Influence of the Peltzman effect on the recurrent COVID-19 waves in Europe

Iyengar, Karthikeyan P; Ish, Pranav; Botchu, Rajesh; Jain, Vijay Kumar; Vaishya, Raju

doi:10.1136/postgradmedj-2021-140234

Cited by 27 publications

(25 citation statements)

References 6 publications

(5 reference statements)

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“…The copyright holder for this preprint this version posted March 2, 2022. ; https://doi.org/10.1101/2022.03.02.22271385 doi: medRxiv preprint individuals/households, resulting in more infections than expected. Such behavioral changes have been attributed to the Peltzman effect that suggests people typically adjust their behaviour according to perceived risk (31,32). Our study highlights the need for appropriate communication of public health messages when interventions are being introduced for better disease control.…”

Section: Vaccinated Individuals Carry Similar Transmission Risks Emph...mentioning

confidence: 74%

“…The perceived lower risk of acquiring infection upon vaccination, especially among the younger people, may have caused an increased tendency for not following COVID-19 appropriate behaviour by these individuals/households, resulting in more infections than expected. Such behavioral changes have been attributed to the Peltzman effect that suggests people typically adjust their behaviour according to perceived risk (31, 32). Our study highlights the need for appropriate communication of public health messages when interventions are being introduced for better disease control.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Delta and Vaccination on SARS-CoV-2 transmission risk: Lessons for Emerging Breakthrough infections

Sriraman

Shaikh

Vaswani

et al. 2022

Preprint

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With the continuous emergence of SARS-CoV-2 variants of concern and implementation of mass-scale interventions like vaccination, understanding factors affecting disease transmission has critical implications for control efforts. Here we used a simple adapted N95 mask sampling method to demonstrate the impact of circulating SARS-CoV-2 variants and vaccination on 92 COVID-19 patients to expel virus into the air translating to a transmission risk. Between July and September 2021, when the Delta was the dominant circulating strain in Mumbai, we noted a two-fold increase in the proportion of people expelling virus (95%), about an eighty-fold increase in median viral load and a three-fold increase in high emitter type (41%; people expelling >1000 viral copy numbers in 30 minutes) compared to initial strains of 2020. Eight percent of these patients continued to be high emitters even after eight days of symptom onset, suggesting a probable increased transmission risk for Delta strain even at this stage. There was no significant difference in expelling pattern between partial, full and un-vaccinated individuals suggesting similar transmission risk. We noted significantly more infections among vaccinated study patients and their household members than unvaccinated, probably due to increased duration from vaccination and/or increased risk behaviour upon vaccination due to lower perceived threat. This study provides biological evidence for possible continued transmission of the Delta strain even with vaccination, emphasizing the need to continue COVID-19 appropriate behaviour. The study also indicates that the mask method may be useful for screening future vaccine candidates, therapeutics or interventions for their ability to block transmission.

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Section: Vaccinated Individuals Carry Similar Transmission Risks Emph...mentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Impact of Delta and Vaccination on SARS-CoV-2 transmission risk: Lessons for Emerging Breakthrough infections

Sriraman

Shaikh

Vaswani

et al. 2022

Preprint

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“…A possible reason for the apparent increased incidence of infection in vaccinated versus unvaccinated SOT recipients may be risk compensation with reduced adherence to NPI in the vaccinated population. 30 Modeling has shown that risk compensation is likely to disproportionately reduce VE in high-risk populations. 31 UKHSA reported on >90% protection against mortality with both ChAdOx1-S and BNT162b2 vaccines during both Alpha and Delta variant surges in the United Kingdom.…”

Section: Discussionmentioning

confidence: 99%

Real-world Effectiveness of the Pfizer-BioNTech BNT162b2 and Oxford-AstraZeneca ChAdOx1-S Vaccines Against SARS-CoV-2 in Solid Organ and Islet Transplant Recipients

et al. 2022

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Background. The clinical effectiveness of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in immunosuppressed solid organ and islet transplant (SOT) recipients is unclear. Methods. We linked 4 national registries to retrospectively identify laboratory-confirmed SARS-CoV-2 infections and deaths within 28 d in England between September 1, 2020, and August 31, 2021, comparing unvaccinated adult SOT recipients and those who had received 2 doses of ChAdOx1-S or BNT162b2 vaccine. Infection incidence rate ratios were adjusted for recipient demographics and calendar month using a negative binomial regression model, with 95% confidence intervals. Case fatality rate ratios were adjusted using a Cox proportional hazards model to generate hazard ratio (95% confidence interval). Results. On August 31, 2021, it was found that 3080 (7.1%) were unvaccinated, 1141 (2.6%) had 1 vaccine dose, and 39 260 (90.3%) had 2 vaccine doses. There were 4147 SARS-CoV-2 infections and 407 deaths (unadjusted case fatality rate 9.8%). The riskadjusted infection incidence rate ratio was 1.29 (1.03-1.61), implying that vaccination was not associated with reduction in risk of testing positive for SARS-CoV-2 RNA. Overall, the hazard ratio for death within 28 d of SARS-CoV-2 infection was 0.80 (0.63-1.00), a 20% reduction in risk of death in vaccinated patients (P = 0.05). Two doses of ChAdOx1-S were associated with a significantly reduced risk of death (hazard ratio, 0.69; 0.52-0.92), whereas vaccination with BNT162b2 was not (0.97; 0.71-1.31). Conclusions. Vaccination of SOT recipients confers some protection against SARS-CoV-2-related mortality, but this protection is inferior to that achieved in the general population. SOT recipients require additional protective measures, including further vaccine doses, antiviral drugs, and nonpharmaceutical interventions. (Transplantation 2022;106: 436-446).

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“…Infection was in fact more frequent in vaccinated recipients (incidence rate ratio, 1.29; 95% confidence intervals [CI], 1.03-1.61), hypothesized to relate to risk compensation behavior in vaccinated individuals. 157 Of SOT recipients testing positive for SARS-CoV-2, vaccination associated with a 20% reduction in risk of death (8.2% versus 10.4%), but this was driven by a 30% mortality reduction in those receiving ChAdOx1 (hazard ratio, 0.69; 95% CI, 0.52-0.92), whereas BNT162b2 did not confer mortality benefit (hazard ratio, 0.97; 95% CI, 0.71-1.31). 100 In Scotland, vaccine effectiveness of 40% at preventing infection and hospitalization has been being reported in kidney transplant recipients, 155 lower than the 70%–90% vaccine effectiveness in general populations.…”

Section: Management Of Covid-19: Infection Preventionmentioning

confidence: 99%

The Global Impact of COVID-19 on Solid Organ Transplantation: Two Years Into a Pandemic

et al. 2022

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The coronavirus disease 2019 (COVID-19) pandemic has had a major global impact on solid organ transplantation (SOT). An estimated 16% global reduction in transplant activity occurred over the course of 2020, most markedly impacting kidney transplant and living donor programs, resulting in substantial knock-on effects for waitlisted patients. The increased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection risk and excess deaths in transplant candidates has resulted in substantial effort to prioritize the safe restart and continuation of transplant programs over the second year of the pandemic, with transplant rates returning towards prepandemic levels. Over the past 2 y, COVID-19 mortality in SOT recipients has fallen from 20%–25% to 8%–10%, attributed to the increased and early availability of SARS-CoV-2 testing, adherence to nonpharmaceutical interventions, development of novel treatments, and vaccination. Despite these positive steps, transplant programs and SOT recipients continue to face challenges. Vaccine efficacy in SOT recipients is substantially lower than the general population and SOT recipients remain at an increased risk of adverse outcomes if they develop COVID-19. SOT recipients and transplant teams need to remain vigilant and ongoing adherence to nonpharmaceutical interventions appears essential. In this review, we summarize the global impact of COVID-19 on transplant activity, donor evaluation, and patient outcomes over the past 2 y, discuss the current strategies aimed at preventing and treating SARS-CoV-2 infection in SOT recipients, and based on lessons learnt from this pandemic, propose steps the transplant community could consider as preparation for future pandemics.

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Influence of the Peltzman effect on the recurrent COVID-19 waves in Europe

Cited by 27 publications

References 6 publications

Impact of Delta and Vaccination on SARS-CoV-2 transmission risk: Lessons for Emerging Breakthrough infections

Impact of Delta and Vaccination on SARS-CoV-2 transmission risk: Lessons for Emerging Breakthrough infections

Real-world Effectiveness of the Pfizer-BioNTech BNT162b2 and Oxford-AstraZeneca ChAdOx1-S Vaccines Against SARS-CoV-2 in Solid Organ and Islet Transplant Recipients

The Global Impact of COVID-19 on Solid Organ Transplantation: Two Years Into a Pandemic

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