Acceptability of COVID-19 Vaccine Among Hospital Employees in the Department of Paediatrics, Gynaecology and Obstetrics in the University Hospitals of Geneva, Switzerland

BACKGROUND AND AIMS: COVID-19 vaccination has been in the spotlight for almost a year now, both within the scientific community and in the general population. The issue of healthcare workers' (HCWs) hesitancy is particularly salient, given that they are at the forefront of the fight against COVID-19. Not only could unvaccinated HCW spread the disease, but HCWs are also critical messengers in building confidence towards COVID-19 vaccines. The goal of this study was to examine the perception of COVID-19 risk and of its vaccine acceptance among employees (i.e., HCW plus administrative staff) in the Department of Paediatrics, Gynaecology and Obstetrics at the University Hospitals of Geneva, for the purpose of drawing lessons on the determinants of vaccination morale. METHODS: We conducted an anonymous online survey comparing vaccination attitudes among vaccinated and unvaccinated workers in June 2021. It included questions on perception of COVID-19 risks and COVID-19 vaccines. Vaccination was not mandatory in our institution but was strongly recommended. RESULTS: In June 2021, 66% of the 1,800 employees of our department had received two doses of COVID-19 vaccine by the time of the survey. Among the employees, 776 participated (43%) to the survey, and among them 684 (88%) had chosen to be vaccinated. Participants working for longer in a hospital, with a chronic disease and a household contact with chronic disease were more likely to be vaccinated. Doctors were twice as likely to be vaccinated than nurses. Among unvaccinated hospital employees, 48 (52%) responded that they would not change their mind. Further, 35 (38%) were not feeling in danger of contracting severe COVID-19, and 32 (35%) had fears about possible side effects of COVID-19 vaccines that they wanted to discuss with a specialist. CONCLUSION: Our study indicates that, while two-third of the employees had been vaccinated, quite many were still hesitant. The unvaccinated explained their choice by not feeling at risk of complicated COVID-19, and because of fear of possible side effects associated with the vaccine. Investments in COVID-19 vaccine education is a critical component for increasing vaccine acceptance among the unvaccinated

Multicenter Randomized Trial of Methylprednisolone vs. Intravenous Immunoglobulins to Treat the Pediatric Inflammatory Multisystem Syndrome-Temporally Associated With SARS-CoV-2 (PIMS-TS): Protocol of the Swissped RECOVERY Trial.

Introduction: In 2020, a new disease entitled Pediatric Inflammatory Multisystem Syndrome temporally associated with COVID-19 (PIMS-TS), or Multisystem Inflammatory Syndrome in Children (MIS-C), emerged, with thousands of children affected globally. There is no available evidence based on randomized controlled trials (RCT) to date on the two most commonly used immunomodulatory treatments, intravenous immunoglobulins (IVIG) and corticosteroids. Therefore, the Swissped RECOVERY trial was conducted to assess whether intravenous (IV) methylprednisolone shortens hospital length of stay compared with IVIG. Methods and Analysis: Swissped RECOVERY is an ongoing investigator-initiated, open-label, multicenter two-arm RCT in children and adolescents <18 years hospitalized with a diagnosis of PIMS-TS. The trial is recruiting at 10 sites across Switzerland. Patients diagnosed with PIMS-TS are randomized 1:1 to methylprednisolone IV (10 mg/kg/day for 3 days) or IVIG (2 g/kg as a single dose). The primary outcome is hospital length of stay censored at day 28, death, or discharge (whichever is first). The target total sample size is ~80 patients 1:1 randomized to each study arm. Ancillary and exploratory studies on inflammation, vaccination acceptance and coverage, long-term outcomes, and healthcare costs are pre-planned. Significance: Currently, robust trial evidence for the treatment of PIMS-TS is lacking, with a controversy surrounding the use of corticosteroids vs. IVIG. This trial will provide evidence for the effectiveness and safety of these two treatments. Ethics and Dissemination: The study protocol, which was designed based on the U.K. RECOVERY trial, the patient information and consent forms, and other study-specific study documents were approved by the local ethics committees (Project ID: 2021-00362). Registration Details: The study is registered on the Swiss National Clinical Trials Portal (SNCTP000004720) and Clinicaltrials.gov (NCT04826588)

Persistence of protection against invasive bacteria-memory b cell response in infants after immunisation

Rapid waning of antibody and vaccine effectiveness is observed following infant immunisation with protein-polysaccharide conjugate vaccines. This is despite the demonstrable presence of immunological memory. However, disease can develop within a few days of carriage acquisition of encapsulated bacteria. Persistence of functional antibody, therefore, appears to be the key determinant of long-term protection against invasive bacterial diseases. Antibody persistence is thought to depend on the survival of long-lived plasma cells and memory B cells generated in germinal centres (GC). Using the ELISpot method, the kinetics of the B cell response following a booster dose of MenC conjugate vaccine (MenCV) at one year of age, and following a 2 dose-primary course of a new tetravalent meningococcal vaccine (MenACWY-CRM197) given at 2 and 4 months of age, were determined. It was found that priming with these vaccines induced protective antibody levels in the majority of children but detectable memory B cells only in a subset of children. A strong association was found between the level of polysaccharide-specific antibody and memory B cells produced after priming, and the persistence of functional antibody at one year of age. The kinetics of a primary B cell response were determined in healthy adults after immunisation with rabies vaccine, and compared to the B cell response following primary immunisation with MenCV in 2 months old infants. The timing of appearance of the B cells in peripheral blood was similar in infants and adults, although the magnitude of the response was slightly lower in infants. These observations suggest that long-term humoral immunity induced by immunisation with protein-polysaccharide conjugate vaccines in early infancy depends on the production of adequate GCs during priming. The children who generate efficient GCs during priming (identified by higher production of memory B cells, plasma cells and Abs) may best maintain protective antibody levels in the long-term, while those children generating less efficient GCs, have a smaller B cell pool, lower antibody response during priming, and might not maintain protective antibody levels in the long-term

Persistence of protection against invasive bacteria memory B cell responses in infants after immunisation

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Persistence of protection against invasive bacteria-memory b cell response in infants after immunisation

Rapid waning of antibody and vaccine effectiveness is observed following infant immunisation with protein-polysaccharide conjugate vaccines. This is despite the demonstrable presence of immunological memory. However, disease can develop within a few days of carriage acquisition of encapsulated bacteria. Persistence of functional antibody, therefore, appears to be the key determinant of long-term protection against invasive bacterial diseases. Antibody persistence is thought to depend on the survival of long-lived plasma cells and memory B cells generated in germinal centres (GC). Using the ELISpot method, the kinetics of the B cell response following a booster dose of MenC conjugate vaccine (MenCV) at one year of age, and following a 2 dose-primary course of a new tetravalent meningococcal vaccine (MenACWY-CRM197) given at 2 and 4 months of age, were determined. It was found that priming with these vaccines induced protective antibody levels in the majority of children but detectable memory B cells only in a subset of children. A strong association was found between the level of polysaccharide-specific antibody and memory B cells produced after priming, and the persistence of functional antibody at one year of age. The kinetics of a primary B cell response were determined in healthy adults after immunisation with rabies vaccine, and compared to the B cell response following primary immunisation with MenCV in 2 months old infants. The timing of appearance of the B cells in peripheral blood was similar in infants and adults, although the magnitude of the response was slightly lower in infants. These observations suggest that long-term humoral immunity induced by immunisation with protein-polysaccharide conjugate vaccines in early infancy depends on the production of adequate GCs during priming. The children who generate efficient GCs during priming (identified by higher production of memory B cells, plasma cells and Abs) may best maintain protective antibody levels in the long-term, while those children generating less efficient GCs, have a smaller B cell pool, lower antibody response during priming, and might not maintain protective antibody levels in the long-term.</p

Pediatric COVID-19: Immunopathogenesis, Transmission and Prevention

Children are unique in the context of the COVID-19 pandemic. Overall, SARS-CoV-2 has a lower medical impact in children as compared to adults. A higher proportion of children than adults remain asymptomatic following SARS-CoV-2 infection and severe disease and death are also less common. This relative resistance contrasts with the high susceptibility of children to other respiratory tract infections. The mechanisms involved remain incompletely understood but could include the rapid development of a robust innate immune response. On the other hand, children develop a unique and severe complication, named multisystem inflammatory syndrome in children, several weeks after the onset of symptoms. Although children play an important role in the transmission of many pathogens, their contribution to the transmission of SARS-CoV-2 appears lower than that of adults. These unique aspects of COVID-19 in children must be considered in the benefit–risk analysis of vaccination. Several COVID-19 vaccines have been authorized for emergency use in adolescents and clinical studies are ongoing in children. As the vaccination of adolescents is rolled out in several countries, we shall learn about the impact of this strategy on the health of children and on transmission within communities

Impact of COVID-19 and intensive care unit capacity on vaccination support: evidence from a two-leg representative survey in the United Kingdom

Background Overcoming coronavirus disease (COVID-19) will likely require mass vaccination. With vaccination scepticism rising in many countries, assessing the willingness to vaccinate against COVID-19 is of crucial global health importance. Objective The goal of this study was to examine how personal and family COVID-19 risk and ICU (intensive care unit) availability just before the pandemics influence the acceptance of future COVID-19 vaccines. Methods A two-leg survey was carried out for comparing vaccination attitudes pre-and post-COVID-19. UK residents were surveyed in October 2019 about their vaccination attitudes, and again in a follow-up survey in April 2020, containing the previous questions and further ones related to COVID-19 exposure and COVID-19 vaccine attitudes. The study combined survey results with local COVID-19 incidence and pre-COVID-19 measures of ICU capacity and occupancy. Regression analysis of the impact of individual and public health factors on attitudes towards COVID-19 vaccination was performed. Results The October 2019 survey included a nationally representative sample of 1653 UK residents. All of them were invited for the follow-up survey in April 2020, and 1194 (72%) participated. The April 2020 sample remained nationally representative. Overall, 85% of respondents (and 55% of vaccine sceptics) would be willing to be vaccinated against COVID-19. Higher personal and family risk for COVID-19 was associated with stronger COVID-19 vaccination willingness, whereas low pre-COVID-19 ICU availability was associated with lower trust in medical experts and lower COVID-19 vaccine support. Further, general vaccination support has risen during the COVID-19 pandemic. Conclusion Support for COVID-19 vaccination is high amongst all groups, even vaccine sceptics, boding well for future vaccination take-up rates. Vaccination willingness is correlated with health care availability during the COVID-19 crisis, suggesting a powerful synergy between health care system performance during crisis and the general population's trust in the medical profession – as reflected in vaccination support

Sustaining immunity after immunization against encapsulated bacteria

Infections by encapsulated bacteria are important causes of infant mortality worldwide. Over the last 20 years protein-polysaccharide conjugate vaccines have been developed to protect against the major invasive bacterial diseases of childhood, Streptococcus pneumoniae, Haemophilus influenzae type b (Hib) and Neisseria meningitidis. These vaccines are highly immunogenic and have resulted in a huge reduction in the diseases caused by these bacteria in the countries that have introduced them in their immunisation schedules. However, it has been reported that infant immunisation is associated with a relatively short duration of antibody levels and vaccine effectiveness, despite the demonstrable presence of booster responses to further vaccine dose. In contrast, at older ages, more sustained protection has been described with just a single dose of a conjugate vaccine. Understanding the generation of long-term immunity, by protein-polysaccharide conjugate vaccines, is essential to reduce infant mortality through the improvement of vaccine formulation and scheduling

Comparison of a limiting dilution assay and ELISpot for detection of memory B-cells before and after immunisation with a protein-polysaccharide conjugate vaccine in children

In the present study, the limiting dilution assay (LDA) and the ELISpot are compared in their ability to detect serogroup C meningococcal (MenC)-specific memory B-cells in peripheral blood of 12 month old children, after 3-dose priming with serogroup C meningococcal conjugate vaccine (MenCV) in infancy. At 12 months of age, MenC-memory B-cells were detected by ELISpt in 61% of children and in 5% by LDA. In contrast, carrier-specific memory B-cells were measurable in 36% of children by LDA and 78% by ELISpot. One month after a booster dose of MenCV given at 12 months of age, MenC-specific memory B-cells were detected in 89% of children by ELISpot and 65% of children by LDA, while diphtheria toxoid-specific memory B-cells were detected in 88% of childen by ELISpot and in 74% of children by LDA. Two statistical methods were applied to enumerate memory B-cells with the LDA assay; the Poisson method allowed determination of very low frequencies that could not be determined by the Reed and Muench method. These data are examples of alternative methods to assess long-term protection after protein-polysaccharide conjugate vaccine, through direct measurement of memory B-cells in peripheral blood shortly after immunisation

Pediatric covid-19: Immunopathogenesis, transmission and prevention

Children are unique in the context of the COVID-19 pandemic. Overall, SARS-CoV-2 has a lower medical impact in children as compared to adults. A higher proportion of children than adults remain asymptomatic following SARS-CoV-2 infection and severe disease and death are also less common. This relative resistance contrasts with the high susceptibility of children to other respiratory tract infections. The mechanisms involved remain incompletely understood but could include the rapid development of a robust innate immune response. On the other hand, children develop a unique and severe complication, named multisystem inflammatory syndrome in children, several weeks after the onset of symptoms. Although children play an important role in the transmission of many pathogens, their contribution to the transmission of SARS-CoV-2 appears lower than that of adults. These unique aspects of COVID-19 in children must be considered in the benefit–risk analysis of vaccination. Several COVID-19 vaccines have been authorized for emergency use in adolescents and clinical studies are ongoing in children. As the vaccination of adolescents is rolled out in several countries, we shall learn about the impact of this strategy on the health of children and on transmission within communities.SCOPUS: re.jinfo:eu-repo/semantics/publishe