Shuaibing Dong

Background: Hand, foot, and mouth disease (HFMD) remains a major public-health concern in China. While the monovalent EV-A71 vaccine has effectively reduced EV-A71–associated cases, it offers no protection against CV-A16. The introduction of a bivalent EV-A71/CV-A16 vaccine may offer broader protection, but its economic viability under different immunization strategies remains uncertain. Methods: We developed a dynamic transmission model integrated with cost-effectiveness analysis to assess the epidemiological and economic impact of a hypothetical bivalent EV-A71/CV-A16 vaccine in China. Based on the immunization program policy, seven vaccination strategies, vaccine effectiveness (VE) levels ranging from 50–95% against EV-A71/CV-A16, and coverage levels from 0–95% were evaluated. The threshold vaccine price (TVP) was derived based on incremental cost-effectiveness ratio (ICER) calculations. Cost-effectiveness was assessed using willingness-to-pay (WTP) thresholds defined as 1–3 times the gross domestic product (GDP) per capita. Results: The mean cost of two doses of the monovalent EV-A71 vaccine was USD133.0 (95% CI: 126.9–139.1). Strategy 2, which targeted individuals unvaccinated with the monovalent EV-A71 vaccine, demonstrated the most favorable cost-effectiveness. At 45% coverage and 85% vaccine effectiveness, the estimated threshold price per dose was USD 107.7 (95% CI: 103.4–112.0), with threshold vaccine prices increasing as coverage declined. When vaccination coverage exceeded 80%, the threshold vaccine price decreased substantially, falling below USD 45.9 (95% CI: 43.5–48.3) per dose. Conclusions: Large-scale inclusion in the national immunization program may not be economically justified at current cost levels. Targeted voluntary vaccination of unvaccinated, susceptible populations represents a more cost-effective and practical strategy during the early stage of vaccine introduction.

Background/Objectives: Understanding the factors influencing breakthrough infections following COVID-19 vaccination is critical for disease prevention, especially in households where transmission risks are high. Factors such as age, symptoms, living conditions, and viral load contribute to household transmission dynamics. Methods: To elucidate this complex interplay of these factors, we analyzed a detailed household transmission study of COVID-19 involving 839 households and 1598 vaccinated individuals during the Omicron variant outbreak in Beijing, China, from April to June 2022. Using multivariate logistic regression models, we analyzed the impact of demographic, environmental, clinical, and virological factors on the risk of breakthrough infections. Results: In multivariate analysis. we estimated that index cases aged 45–59 and 60+ years were associated with 80% (95% confidence interval [CI]: 35%, 140%) and 288% (95% CI: 160%, 481%) higher infectivity compared with index cases aged 18–44 years. We estimated that index cases with fever, headache and cough were associated with 43% (95% CI: 11%, 84%), 78% (95% CI: 18%, 168%) and 67% (25%, 123%) higher infectivity compared with those without. Index cases with higher viral loads were associated with higher infectivity in univariate analysis, but this was no longer significant in multivariate analysis. Smaller living space and two-member households were associated with higher odds of breakthrough infections. Conclusions: Age, symptoms, and living conditions were significant risk factors for breakthrough infections during the Omicron outbreak. Suburban settings, smaller spaces, and two-member households enhance transmission risks. These findings inform targeted interventions to reduce household transmission.

The present study aimed to evaluate the vaccine effectiveness (VE) of different doses of an inactivated coronavirus disease 2019 (COVID-19) vaccine against Omicron BA.2.2 infection in Beijing, China, 2022. Based on data from a previous cohabitation retrospective cohort of COVID-19 outbreak in Beijing, China, 2022, the cohabitating contacts of individuals with BA.2.2 infection were followed up. Using a log-binomial regression model in which the unvaccinated group as the control group, the risk ratios of different doses of inactivated vaccine in terms of preventing SARS-CoV-2 infection, symptoms of COVID-19, and pneumonia were calculated, and the protective effect of the vaccine was estimated. The Kruskal–Wallis rank-sum test was used to compare the effect of vaccination on the viral load of infected patients. From April to June 2022, a total of 2259 cohabiting close contacts of 1308 patients with SARS-CoV-2 infection aged ≥3 years were included. Of the included close contacts, 737 (32.63%) were positive for SARS-CoV-2 during the isolation period: 140 (19.00%) were infected but asymptomatic, 525 (71.23%) had mild infection, and 72 (9.77%) had pneumonia. There were no cases of severe or critical infection or death. The VE of the primary in preventing BA.2.2 infection, symptoms, and pneumonia was 37.35% (95% CI: 24.00–48.35), 42.36% (95% CI: 28.41–53.60), and 48.35% (95% CI: −5.34–74.67), respectively. The VE of the booster shot in preventing SARS-CoV-2 infection, symptoms, and pneumonia was 37.08% (95% CI: 24.29–47.70), 44.38% (95% CI: 31.45–54.87), and 61.46% (95% CI: 29.79–78.85), respectively. Six months after the booster vaccination, the VE of the booster in terms of preventing SARS-CoV-2 remained above 46%, and its VE in terms of the prevention of pneumonia remained above 72%. In the unvaccinated group, the Ct values of the N gene and ORFlab gene (represented by the median value and Q1 and Q3 in parentheses) were 26.45 (21.09, 31.61) and 28.06 (22.21, 32.06), respectively. There was no significant difference in the median value of either gene between the unvaccinated group, the partial group [25.81 (19.91, 31.78) and 26.98 (21.63, 31.17)], the primary group [28.79 (22.08, 32.34) and 29.30 (23.81, 33.86)], and the booster group [26.23 (21.66, 31.46) and 27.73 (23.38, 32.52)] (p > 0.05). Inactivated COVID-19 vaccines provided a certain level protection from infection and symptoms, very good protection against pneumonia, and it still has a modest protective effect at 6 months after vaccination. Booster doses are necessary to provide strongest protection. However, irrespective of their vaccination status, individuals with COVID-19 have a similar viral load.