RESUMO
ChAdOx1-S is a viral vector vaccine developed by AstraZeneca. We aimed to assess the effectiveness of 1 and 2 doses of the ChAdOx1-S vaccine in reducing COVID-19-related in-hospital mortality in individuals with schizophrenia. This is a retrospective cohort study using a nationwide hospital database in Brazil. Individuals diagnosed with COVID-19 and schizophrenia were included in the study. The exposures were 0, 1, and 2 doses of ChAdOx1-S. The outcome of mortality was measured in hazard ratios (HR), calculated using multivariable Cox regression models. The study included 1,929 positive cases of COVID-19 in schizophrenia patients. After adjusting for age, socioeconomic factors, and comorbidities, we observed a significant 55% decrease in the hazard of mortality in the 2-dose vaccination group (HR 0.45, 95% CI: 0.310-0.652) compared to the unvaccinated. Surprisingly, our results did not show any significant reduction in the hazard of mortality in the 1 dose vaccination group (HR 1.278, 95% CI: 0.910-1.795). The effectiveness of two doses of ChAdOx1-S in individuals with schizophrenia aligns with findings from studies on the general population. That one dose was insignificant. Overall, these findings are important for informing public health decisions - prioritizing individuals with schizophrenia for vaccinations and managing acceptance of vaccines.
Assuntos
COVID-19 , Mortalidade Hospitalar , Esquizofrenia , Humanos , Estudos Retrospectivos , Esquizofrenia/mortalidade , COVID-19/prevenção & controle , COVID-19/mortalidade , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Brasil/epidemiologia , SARS-CoV-2/imunologia , ChAdOx1 nCoV-19 , Idoso , Vacinação , Eficácia de Vacinas , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/imunologiaRESUMO
Down syndrome is the most common human chromosomal disorder. Whether Down syndrome is a risk factor for severe COVID-19 outcomes in pediatric patients remains unclear, especially in low-to-middle income countries. We gathered data on patients <18 years of age with SARS-CoV-2 infection from a national registry in Brazil to assess the risk for severe outcomes among patients with Down syndrome. We included data from 14,684 hospitalized patients, 261 of whom had Down syndrome. After adjustments for sociodemographic and medical factors, patients with Down syndrome had 1.8 times higher odds of dying from COVID-19 (odds ratio 1.82, 95% CI 1.22-2.68) and 27% longer recovery times (hazard ratio 0.73, 95% CI 0.61-0.86) than patients without Down syndrome. We found Down syndrome was associated with increased risk for severe illness and death among COVID-19 patients. Guidelines for managing COVID-19 among pediatric patients with Down syndrome could improve outcomes for this population.
Assuntos
COVID-19 , Síndrome de Down , Humanos , Criança , COVID-19/epidemiologia , SARS-CoV-2 , Síndrome de Down/complicações , Síndrome de Down/epidemiologia , Brasil/epidemiologia , Fatores de RiscoRESUMO
OBJECTIVE: COVID-19 in post-partum women is commonly overlooked. The present study assessed whether puerperium is an independent risk factor of COVID-19 related in-hospital maternal death and whether fatality is preventable in the Brazilian context. METHODS: We retrospectively studied the clinical data of post-partum/pregnant patients hospitalized with COVID-19 gathered from a national database that registered severe acute respiratory syndromes (SIVEP-Gripe) in Brazil. Logistic regressions were used to examine the associations of in-hospital mortality with obstetric status and with the type of public healthcare provider, adjusting for socio-demographic, epidemiologic, clinical and healthcare-related measures. RESULTS: As of 30 November 2021, 1943 (21%) post-partum and 7446 (79%) pregnant patients of age between 15 and 45 years with COVID-19 that had reached the clinical endpoint (death or discharge) were eligible for inclusion. Case-fatality rates for the two groups were 19.8% and 9.2%, respectively. After the adjustment for covariates, post-partum patients had almost twice the odds of in-hospital mortality compared with pregnant patients. Patients admitted to private (not-for-profit) hospitals, those that had an obstetric centre or those located in metropolitan areas were less likely to succumb to SARS-CoV-2 infection. Those admitted to the Emergency Care Unit had similar mortality risk to those admitted to other public healthcare providers. CONCLUSION: We demonstrated that puerperium was associated with an increased odds of COVID-19-related in-hospital mortality. Only part of the risk can be reduced by quality healthcare such as non-profit private hospitals, those that have an obstetric centre or those located in urban areas.
Assuntos
COVID-19 , Morte Materna , Gravidez , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , SARS-CoV-2 , Brasil/epidemiologia , Estudos Retrospectivos , Hospitais , Período Pós-Parto , Atenção à SaúdeRESUMO
BACKGROUND: Milder symptoms were observed in children with COVID-19. However, whether this also holds true for neonates is not known. METHODS: The clinical data of a total of 3213 patients aged 2 years or below, including 749 neonates, in Brazil nationwide were studied. Comparisons were made between neonate and infant patients by conducting statistical tests. RESULTS: Neonates appeared to bear more severe clinical courses. In addition to higher case fatality rates, newborns with COVID-19 had much shorter time from symptom onset to death and longer time from symptom onset to discharge. Dyspnoea, sore throat and cough were more prominent in neonate patients, suggestive of both upper and lower respiratory tract infection, as opposed to upper respiratory tract symptoms mostly observed in children. CONCLUSION: Findings suggested that trained immunity provides a possible explanation because the innate immune system in newborns is not "well-trained" while that in adult tends to hyperactive.