponding fold increases were calculated using t tests and linear mixed-effects models. RESULTS: Among 170 unvaccinated participants with SARS-CoV-2 infection, 158 (93%) developed nAbs with a GMT of 1003 (95% confidence interval, 766-1315). Among 139 previously uninfected participants, 138 (99%) developed nAbs after mRNA vaccine dose 2 with a GMT of 3257 (2596-4052). GMT was higher among those receiving mRNA-1273 vaccine (GMT, 4698; 3186-6926) compared with BNT162b2 vaccine (GMT, 2309; 1825-2919). Among 32 participants with prior SARS-CoV-2 infection, GMT was 21 655 (14 766-31 756) after mRNA vaccine dose 1, without further increase after dose 2. CONCLUSIONS: A single dose of mRNA vaccine after SARS-CoV-2 infection resulted in the highest observed nAb response. Two doses of mRNA vaccine in previously uninfected participants resulted in higher nAbs to SARS-CoV-2 than after 1 dose of vaccine or SARS-CoV-2 infection alone. nAb response also differed by mRNA vaccine product.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Vacina de mRNA-1273 contra 2019-nCoV , Adulto , Anticorpos Neutralizantes , Anticorpos Antivirais , Vacina BNT162 , COVID-19/prevenção & controle , Humanos , Testes de Neutralização , Estudos Prospectivos , SARS-CoV-2 , Glicoproteína da Espícula de Coronavírus , Vacinas Sintéticas , Vacinas de mRNA
12.
MMWR Morb Mortal Wkly Rep ; 71(11): 422-428, 2022 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-35298453

RESUMO

The BNT162b2 (Pfizer-BioNTech) mRNA COVID-19 vaccine was recommended by CDC's Advisory Committee on Immunization Practices for persons aged 12-15 years (referred to as adolescents in this report) on May 12, 2021, and for children aged 5-11 years on November 2, 2021 (1-4). Real-world data on vaccine effectiveness (VE) in these age groups are needed, especially because when the B.1.1.529 (Omicron) variant became predominant in the United States in December 2021, early investigations of VE demonstrated a decline in protection against symptomatic infection for adolescents aged 12-15 years and adults* (5). The PROTECT† prospective cohort of 1,364 children and adolescents aged 5-15 years was tested weekly for SARS-CoV-2, irrespective of symptoms, and upon COVID-19-associated illness during July 25, 2021-February 12, 2022. Among unvaccinated participants (i.e., those who had received no COVID-19 vaccine doses) with any laboratory-confirmed SARS-CoV-2 infection, those with B.1.617.2 (Delta) variant infections were more likely to report COVID-19 symptoms (66%) than were those with Omicron infections (49%). Among fully vaccinated children aged 5-11 years, VE against any symptomatic and asymptomatic Omicron infection 14-82 days (the longest interval after dose 2 in this age group) after receipt of dose 2 of the Pfizer-BioNTech vaccine was 31% (95% CI = 9%-48%), adjusted for sociodemographic characteristics, health information, frequency of social contact, mask use, location, and local virus circulation. Among adolescents aged 12-15 years, adjusted VE 14-149 days after dose 2 was 87% (95% CI = 49%-97%) against symptomatic and asymptomatic Delta infection and 59% (95% CI = 22%-79%) against Omicron infection. Fully vaccinated participants with Omicron infection spent an average of one half day less sick in bed than did unvaccinated participants with Omicron infection. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations.


Assuntos
Vacina BNT162/administração & dosagem , Vacina BNT162/uso terapêutico , COVID-19/prevenção & controle , SARS-CoV-2/imunologia , Eficácia de Vacinas , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Prospectivos , Estados Unidos
13.
Inorg Chem ; 61(17): 6574-6583, 2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35436407

RESUMO

We demonstrate reactivity between a ß-diketiminate-supported niobium(III) imido complex and alkyl azides to form niobatetrazene complexes (BDI)Nb(NtBu)(RNNNNR) (BDI = N,N-bis(2,6-diisopropylphenyl)-3,5-dimethyl-ß-diketiminate; R = cyclohexyl (1), benzyl (2)). Intriguingly, niobatetrazene complexes 1 and 2 can be interconverted via addition of an appropriate alkyl azide, likely through a series of concerted [3 + 2] cycloaddition and retrocycloaddition reactions in which π-loaded bis(imido) intermediates are formed. The bis(imido) intermediates were trapped upon addition of alkyl isocyanides to yield five-coordinate bis(imido) complexes (BDI)Nb(NtBu)(NCy)(CNR) (R = tert-butyl (4a), cyclohexyl (4b)). Two computational methods─density functional theory and density functional tight binding (DFTB)─were employed to calculate the lowest energy pathway across the potential energy surface for this multistep transformation. Reaction path calculations for individual cycloaddition or retrocycloaddition processes along the multistep reaction pathway showed that these transformations occur via a concerted, yet highly asynchronous mechanism, in which the two bond-breaking or -making events do not occur simultaneously. The use of the DFTB method in this work highlights its advantages and utility for studying transition metal systems.

14.
JAMA ; 328(15): 1523-1533, 2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-36255426

RESUMO

Importance: Data on the epidemiology of mild to moderately severe COVID-19 are needed to inform public health guidance. Objective: To evaluate associations between 2 or 3 doses of mRNA COVID-19 vaccine and attenuation of symptoms and viral RNA load across SARS-CoV-2 viral lineages. Design, Setting, and Participants: A prospective cohort study of essential and frontline workers in Arizona, Florida, Minnesota, Oregon, Texas, and Utah with COVID-19 infection confirmed by reverse transcriptase-polymerase chain reaction testing and lineage classified by whole genome sequencing of specimens self-collected weekly and at COVID-19 illness symptom onset. This analysis was conducted among 1199 participants with SARS-CoV-2 from December 14, 2020, to April 19, 2022, with follow-up until May 9, 2022, reported. Exposures: SARS-CoV-2 lineage (origin strain, Delta variant, Omicron variant) and COVID-19 vaccination status. Main Outcomes and Measures: Clinical outcomes included presence of symptoms, specific symptoms (including fever or chills), illness duration, and medical care seeking. Virologic outcomes included viral load by quantitative reverse transcriptase-polymerase chain reaction testing along with viral viability. Results: Among 1199 participants with COVID-19 infection (714 [59.5%] women; median age, 41 years), 14.0% were infected with the origin strain, 24.0% with the Delta variant, and 62.0% with the Omicron variant. Participants vaccinated with the second vaccine dose 14 to 149 days before Delta infection were significantly less likely to be symptomatic compared with unvaccinated participants (21/27 [77.8%] vs 74/77 [96.1%]; OR, 0.13 [95% CI, 0-0.6]) and, when symptomatic, those vaccinated with the third dose 7 to 149 days before infection were significantly less likely to report fever or chills (5/13 [38.5%] vs 62/73 [84.9%]; OR, 0.07 [95% CI, 0.0-0.3]) and reported significantly fewer days of symptoms (10.2 vs 16.4; difference, -6.1 [95% CI, -11.8 to -0.4] days). Among those with Omicron infection, the risk of symptomatic infection did not differ significantly for the 2-dose vaccination status vs unvaccinated status and was significantly higher for the 3-dose recipients vs those who were unvaccinated (327/370 [88.4%] vs 85/107 [79.4%]; OR, 2.0 [95% CI, 1.1-3.5]). Among symptomatic Omicron infections, those vaccinated with the third dose 7 to 149 days before infection compared with those who were unvaccinated were significantly less likely to report fever or chills (160/311 [51.5%] vs 64/81 [79.0%]; OR, 0.25 [95% CI, 0.1-0.5]) or seek medical care (45/308 [14.6%] vs 20/81 [24.7%]; OR, 0.45 [95% CI, 0.2-0.9]). Participants with Delta and Omicron infections who received the second dose 14 to 149 days before infection had a significantly lower mean viral load compared with unvaccinated participants (3 vs 4.1 log10 copies/µL; difference, -1.0 [95% CI, -1.7 to -0.2] for Delta and 2.8 vs 3.5 log10 copies/µL, difference, -1.0 [95% CI, -1.7 to -0.3] for Omicron). Conclusions and Relevance: In a cohort of US essential and frontline workers with SARS-CoV-2 infections, recent vaccination with 2 or 3 mRNA vaccine doses less than 150 days before infection with Delta or Omicron variants, compared with being unvaccinated, was associated with attenuated symptoms, duration of illness, medical care seeking, or viral load for some comparisons, although the precision and statistical significance of specific estimates varied.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Vacinação , Carga Viral , Adulto , Feminino , Humanos , Masculino , COVID-19/diagnóstico , COVID-19/genética , COVID-19/prevenção & controle , COVID-19/virologia , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/uso terapêutico , Estudos Prospectivos , RNA Viral/análise , RNA Viral/genética , DNA Polimerase Dirigida por RNA , SARS-CoV-2/genética , Vacinação/estatística & dados numéricos , Estados Unidos/epidemiologia , Carga Viral/efeitos dos fármacos , Carga Viral/genética , Carga Viral/estatística & dados numéricos , Sequenciamento Completo do Genoma , Infecções Assintomáticas/epidemiologia , Infecções Assintomáticas/terapia , Fatores de Tempo , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vacinas de mRNA
15.
Angew Chem Int Ed Engl ; 61(43): e202209122, 2022 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-36001771

RESUMO

A dinuclear hafnium complex containing the parent imido ligand [(PN)(PNC)Hf=NH{µ2 -K}]2 (2) (PN- =(N-(2-Pi Pr2 -4-methylphenyl)-2,4,6-Me3 C6 H2 ; PNC2- =(N-(2-Pi Pr2 -4-methylphenyl)-2,4,6-CH2 Me2 C6 H2 ), was prepared by reduction of the bisazide trans-[(PN)2 Hf(N3 )2 ] (1) with two equiv of KC8 . Encapsulation of K+ in 2 with crown-ether or cryptand affords the first discrete salt [K(encap)][(PN)(PNC)Hf≡NH] (encap=18-crown-6(THF)2 , 3; 2,2,2-Kryptofix, 4), featuring a terminal parent imide and possessing some of the shortest Hf-N bond lengths known to date. DFT calculations revealed formation of 2 to proceed via an extremely basic monomeric nitrido, [(PN)2 Hf≡N]- (A), having a computed pKBH+ of ∼57 followed by heterolytic splitting of an inert 1,2-CH bond of a benzylic methyl group across the Hf≡N triple bond in A. An electronic structure analysis reveals A to possess a covalent Hf≡N triple bond and of super-basic character. We also showcase reactivity of the Hf≡NH bond with various electrophiles.

16.
Clin Infect Dis ; 73(11): 1973-1981, 2021 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-34245243

RESUMO

BACKGROUND: RIV4 and cell-culture based inactivated influenza vaccine (ccIIV4) have not been compared to egg-based IIV4 in healthcare personnel, a population with frequent influenza vaccination that may blunt vaccine immune responses over time. We conducted a randomized trial among healthcare personnel (HCP) aged 18-64 years to compare humoral immune responses to ccIIV4 and RIV4 to IIV4. METHODS: During the 2018-2019 season, participants were randomized to receive ccIIV4, RIV4, or IIV4 and had serum samples collected prevaccination, 1 and 6 months postvaccination. Serum samples were tested by hemagglutination inhibition (HI) for influenza A/H1N1, B/Yamagata, and B/Victoria and microneutralization (MN) for A/H3N2 against cell-grown vaccine reference viruses. Primary outcomes at 1 month were seroconversion rate (SCR), geometric mean titers (GMT), GMT ratio, and mean fold rise (MFR) in the intention-to-treat population. RESULTS: In total, 727 participants were included (283 ccIIV4, 202 RIV4, and 242 IIV4). At 1 month, responses to ccIIV4 were similar to IIV4 by SCR, GMT, GMT ratio, and MFR. RIV4 induced higher SCRs, GMTs, and MFRs than IIV4 against A/H1N1, A/H3N2, and B/Yamagata. The GMT ratio of RIV4 to egg-based vaccines was 1.5 (95% confidence interval [CI] 1.2-1.9) for A/H1N1, 3.0 (95% CI: 2.4-3.7) for A/H3N2, 1.1 (95% CI: .9-1.4) for B/Yamagata, and 1.1 (95% CI: .9-1.3) for B/Victoria. At 6 months, ccIIV4 recipients had similar GMTs to IIV4, whereas RIV4 recipients had higher GMTs against A/H3N2 and B/Yamagata. CONCLUSIONS: RIV4 resulted in improved antibody responses by HI and MN compared to egg-based vaccines against 3 of 4 cell-grown vaccine strains 1 month postvaccination, suggesting a possible additional benefit from RIV4. CLINICAL TRIALS REGISTRATION: NCT03722589.


Assuntos
Vírus da Influenza A Subtipo H1N1 , Vacinas contra Influenza , Influenza Humana , Anticorpos Antivirais , Técnicas de Cultura de Células , Atenção à Saúde , Testes de Inibição da Hemaglutinação , Humanos , Imunogenicidade da Vacina , Vírus da Influenza A Subtipo H3N2 , Vírus da Influenza B , Influenza Humana/prevenção & controle , Vacinas de Produtos Inativados
17.
MMWR Morb Mortal Wkly Rep ; 70(5152): 1761-1765, 2021 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-34968373

RESUMO

The BNT162b2 (Pfizer-BioNTech) mRNA COVID-19 vaccine has demonstrated high efficacy in preventing infection with SARS-CoV-2 (the virus that causes COVID-19) in randomized placebo-controlled Phase III trials in persons aged 12-17 years (referred to as adolescents in this report) (1); however, data on real-word vaccine effectiveness (VE) among adolescents are limited (1-3). As of December 2021, the Pfizer-BioNTech vaccine is approved by the Food and Drug Administration (FDA) for adolescents aged 16-17 years and under FDA emergency use authorization for those aged 12-15 years. In a prospective cohort in Arizona, 243 adolescents aged 12-17 years were tested for SARS-CoV-2 by reverse transcription-polymerase chain reaction (RT-PCR) each week, irrespective of symptoms, and upon onset of COVID-19-like illness during July 25-December 4, 2021; the SARS-CoV-2 B.1.617.2 (Delta) variant was the predominant strain during this study period. During the study, 190 adolescents contributed fully vaccinated person-time (≥14 days after receiving 2 doses of Pfizer-BioNTech vaccine), 30 contributed partially vaccinated person-time (receipt of 1 dose or receipt of 2 doses but with the second dose completed <14 days earlier), and 66 contributed unvaccinated person-time. Using the Cox proportional-hazards model, the estimated VE of full Pfizer-BioNTech vaccination for preventing SARS-CoV-2 infection was 92% (95% CI = 79%-97%), adjusted for sociodemographic characteristics, health information, frequency of social contact, mask use, location, and local virus circulation. These findings from a real-world setting indicate that 2 doses of Pfizer-BioNTech vaccine are highly effective in preventing SARS-CoV-2 infection among Arizona adolescents. CDC recommends COVID-19 vaccination for all eligible persons in the United States, including persons aged 12-17 years.


Assuntos
Vacina BNT162/administração & dosagem , COVID-19/prevenção & controle , Eficácia de Vacinas/estatística & dados numéricos , Adolescente , Arizona/epidemiologia , COVID-19/epidemiologia , Teste para COVID-19 , Criança , Feminino , Humanos , Masculino
18.
MMWR Morb Mortal Wkly Rep ; 70(13): 495-500, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33793460

RESUMO

Messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines have been shown to be effective in preventing symptomatic COVID-19 in randomized placebo-controlled Phase III trials (1,2); however, the benefits of these vaccines for preventing asymptomatic and symptomatic SARS-CoV-2 (the virus that causes COVID-19) infection, particularly when administered in real-world conditions, is less well understood. Using prospective cohorts of health care personnel, first responders, and other essential and frontline workers* in eight U.S. locations during December 14, 2020-March 13, 2021, CDC routinely tested for SARS-CoV-2 infections every week regardless of symptom status and at the onset of symptoms consistent with COVID-19-associated illness. Among 3,950 participants with no previous laboratory documentation of SARS-CoV-2 infection, 2,479 (62.8%) received both recommended mRNA doses and 477 (12.1%) received only one dose of mRNA vaccine.† Among unvaccinated participants, 1.38 SARS-CoV-2 infections were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) per 1,000 person-days.§ In contrast, among fully immunized (≥14 days after second dose) persons, 0.04 infections per 1,000 person-days were reported, and among partially immunized (≥14 days after first dose and before second dose) persons, 0.19 infections per 1,000 person-days were reported. Estimated mRNA vaccine effectiveness for prevention of infection, adjusted for study site, was 90% for full immunization and 80% for partial immunization. These findings indicate that authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection, regardless of symptom status, among working-age adults in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.


Assuntos
Vacinas contra COVID-19/imunologia , COVID-19/prevenção & controle , Socorristas , Pessoal de Saúde , Doenças Profissionais/prevenção & controle , Ocupações/classificação , Adolescente , Adulto , Vacina BNT162 , COVID-19/epidemiologia , Teste de Ácido Nucleico para COVID-19 , Vacinas contra COVID-19/administração & dosagem , Socorristas/estatística & dados numéricos , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estados Unidos/epidemiologia , Vacinas Sintéticas/imunologia , Adulto Jovem , Vacinas de mRNA
19.
Inorg Chem ; 60(8): 5635-5646, 2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33825450

RESUMO

The nitride salt [(PN)2Ti≡N{µ2-K(OEt2)}]2 (1) (PN- = (N-(2-PiPr2-4-methylphenyl)-2,4,6-Me3C6H2) can be oxidized with two equiv of I2 or four equiv of ClCPh3 to produce the phosphinimide-halide complexes (NPN')(PN)Ti(X) (X- = I (2), Cl (3); NPN' = N-(2-NPiPr2-4-methylphenyl)-2,4,6-Me3C6H22-), respectively. In the case of 2, H2 was found to be one of the other products; whereas, HCPh3 and Gomberg's dimer were observed upon the formation of 3. Independent studies suggest that the oxidation of 1 could imply the formation of the transient nitridyl species [(PN)2Ti(≡N•)] (A), which can either oxidize the proximal phosphine atom to produce the Ti(III) intermediate [(NPN')(PN)Ti] (B) or, alternatively, engage in H atom abstraction to form the parent imido (PN)2Ti≡NH (4). The latter was independently prepared and was found to photochemically convert to the titanium-hydride, (NPN')(PN)Ti(H) (5). Isotopic labeling studies using (PN)2Ti≡ND (4-d1) as well as reactivity studies of 5 with a hydride abstractor demonstrate the presence of the hydride ligand in 5. An alternative route to putative A was observed via a photochemically promoted incomplete reduction of the azide ligand in (PN)2Ti(N3) (6) to 4. This process was accompanied by some formation of 5. Frozen matrix X-band EPR studies of 6, performed under photolytic conditions, were consistent with species B being formed under these reaction conditions, originating from a low barrier N-insertion into the phosphine group in the putative nitridyl species A. Computational studies were also undertaken to discover the mechanism and plausibility of the divergent pathways (via intermediates A and B) in the formation of 2 and 3, and to characterize the bonding and electronic structure of the elusive nitrogen-centered radical in A.

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