Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Caracterização de vias de imunidade em Lutzomyia longipalpis (Diptera: Psychodidae)

Made available in DSpace on 2016-04-04T12:35:25Z (GMT). No. of bitstreams: 2 bruno_nunes_ioc_mest_2014.pdf: 2295523 bytes, checksum: ae908a52d5c21a69d898434ee645c5cf (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2014Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, BrasilInsetos são expostos a diversos microrganismos patogênicos durante seu ciclo de vida. Para sobreviverem a riscos de infecções, os insetos possuem várias barreiras e respostas imunes. O sistema imune de insetos é basicamente composto por vias de sinalização que controlam uma diversidade de mecanismos efetores, deste modo permitindo o controle da maior parte das infecções. Assim como em outros organismos, há três principais vias de sinalização relacionadas à imunidade em insetos: Toll, Imd e Jak/STAT. Nosso objetivo foi caracterizar estas vias imunes em L. longipalpis, o principal vetor da leishmaniose visceral no Brasil. Para isto, nós transfectamos células embrionárias LL5 de L. longipalpis com RNA dupla fita para os genes repressores cactus (Toll), caspar (Imd) e pias (Jak/STAT). Usando esta abordagem, foi possível correlacionar a expressão dos peptídeos anti-microbianos (AMPs) com as vias correspondentes. Nós vimos que cecropina e defensina 4 foram reguladas positivamente após transfecção com RNA dupla fita para cactus e caspar, mostrando regulação redundante pelas vias Toll e Imd. Nós também silenciamos o gene cactus em insetos adultos. Diferente do que foi observado em células LL5, atacina, cecropina e defensina 4 foram reguladas negativamente após o silenciamento. É possível que este resultado seja explicado pelo efeito de uma alça de regulação negativa da via Toll, de modo a preservar a microbiota na ausência de estímulo imune Além disso, nós avaliamos a resposta de genes de imunidade durante a infecção por Leishmania infantum chagasi em insetos adultos. Cactus foi regulado positivamente 48 horas após infecção, demonstrando o papel da via Toll em resposta à infecção por Leishmania. A expressão de SHP-1 foi modulada durante a infecção, com aumento significativo da expressão, em 48 horas. Este resultado sugere que, assim como em macrófagos, Gp63 ativa SHP-1, do hospedeiro invertebrado e, com isso, inibe a via Toll, possivelmente imunossuprimindo o flebotomíneo. Os AMPs atacina, cecropina e defensina 4 mostraram aumento significativo da expressão 72 horas após infecção, quando o parasita interage diretamente com o epitélio intestinal do flebotomíneo. A carga parasitária diminuiu significativamente nos terceiro e quarto dias, provavelmente devido ao aumento da expressão de AMPs nestes pontos. Estes resultados indicam que esses genes são regulados pelo flebotomíneo em resposta a presença de Leishmania, e que podem causar impactos na sobrevivência do parasita no intestino do inseto durante a infecçãonsects are exposed to a wide range of pathogenic microorganisms during their life cycle. In order to survive infection risks, insects developed several structural barriers and immune responses . The insect immune system is basically composed of signaling pathways that control a diversity of effector mechanisms, thus allowing control of most infections. As found in other organisms, there are three main signaling pathways related to immunity in insects: Toll, Imd and Jak/STAT. Our purpose was to characterize these immune pathways in L. longipalpis, the main vector of visceral leishmaniasis in Brazil. For this, we transfected L. longipalpis embryonic LL5 cells with dsRNA for the repressor genes cactus (Toll), caspar (Imd) and PIAS (Jak/STAT). Using this approach, it was possible to correlate the expression of AMPs to corresponding pathways. We found that cecropin and defensin 4 were upregulated after t ransfection by dsRNA for cactus and caspar, showing redundant regulation via the Toll and IMD pathways. We also silenced the cactus gene in adult insects by dsRNA. U nlike what was observed in LL5 cells , attacin, cecropin and defensin 4 genes were downregul ated after silencing. This result might be explained by the effect of a negative regulation loop via Toll, to preserve the microbiota in the absence of immune stimulation. Furthermore, we assessed the response of immunity genes upon Leishmania infantum cha gasi infection in adult insect. Cactus was upregulated at 48 hours after infection, demonstrating the role of the Toll pathway in response to Leishmania infection. The SHP - 1 expression was modulated during infection , with a significant increase in expressi on at 48 hours. This result suggests that, like in macrophages , Leishmania Gp63 activates SHP - 1 of the invertebrate host and thereby inhibits the Toll pathway , possibly immunosuppressing the sandfly . The AMPs attacin, cecropin and defensin 4 showed signifi cant increase in expression at 72 hours after infection, when the parasite is interacting closely with the sand fly intestinal epithelium . The parasite load decreased significantly on the third and fourth days after infection , probably due to increasead AM Ps expression at this point. These results indicate that these genes are regulated by the sand fly immune response upon the presence of Leishmania , which may have an impact on parasite survival in the insect gut during infectio

The sandfly Lutzomyia longipalpis LL5 embryonic cell line has active Toll and Imd pathways and shows immune responses to bacteria, yeast and Leishmania

Submitted by Sandra Infurna ([email protected]) on 2016-12-29T16:22:07Z No. of bitstreams: 1 bruno_nunes_etal_IOC_2016.pdf: 1229712 bytes, checksum: 11bb095573e0fd7b51b849adad88342a (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2016-12-29T16:33:06Z (GMT) No. of bitstreams: 1 bruno_nunes_etal_IOC_2016.pdf: 1229712 bytes, checksum: 11bb095573e0fd7b51b849adad88342a (MD5)Made available in DSpace on 2016-12-29T16:33:06Z (GMT). No. of bitstreams: 1 bruno_nunes_etal_IOC_2016.pdf: 1229712 bytes, checksum: 11bb095573e0fd7b51b849adad88342a (MD5) Previous issue date: 2016Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia Molecular de Parasitas e Vetores. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia Molecular de Parasitas e Vetores. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia Molecular de Parasitas e Vetores. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia Molecular de Parasitas e Vetores. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia Molecular de Parasitas e Vetores. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia Molecular de Parasitas e Vetores. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia Molecular de Parasitas e Vetores. Rio de Janeiro, RJ, Brasil.Lutzomyia longipalpis is the main vector of visceral leishmaniasis in Latin America. Sandfly immune responses are poorly understood. In previous work we showed that these vector insects respond to bacterial infections by modulating a defensin gene expression and activate the Imd pathway in response to Leishmania infection. Aspects of innate immune pathways in insects (including mosquito vectors of human diseases) have been revealed by studying insect cell lines, and we have previously demonstrated antiviral responses in the L. longipalpis embryonic cell line LL5