INTERNATIONAL AIRLINE MEDICAL ASSOCIATION

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Brief Notes:

This week there is a further downgrading of CDC alert levels in many locations, especially in Africa, but also in Philippines, Mexico, UAE and some others.
(The alert levels were raised to the highest levels for Hong Kong, Thailand, and New Zealand because of high and rising case numbers.) 

This commentary on travel measures from the London School of Hygiene and Tropical Medicine is interesting, and well worth reading – Kucharski et al:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00366-X/fulltext

A very large nationwide French study looking at effectiveness of the Janssen vaccine compared with the Pfizer, was published by Botton et al: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789572

“This study found that the Ad26.COV2.S [Janssen] vaccine is less effective against COVID-19–related hospitalization than the BNT162b2 [Pfizer] vaccine. These results strengthen the evidence supporting a second dose in people who received the [Janssen] vaccine by an mRNA vaccine as recommended in both France and the US.”

In the last update, I should have clarified that the Tartof article below related to pre-Omicron data.  The other studies referenced related to the Omicron period.

I omitted to include a reference from the UK Health Security Agency, which is an evidence review showing that the risk of long COVID is approximately halved by prior vaccination (and also somewhat reduced by vaccination AFTER infection). Protection was greater in older age groups: https://www.gov.uk/government/news/ukhsa-review-shows-vaccinated-less-likely-to-have-long-covid-than-unvaccinated

A new CDC report on waning of third dose – efficacy against emergency room attendance/hospitalisation declines from 87/91% (2 months) to 66/78% (four months). Ferdinands et al: https://www.cdc.gov/mmwr/volumes/71/wr/mm7107e2.htm This is consistent with earlier results from the UK Health Security Agency.

And a US study with several CDC authors, a case-control design looking at hospitalisation vs vaccination status, here – Lauring et al https://www.medrxiv.org/content/10.1101/2022.02.06.22270558v1 This showed that 2 doses of vaccine provided 65% effectiveness against hospitalisation with Omicron. However, 3 doses provided protection against hospitalisation with Omicron similar (86%) to that provided by 2 doses against Delta or Alpha (85%). It confirmed severity was higher for Delta, than Alpha, and lower for Omicron. In all cases, severity was lower amongst the vaccinated.

According, to the WHO, during the week of January 24 to January 30, the global number of new weekly cases remained stable with a 4% increase (over 22 million new cases) while deaths increased by 18% (over 59,000 new deaths reported).

In Africa there was a decrease in deaths, in Western Pacific no change but in other WHO regions (Americas, EMRO, Europe and Asia) deaths increased. Source: BlueDot.

Omicron now predominates in over 65 countries, with reduced vaccine effectiveness overall but still reasonably good vaccine protection against severe illness (see below).  There is evidence of the Omicron wave having reached its crest in a few locations, this having tended to occur 3-5 weeks after the beginning of the rapid rise.

The IATA Medical Evidence Document was updated again (10th edition) over the holiday period, incorporating information on Omicron: https://www.iata.org/globalassets/iata/programs/covid/restart/covid-public-health-meausures-evidence-doc.pdf and another update of the document should follow soon, followed by a move to a different format. 

The WHO Emergency Committee met and confirmed that COVID-19 still constitutes a Public Health Emergency of International Concern (PHEIC) as defined in the International Health Regulations. The committee provided advice in its statement here: https://www.who.int/news/item/19-01-2022-statement-on-the-tenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic

There were 15 million reported COVID cases in the second week of 2022, up from 7 million in the first week of 2022 which saw over 1% of the population catching Covid-19 each week in 26 countries.  These numbers are of course underestimates of the real case numbers. However, numbers of new deaths reported globally remained stable. Omicron is now in more than 160 countries, rapidly outperforming and replacing Delta; Omicron is now the predominant variant in at least 60 countries.