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      The effectiveness of COVID–19 vaccination against all–cause mortality in patients with type 2 diabetes mellitus: the observation during the initial period of the cancellation of the “Dynamic Zero Policy” in mainland China

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          Abstract

          Aims

          This study aims to assess the effectiveness of COVID–19 vaccination against all–cause death in patients with type 2 diabetes mellitus (T2DM).

          Methods

          Subjects were patients with T2DM who were administered by general practitioner (GP). Use electronic exchange platform to obtain the information on COVID–19 vaccination, all–cause deaths and risk factors. Logistic regression models were used to calculate the odd ratio (OR) and 95% CI for the association between COVID–19 vaccination and mortality. The vaccine effectiveness (VE) was calculated as (1- adjusted OR) ×100%.

          Results

          A total of 27,156 subjects had 53.81%, 17.65%, and 23.43% coverage for the booster, full, and partial COVID-19 vaccination, reported 328 deaths and a mortality of 1.2%. The adjusted OR (95%CI) was 0.85(0.60–1.21) for those received partial vaccination, 0.31(0.22–0.43) for those received full vaccination, and 0.12(0.08–0.18) for those received booster vaccination, compared to the unvaccinated individuals. The VE (95%CI) was 88.00(82.30–91.80) of booster vaccination, 69.30(56.60–78.30) of full vaccination, and 17.60(-17.10–42.00) of partial vaccination.

          Conclusion

          COVID–19 vaccination could effectively prevent the all–cause death in patients with T2DM during the omicron variant outbreak period, after the cancellation of the “Dynamic Zero Policy” in mainland China.

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Fei Zhou, Ting Yu, Ronghui Du … (2020)
          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            Sex differences in immune responses that underlie COVID-19 disease outcomes

            Takehiro Takahashi, Mallory Ellingson, Patrick Wong … (2020)
            A growing body of evidence indicates sex differences in the clinical outcomes of coronavirus disease 2019 (COVID-19) 1–5 . However, whether immune responses against SARS-CoV-2 differ between sexes, and whether such differences explain male susceptibility to COVID-19, is currently unknown. In this study, we examined sex differences in viral loads, SARS-CoV-2-specific antibody titers, plasma cytokines, as well as blood cell phenotyping in COVID-19 patients. By focusing our analysis on patients with moderate disease who had not received immunomodulatory medications, our results revealed that male patients had higher plasma levels of innate immune cytokines such as IL-8 and IL-18 along with more robust induction of non-classical monocytes. In contrast, female patients mounted significantly more robust T cell activation than male patients during SARS-CoV-2 infection, which was sustained in old age. Importantly, we found that a poor T cell response negatively correlated with patients’ age and was associated with worse disease outcome in male patients, but not in female patients. Conversely, higher innate immune cytokines in female patients associated with worse disease progression, but not in male patients. These findings reveal a possible explanation underlying observed sex biases in COVID-19, and provide important basis for the development of sex-based approach to the treatment and care of men and women with COVID-19.
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              Global impact of the first year of COVID-19 vaccination: a mathematical modelling study

              Oliver J Watson, Gregory Barnsley, Jaspreet Toor … (2022)
              Background The first COVID-19 vaccine outside a clinical trial setting was administered on Dec 8, 2020. To ensure global vaccine equity, vaccine targets were set by the COVID-19 Vaccines Global Access (COVAX) Facility and WHO. However, due to vaccine shortfalls, these targets were not achieved by the end of 2021. We aimed to quantify the global impact of the first year of COVID-19 vaccination programmes. Methods A mathematical model of COVID-19 transmission and vaccination was separately fit to reported COVID-19 mortality and all-cause excess mortality in 185 countries and territories. The impact of COVID-19 vaccination programmes was determined by estimating the additional lives lost if no vaccines had been distributed. We also estimated the additional deaths that would have been averted had the vaccination coverage targets of 20% set by COVAX and 40% set by WHO been achieved by the end of 2021. Findings Based on official reported COVID-19 deaths, we estimated that vaccinations prevented 14·4 million (95% credible interval [Crl] 13·7–15·9) deaths from COVID-19 in 185 countries and territories between Dec 8, 2020, and Dec 8, 2021. This estimate rose to 19·8 million (95% Crl 19·1–20·4) deaths from COVID-19 averted when we used excess deaths as an estimate of the true extent of the pandemic, representing a global reduction of 63% in total deaths (19·8 million of 31·4 million) during the first year of COVID-19 vaccination. In COVAX Advance Market Commitment countries, we estimated that 41% of excess mortality (7·4 million [95% Crl 6·8–7·7] of 17·9 million deaths) was averted. In low-income countries, we estimated that an additional 45% (95% CrI 42–49) of deaths could have been averted had the 20% vaccination coverage target set by COVAX been met by each country, and that an additional 111% (105–118) of deaths could have been averted had the 40% target set by WHO been met by each country by the end of 2021. Interpretation COVID-19 vaccination has substantially altered the course of the pandemic, saving tens of millions of lives globally. However, inadequate access to vaccines in low-income countries has limited the impact in these settings, reinforcing the need for global vaccine equity and coverage. Funding Schmidt Science Fellowship in partnership with the Rhodes Trust; WHO; UK Medical Research Council; Gavi, the Vaccine Alliance; Bill & Melinda Gates Foundation; National Institute for Health Research; and Community Jameel.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Diabetes Res Clin Pract
                Journal ID (iso-abbrev): Diabetes Res Clin Pract
                Title: Diabetes Research and Clinical Practice
                Publisher: Elsevier B.V.
                ISSN (Print): 0168-8227
                ISSN (Electronic): 1872-8227
                Publication date PMC-release: 8 May 2023
                Publication date (Electronic): 8 May 2023
                Electronic Location Identifier: 110694
                Affiliations
                [a ]HangZhou Center for Disease Control and prevention, HangZhou, ZheJiang, China
                Author notes
                [* ]Corresponding author.
                Article
                Publisher Item ID: S0168-8227(23)00457-6 Publisher ID: 110694
                DOI: 10.1016/j.diabres.2023.110694
                PMC ID: 10165863
                SO-VID: 41b0f3fe-b055-41fe-a114-94daf09ff39e
                Copyright © © 2023 Elsevier B.V. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 13 March 2023
                Date revision received : 21 April 2023
                Date accepted : 2 May 2023
                Categories
                Subject: Article

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: sars-cov-2,covid-19 vaccination,vaccine effectiveness,type 2 diabetes mellitus,all-cause death
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: sars-cov-2, covid-19 vaccination, vaccine effectiveness, type 2 diabetes mellitus, all-cause death

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