@WitsVIDA proudly involved in first study to show 82% efficacy (reduced risk) against severe Respiratory Syncytial Virus (RSV) lower respiratory tract infection (LRTI) by vaccinating their mothers during pregnancy with a RSV protein vaccine. Published in NEJM today. How does it work- vaccination of pregnant women can confer benefit to the mother (eg for influenza), lower risk of preterm birth and stillbirth ( eg flu and Covid vaccine) and protect the babies in 1st few months of life ( shown for whooping cough, tetanus , flu) and now RSV 👍🏼

@WitsVIDA led study on effect of reduced dosing - single priming dose and a booster pneumococcal conjugate vaccine (PCV) on risk of colonisation in children in Lancet Adolesc and Child Health sciencedirect.com/science/articl… Why did we do the study and what did we find … Pneumococcus, a bacterium, caused>800,000 deaths (50% in Africa) before PCV was introduced into chid immunisation programs since 2000. It took almost 10 yrs before the vaccine was widely used in African countries, mainly due to cost and limited access.

With the Northern. Hemisphere countries facing one of its worse Respiratory Syncytial Virus (RSV) epidemic, some good news at hand to reduce magnitude of future annual epidemics. Notably, RSV causes 66,000-199,000 childhood deaths annually- >98% in Low Middle Income Countries @WitsVIDA proud to be involved in a multi-centre study which demonstrates Nirsevimab (a monoclonal antibody which attaches to the part of the protein RSV uses to enter into cells and then spread) reduces risk of RSV hospitalisation, including in high risk children.

Pre-print of SA (Gauteng) experience with BA.4/BA.5 wave which has now subsided. medrxiv.org/cgi/content/sh… Main findings : at onset of BA.4/BA.5 resurgence only 27% had received at least single dose of Covid vaccine. But, 90% of population were seropos, including 89% of unvaccinated and 84% in unvaccInated children <12 yrs. Overall increase from 73% pre BA.1 wave.

NDoH extends regulations on masking, gathering and travel- none of which is fit for purpose and regulations full of internal contradictions. Simply stated, regulations that are still focussed on the pretence of preventing infections - which in the SA context have failed dismally Mask- type of masks used by minority that still abide even when indoors (ie cloth mask) does little to prevent infections or reduce transmission. If it worked- wouldn’t have >85% in SA infected. PS! Suspect such mask generally not been washed for >1 yr ?🤔

With end of “world immunisation week 2022” worth reflecting what is happening and what to guard against. This report from WHO rings the early warning bells of what to anticipate unless we GVt acts now who.int/news/item/27-0… South Africa, has among the most comprehensive vaccine schedules and led the way in Africa in introducing life saving vaccines into public immunisation programs , nevertheless lags behind with vaccine coverage- <80% children are fully immunised. Image reader.elsevier.com/reader/sd/pii/…

South Africa on cusp of resurgence, after the high infection rate with Omicron- albeit massive decoupling of infections and severe disease materialising. Current resurgence likely due to sub-lineage of Omicron- BA4. What can we expect, now that >80% population have some immunity Most of immunity in SA unfortunately resulted from infection (>80% infected since start of pandemic). In addition ~40% received at lease single dose Covid vaccine. Evidence indicates hybrid immunity protects as well as vaccine only induced immunity (rare in SA), if not better

Confirmation of early observations from Gauteng (home to 25% South Africans; n=15.5 million) of impressive decoupling of SARS-CoV-2 infections and severe/fatal Covid during course of Omicron relative to earlier waves published by Wits-VIDA in NEJM today. nejm.org/doi/full/10.10… Study report on population based sero-survey across age-groups pre onset of Omicron wave, and incidence of recorded Covid cases, hospitalization and death, and excess mortality attributable Covid death estimate from the start of the pandemic until tail end of the Omicron wave

Latest excess mortality, with 1 week delay relative recorded deaths. Both on downward trajectory . Since start of pandemic, approx 50% Covid deaths occurred during delta wave and under 5% during omicron wave . Decoupling has taken place, with -73% population immunity In SA, Covid attributable morality rate is 480 per 100,000 ( higher than any high income country), immunity mainly due to high force past infection in 1st 3 waves, with only 15% population having received 2 doses of Covid vaccine. SA does NOT have a low risk population.

No better way to start 2022 than revel in earlier optimism of being in a new phase of pandemic. Further variants always a likelihood, however, Omicron in SA hopefully a prelude to what to expect moving ahead- death rate only 13% compared to delta wave. Case rate peaked at slightly lower than for delta wave, despite SA not going to higher levels of restrictions as it did in the past when there was an increase in cars. Also, total recorded cases lower than for delta wave, albeit possible differences in testing rate.

@HealthZA an astounding U turning doing away with quarantine and contact tracing, Can only marvel how NDoH once again clutches defeat from the jaws of victory! The reasons why contact tracing and quarantine are futile in the SA context has been detailed dailymaverick.co.za/article/2021-1… Bottom line, it might have served some purpose in the distant past, and probably still has a role to play where majority of cases are diagnosed. This is NOT the case in SA where we identify less than 10% of infections based on reported cases and serosurvey data.

After much scepticism of SA data, indicative of “unless we say so”, appears that scientists and Governments from high income countries have come around that Omicron causes less severe illness, despite being the most antibody evasive variant. Experience seems to be tracking SA. Reason for less severe disease probably underlying cell mediated immunity induced by vaccines and more diversely so by natural infection. Despite greater infectiousness and transmissibility, Omicron more adapt in replicating in upper airway could contribute to milder illness

One week later and heading into week 5 of Omicron wave in Gauteng SA and outlook remains positive for what matters most - relatively low rates of severe disease and death. Many other provinces now also showing rapid rate of increase, however in Gauteng: 1. Wave of Covid cases has peaked and on a downward trajectory already. Peaked 4 weeks after onset , compared with peaking at 8 weeks after onset in previous 2 waves. Has peaked at same positivity rate of 38%, but at lower case rate per 100000 than delta.

Reflecting on SA experience with Omricon thus far in Gauteng - the epicentre in SA. 1. Rate of increase per capita much quicker than any of previous three waves. Strongly suggestive of more transmissible than even delta. 2. Positivity rate 30-40% in some settings. 3. Three weeks into resurgence, many adults and children testing SARS-CoV-2 pos in hospital , but COVID hospitalisation remains low relative to community case rate. High % (30%) women in labour coincidentally testing positive. Also,most children testing pos are coincidental Ix.

@PresidencyZA @HealthZA @SouthAfricanASP Apologies long post -suggest do’s and don’t for resurgence Don’t: 1. Indiscriminately impose further restrictions, except on indoor gatherings. If it has NOT reduced infections in past 3 waves, considering 60%-80% people were infected. 2. Don’t have domestic (or International) travel ban - the virus will disseminate irrespective of this - as has been case in the past.
3. Don’t announce and pretend that people adhere to regulations that are not implementable or enforceable in the local context;