There is a lot of confusion about the efficacy of AstraZeneca/ChAdOx1 vaccine against COVID19 due to B.1.351 / 501Y.V2 - summarising the results of phase 1b/2a double-blind randomized trial conducted in South Africa (based on @GovernmentZA press conference).🧵(1/6)
Adults aged 18-65 years without severe comorbidities and HIV were recruited. It was designed to show >60% efficacy against symptomatic disease, but because only 2000 participants were recruited with 42 total events, this analysis was not statistically powered. (2/6) Image
In total, 1749 participants were recruited, the population enrolled was young and generally healthy; the prevalence of hypertension, respiratory disease, and diabetes was low. Therefore, it was not designed to assess efficacy against severe disease. (3/6) Image
Of the 42 cases that occurred, 2/3 had mild (fever, cough, and >2 respiratory sx) and 1/3 had moderate infection (fever or LRTI w/o O2 requirement). No significant risk reduction for mild-mod illness but with a very large confidence interval (-50 to 59.8)! (4/6) Image
In conclusion, this was a small study, so cannot answer the efficacy question with confidence, and protection against severe illness is currently unknown but probable. E.g. J&J vaccine (similar design) shows excellent protection (89%) against severe disease due to B.1.351. (5/6) Image
This slide summarises what we (don't) know about B.1.351 variant & the efficacy of different vaccines. In the meantime, given B.1.351 is the dominant variant in SA, AZ rollout has been put on temporary hold awaiting clinical efficacy information. (6/6) (facebook.com/HealthZA/video…\) Image
Addendum: This is based on the same trial that was published in the Lancet. SA researchers analyzed the data after the 31st of October cut-off when B.1.351 became the dominant variant. Before this period, AZ vaccine demonstrated >75% efficacy. (thelancet.com/journals/lance…) Image

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More from @mugecevik

24 Aug
There is a lot of concern/confusion about vaccine effectiveness against the delta variant. How effective are the vaccines against Delta & how to interpret real-world observational data? So much misinformation is being circulated, so this thread brings key data together. 🧵(1/n)
Vaccine efficacy measures the relative reduction in infection/disease for the vaccinated vs unvaccinated arm. For instance, a vaccine that eliminates all risk would have an efficacy of 100%. Efficacy of 50% means you have a 50% reduced risk compared to an unvaxxed person. (2/n) Image
All studies assessing the performance of vaccines against Delta are based on real-world data (vaccine effectiveness), which are influenced by variant transmissibility, human behaviour, and immunity status of the population, therefore they require careful interpretation. (3/n) Image
Read 25 tweets
11 Jan
Concerns about outdoor transmission risk seem to be trending again. What is the risk of transmission outdoors and should we be more worried about outdoors with the new more-transmissible variant? 🧵(1/n)
The risk of transmission is complex and multi-dimensional. It depends on many factors: contact pattern (duration, proximity, activity), individual factors, environment (e.g. outdoor, indoor), socioeconomic factors, and mitigation measures in place. (2/n)(gov.uk/government/pub…\) Image
Transmission is facilitated by close proximity, prolonged contact, and frequency of contacts. So, the longer the time you spend with an infected person and the larger the gathering, the higher the risk is. (3/n) (academic.oup.com/cid/advance-ar…\) Image
Read 26 tweets

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