Effectiveness of ChAdOx1 nCoV-19 coronavius vaccine in preventing severe disease and mortality during the second wave of pandemic:A case-case analysis from a tertiary care center in South India

Objective:To determine the real-world effectiveness of the ChAdOx1 nCoV-19 coronavirus vaccine in preventing severe disease and mortality due to COVID-19.Methods:A case-case design was used to estimate the effect of the ChAdOx1 nCoV-19 coronavirus vaccine on severe SARS-CoV-2 outcomes in individuals aged 40 years and above.Cases(n=200)were COVID-19 patients admitted to intensive care unit(ICU)or who died.Controls(n=223)were those with mild COVID-19,fit for home isolation.The logistic regression model was used to estimate adjusted vaccine effectiveness for full vaccination(two doses≥14 d)and partial vaccination status(one dose≥14 d or two doses<14 d).Results:The proportion of fully vaccinated individuals was significantly lower among cases(12,6.0%)compared to controls(30,13.5%).The adjusted effectiveness of a full dose of ChAdOx1 nCoV-19 coronavirus vaccine in preventing ICU admission or death was 81.9%(95%CI:61.3%-91.6%,P=0.001).Subgroup analysis restricted to age group,sex,and comorbidities found that ChAdOx1 nCoV-19 coronavirus vaccine had a significant positive effect in all subgroups and categories.Conclusion:COVID-19 vaccination reduces ICU admissions or death.Therefore,increased vaccine uptake may reduce the severity of the pandemic,more so in the elderly and those with comorbidities.

Dynamics of transmission of COVID-19 cases and household contacts:A prospective cohort study

Objective:To study the transmission dynamics of coronavirus disease 2019(COVID-19)among 101 confirmed cases and their 387 household contacts and to determine risk factors associated with secondary attack among the household contacts.Methods:A prospective cohort study was conducted from January 1st 2021 to February 28th 2021,among 101 SARS-CoV-2 cases and 387 household contacts who were followed up for 14 days from the last day of contact with the index case of COVID-19.The dynamics of disease transmission was estimated,and factors affecting transmission risk were analyzed.Besides,the association between various factors and household secondary attack rate was determined.Results:The median incubation period was found to be 5 days,and the observed reproductive number(R)was found to be 1.63(95%CI:1.28-1.98).The mean household secondary attack rate was 40.7%.Contacts with comorbidities like diabetes mellitus,hypertension,dyslipidemia,and hypothyroidism had significantly higher attack rates(P<0.05).Conclusions:As new variants of SARS-CoV-2 emerges,it is crucial to know the trasmission dynamics.This study shows a high secondary attack rate of COVID-19 among household contacts that must be closely monitored.

Are Family Doctors Compliant with Breast Family History Guidelines?

Introduction: Optimizing breast cancer care involves accurate risk assessment. Referrals to secondary care need to be appropriate both in terms of healthcare resource utilisation and the reduction of unnecessary patient anxiety. Aim: This study undertook an evaluation of family doctors compliance with NICE guidelines for asymptomatic family history referrals to a breast unit. Methods: A retrospective audit of general practice in County Donegal was carried out between January 2010 and May 2011. NICE guidelines and IBIS computerised model were used to assess whether referrals were appropriate. Results: 77.6% (90/116) met a criterion for secondary care referral. 51.7% (60/116) met the NICE criteria and 64.7% (75/116) met the IBIS criteria for referral to secondary care. 38.8% (45/116) met both. 6 were of low risk, 45 were of moderate risk and 1 was of high risk. 80.4% (45/56) of the patients who did not meet the NICE criteria, failed to do so because they had one 1st degree relative with breast cancer who was over the age of 40. Conclusion: 77.6% of referrals complied with international criteria for referral to secondary care. A greater understanding of what constitutes appropriate referral of 1st degree relatives would enhance the referral process.