Patients at high risk for a severe clinical course of COVID-19 — small-area data in support of vaccination and other population-based interventions in Germany

Holstiege, Jakob; Akmatov, Manas K.; Kohring, Claudia; Dammertz, Lotte; Ng, Frank C.H.; Czihal, Thomas; Stillfried, Dominik von; Bätzing, Jörg

doi:10.1186/s12889-021-11735-3

Cited by 5 publications

(3 citation statements)

References 29 publications

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“… 72 There are limited data regarding vaccine efficacy in high-risk groups such as patients with cancer, with a lack of clinical evidence for the guidance of the vaccination protocols in such patients. High-risk groups, including those with obesity, chronic obstructive pulmonary disease, chronic kidney disease, chronic liver disease, diabetes mellitus, and cardiovascular diseases, 73 , 74 for whom vaccination protection may be attenuated, now carry a tremendous burden of risk amongst the population. Multiple potential future scenarios exist, ranging from complete protection from COVID-19 for patients at high risk via herd immunity to viral evolution for vaccine resistance and increased virulence.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 therapy and vaccination: a clinical narrative review

Chinta¹,

Rodríguez-Guerra²,

Shaban³

et al. 2023

DIC

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The SARS-CoV-2 pandemic is the most globally impacting health issue our world has faced over the last century. As of January 7, 2022, around 300 million cases have been reported worldwide, with over 5 million deaths. The SARS-CoV-2 infection causes a hyperactive host immune response leading to an excessive inflammatory reaction with the release of many cytokines — cytokine storm — commonly noticed in acute respiratory distress syndrome, sepsis and fulminant multiorgan failure. Since the beginning of the pandemic, the scientific medical community has worked on therapeutic procedures that interfere with the exaggerated immune response. Thromboembolic complications are widespread in patients who are critically ill with COVID-19. Anticoagulant therapy was initially considered a cornerstone in hospitalized patients and even in the early post-discharge period; however, later trials have aborted the clinical benefits except for suspicion of or confirmed thrombosis. Immunomodulatory therapies are still crucial in moderate to severe COVID-19. Immunomodulator therapies include various medications from steroids to hydroxychloroquine, tocilizumab and Anakinra. Anti-inflammatory agents, vitamin supplements and antimicrobial therapy had initial encouraging evidence, but there are limited data to review. Convalescent plasma, immunoglobulins, eculizumab, neutralizing IgG1 monoclonal antibodies and remdesivir have positively impacted inpatient mortality and hospital length of stay. Eventually, wide population vaccination was proven to be the best tool to overcome the SARS-CoV-2 pandemic and help humanity return to regular life. Many vaccines and various strategies have been used since December 2020. This review discusses how the SARS-CoV-2 pandemic has progressed and surged, and summarizes the safety and efficacy of the most used therapies and vaccines in the light of recent evidence.

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Section: Discussionmentioning

confidence: 99%

COVID-19 therapy and vaccination: a clinical narrative review

Chinta¹,

Rodríguez-Guerra²,

Shaban³

et al. 2023

DIC

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“…Holstiege J и соавт. (2021) выделили группы риска тяжёлого течения COVID-19: группа риска 1 -люди в возрасте от 15 до 59 лет с двумя или более прогностически значимыми хроническими заболеваниями или гематологической опухолью / трансплантацией / иммуносупрессией; группа риска 2 -люди в возрасте от 60 до 79 лет с хотя бы одним прогностически значимым хроническим заболеванием; группа риска 3 -люди в возрасте 80 лет и старше, независимо от сопутствующих хронических заболеваний [17]. К основным прогностически значимым заболеваниям, повышающим риск госпитализации и смерти, отнесены: ожирение, хроническая обструктивная болезнь лёгких, хроническая болезнь почек / почечная недостаточность, хроническое заболевание печени, деменция, сахарный диабет 2-го типа, артериальная гипертензия, сердечно-сосудистые заболевания, ишемическая болезнь сердца, сердечная недостаточность, солидные опухоли, гематологические опухоли, инсульт или постинсультное состояние и цереброваскулярные осложнения [18].…”

Section: обсуждение / Discussionunclassified

Factors associated with adverse outcome among hospitalized patients with moderate to severe COVID-19

Mishinova

Gomon

Kolbin

et al. 2023

GCP

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Aims. To consider factors associated with adverse outcome among hospitalized patients with moderate and severe COVID-19.Materials and methods. Data from 345 case histories of adult patients hospitalized with moderate to severe COVID-19 were analyzed in a single-center retrospective study. Characteristics by sex, age, number of days from disease onset to admission to hospital, duration of hospitalization, duration of disease, population characteristics by medical history of comorbidities and self-medication, outcome of hospitalization and medical technologies used in hospital conditions were given for the whole cohort of patients. All parameters were analyzed using descriptive statistics methods. Qualitative variables are given in absolute (n) and relative (%) values with 95% confidence interval. Continuous variables were presented as median and quartiles. Risk factors for mortality were determined across groups using the χ2 criterion and odds ratio.Results. There was no demonstrated effect of gender, degree of pulmonary tissue lesions on computed tomography data, or time of initiation of respiratory support on disease outcome. At the same time, the age older than 65 years as well as neoplasms, type 2 diabetes mellitus, dementia, Stage 3 arterial hypertension, chronic heart failure, coronary heart disease, myocardial infarction and stroke history, chronic obstructive pulmonary disease, bronchiectatic disease, urogenital diseases were the predictors of unfavorable outcome in patients with moderate and severe COVID-19 form. Prehospital use of antiplatelet agents, direct and indirect oral anticoagulants, drugs affecting the renin-angiotensin system, systemic glucocorticosteroids, antibiotics, antiviral drugs, and analgesics was associated with a decrease in the mortality rate in patients with moderate-to-severe COVID-19, as well as timely use of pronposition and transfer to intensive care unit.Conclusions. Our findings are partially consistent with previous reports on the effect of risk factors on COVID-19 outcomes.

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“…For each analysis, we were interested in understanding the impact of vaccination in adults in Germany aged 60 years and older, as well as those aged 30-59 years with at-risk conditions, mirroring STIKO recommendations. A previous study estimated the approximate size of the population at greater risk of severe COVID-19 outcomes following infection [32]. Using this study, we estimated 21% of the population in Germany aged 30-59 years had at least one chronic condition that increased the risk of a severe outcome following COVID-19 infection.…”

Section: Populationmentioning

confidence: 99%

Clinical impact and cost-effectiveness of the updated COVID-19 mRNA Autumn 2023 vaccines in Germany

Joshi,

Scholz,

Maschio

et al. 2023

Preprint

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ObjectivesTo assess the potential clinical impact and cost-effectiveness of coronavirus disease 2019 (COVID-19) mRNA vaccines updated for Autumn 2023 in adults aged ≥60 years and high-risk persons aged 30-59 years in Germany over a 1-year analytic time horizon (September 2023--August 2024).MethodsA compartmental Susceptible-Exposed-Infected-Recovered model was updated and adapted to the German market. Numbers of symptomatic infections, number of COVID-19 related hospitalisations and deaths, costs, and quality-adjusted life-years (QALYs) gained were calculated using a decision tree model. The incremental cost-effectiveness ratio of an Autumn 2023 Moderna updated COVID-19 (mRNA-1273.815) vaccine was compared to no additional vaccination. Potential differences between the mRNA-1273.815 and the Autumn Pfizer-BioNTech updated COVID-19 (XBB.1.5 BNT162b2) vaccines, as well as societal return on investment for the mRNA-1273.815 vaccine relative to no vaccination, were also examined.ResultsCompared to no Autumn vaccination, the mRNA-1273.815 campaign is predicted to prevent approximately 1,697,900 symptomatic infections, 85,400 hospitalisations, and 4,100 deaths. Compared to an XBB.1.5 BNT162b2 campaign, the mRNA-1273.815 campaign is also predicted to prevent approximately 90,100 symptomatic infections, 3,500 hospitalisations, and 160 deaths. Across both analyses we found the mRNA-1273.815 campaign to be dominant.ConclusionsThe mRNA-1273.815 vaccine can be considered cost-effective relative to the XBB.1.5 BNT162b2 vaccine and highly likely to provide more benefits and save costs compared to no vaccine in Germany, and to offer high societal return on investment.

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Patients at high risk for a severe clinical course of COVID-19 — small-area data in support of vaccination and other population-based interventions in Germany

Cited by 5 publications

References 29 publications

COVID-19 therapy and vaccination: a clinical narrative review

COVID-19 therapy and vaccination: a clinical narrative review

Factors associated with adverse outcome among hospitalized patients with moderate to severe COVID-19

Clinical impact and cost-effectiveness of the updated COVID-19 mRNA Autumn 2023 vaccines in Germany

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