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Outcomes of vaccinated versus unvaccinated COVID-19 patients in Israel during the Omicron and Delta waves—A retrospective cohort study
Resultados de pacientes con COVID-19 vacunados vs. no vacunados en Israel durante las olas de ómicron y delta: Un estudio de cohorte retrospectivo
Itamar Porana,b,
Corresponding author
itamarporan@gmail.com

Corresponding author.
, Amjaad Abu Mokha,b, Daniella Vronskya,b, Genady Drozdinskya,b, Bar Basharima,b, Noa Eliakim-Raza,b
a Rabin Medical Center, Beilinson Hospital, Internal Medicine E, Petah-Tikva, Israel
b Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The coronavirus disease 2019 &#40;COVID-19&#41;&#44; has emerged into our lives more than two years ago to become a pandemic affecting millions of people globally&#46; In Israel&#44; since the introduction of the SARS-CoV-2 BNT162b2 vaccine &#40;BioNTech&#47;Pfizer&#41; in December 2020&#44; over six million people were vaccinated with a second dose which accounts for more than 70&#37; of the adult population <a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46; Despite the high rate of vaccination&#44; at the beginning of the fifth SARS-CoV-2 wave in Israel&#44; the efficacy of the BNT162b2 vaccine against the B&#46;1&#46;1&#46;529 Omicron variant was questioned&#44; and the burden of hospitalized patients was considerable <a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&#46; This study compares the characteristics and hospitalization outcomes of vaccinated versus unvaccinated patients during the Omicron and Delta waves in Israel&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">We conducted a retrospective cohort study of all adult patients admitted to the COVID-19 departments in Rabin Medical Center&#44; during the Delta wave &#40;May 1&#8211;September 30&#44; 2021&#41; and the Omicron wave &#40;December 20&#44; 2021&#8211;February 10&#44; 2022&#41;&#46; All included patients had a positive nasopharyngeal swab &#40;SARS-CoV-2 PCR test&#41; at presentation&#46; Demographic&#44; clinical&#44; and laboratory data were collected from patients electronic medical records&#46; Patients were considered vaccinated if they received at least two doses of the BNT162b2 covid-19 vaccine&#46; Patients with unknown vaccination status were not included in the analysis&#46; Categorical variables were compared using <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test&#46; Continuous variables were compared using Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#46; We used the inverse probability of treatment weighting &#40;IPTW&#41; method to be vaccinated in each wave to adjust for patients characteristics and known risk factors for the outcomes of mechanical ventilation and 30-day all-cause mortality&#46; The study was approved by the ethics committee of Rabin Medical Center&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0015" class="elsevierStylePara elsevierViewall">During the Omicron wave&#44; 298 patients were admitted due to COVID-19 infection&#46; Patients median age was 79 &#40;IQR 65&#8211;85&#41;&#44; the majority were male &#40;162&#44; 54&#46;3&#37;&#41; and 72 &#40;24&#46;1&#37;&#41; were residents of a long-term care facility&#46; Most patients had comorbidities &#40;208&#44; 69&#46;7&#37;&#41; including hypertension &#40;130&#44; 43&#46;6&#37;&#41;&#44; diabetes Mellitus &#40;119&#44; 40&#37;&#41;&#44; and ischemic heart disease &#40;65&#44; 21&#46;8&#37;&#41;&#46; Immunosuppression was present in 56 patients &#40;18&#46;8&#37;&#41; mostly due to chronic use of corticosteroids&#46; In this wave&#44; 209 &#40;70&#46;2&#37;&#41; were vaccinated&#44; 77 &#40;25&#46;8&#37;&#41; were considered unvaccinated and 12 &#40;4&#37;&#41; had unknown vaccination status &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Among vaccinated patients&#44; 28 &#40;13&#46;4&#37;&#41; were mechanically ventilated and 42 &#40;20&#46;1&#37;&#41; had died compared to 16 &#40;20&#46;8&#37;&#41; mechanically ventilated and 25 &#40;32&#46;5&#37;&#41; deaths in the unvaccinated&#46; For vaccinated&#44; the adjusted OR &#40;95&#37;CI&#41; for mechanical ventilation was 0&#46;64 &#40;0&#46;40-1&#46;01&#41; and the adjusted OR &#40;95&#37;CI&#41; for 30 days mortality was 0&#46;50 &#40;0&#46;27-0&#46;95&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The median length of hospital stay was 4 days &#40;IQR 2-7&#41; with no significant difference according to vaccination status&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">During the Delta wave&#44; 269 patients were admitted due to COVID-19 infection&#46; Patients median age was 73 &#40;IQR 63-81&#41;&#44; the majority were male &#40;155&#44; 57&#46;6&#37;&#41; and 89 &#40;33&#37;&#41; were residents of a long-term care facility&#46; Most patients had comorbidities &#40;222&#44; 82&#46;5&#37;&#41; including hypertension &#40;160&#44; 59&#46;5&#37;&#41;&#44; diabetes Mellitus &#40;126&#44; 46&#46;8&#37;&#41;&#44; and ischemic heart disease &#40;57&#44; 21&#46;1&#37;&#41;&#46; Immunosuppression was present in 31 patients &#40;11&#46;5&#37;&#41; mostly due to chronic use of corticosteroids&#46; In this wave&#44; 187 patients &#40;69&#46;5&#37;&#41; were vaccinated&#44; 75 &#40;27&#46;9&#37;&#41; were considered unvaccinated and 7 &#40;2&#46;6&#37;&#41; had unknown vaccination status&#46; Among vaccinated patients&#44; 62 &#40;33&#46;2&#37;&#41; were mechanically ventilated and 53 &#40;28&#46;3&#37;&#41; had died compared to 28 &#40;37&#46;3&#37;&#41; mechanically ventilated and 23 &#40;30&#46;7&#46;&#37;&#41; deaths in the unvaccinated&#46; For vaccinated&#44; the adjusted OR &#40;95&#37;CI&#41; for mechanical ventilation was 0&#46;75 &#40;0&#46;52&#8211;1&#46;09&#41; and the adjusted OR &#40;95&#37;CI&#41; for 30 days mortality was 0&#46;35 &#40;0&#46;17&#8211;0&#46;70&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The median length of hospital stay was 4 days &#40;IQR 2&#8211;8&#41; with no significant difference according to vaccination status&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">In this study of hospitalized SARS-CoV-2 infected patients we observe a decreased risk for 30-day mortality among vaccinated patients&#46; This association&#44; even though consistent in both waves&#44; was of a lesser magnitude during the Omicron wave&#46; Our observation aligns with previous studies evaluating vaccine effectiveness and may be the result of immune evasion of the Omicron variant <a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; Another possible explanation could be the waning vaccine effectiveness and decreased immunogenicity over time <a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; Our study has several limitations&#46; It was a single center with an observational design&#46; Due to the small amount of missing data&#44; we excluded patients with unknown vaccination status from the final analysis&#46; At the end of 2022&#44; the CDC published a recommendation for 3rd &#8220;booster&#8221; vaccine&#46; In our study&#44; we defined vaccinated as patients who received at least two doses of the BNT162b2 vaccine&#46; We chose to do so since this recommendation was not present during the Delta wave&#46; Despite the incompatibility between the current recommendation&#44; we believe that the inclusion of patients after two doses strengthen our results of good outcome among vaccinated patients&#46; In conclusion our result show that vaccinated COVID-19 hospitalized patients had a decreased risk for 30-day mortality in both the Omicron and Delta waves&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Role of funder&#47;Sponsor</span><p id="par0030" class="elsevierStylePara elsevierViewall">Not relevant&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090"><span class="elsevierStyleBold">Funding</span>&#47;Support</span><p id="par0035" class="elsevierStylePara elsevierViewall">No external funding&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">None</p></span></span>"
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            3 => "SARS-CoV-2"
            4 => "BNT162b2"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1663327"
          "palabras" => array:5 [
            0 => "COVID-19"
            1 => "Hospitalizaci&#243;n"
            2 => "Vacunaci&#243;n"
            3 => "SARS-CoV-2"
            4 => "BNT162b2"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Initiation of global vaccination significantly reduced the morbidity and mortality of COVID-19&#46; During the Omicron wave&#44; approximately 70&#37; of the Israeli adult population was fully vaccinated&#44; but the efficacy of the vaccine was questioned&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We conducted a retrospective cohort study of all adult patients admitted to the COVID-19 departments in Rabin Medical Center&#44; during the Delta wave and the Omicron wave&#46; Patients were matched in the 2 waves using the inverse probability of treatment weighting &#40;IPTW&#41; method and risk for mechanical ventilation and 30-day all-cause mortality was assessed&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Vaccination had a significant effect on 30-day mortality in the Delta and Omicron waves with adjusted OR of 0&#46;35 &#40;0&#46;17&#8211;0&#46;70&#41; and 0&#46;5 &#40;0&#46;27&#8211;0&#46;95&#41; respectively&#46; Nonetheless&#44; the rate of mechanical ventilation was similar between the groups with OR of 0&#46;75 &#40;0&#46;52&#8211;1&#46;09&#41; and 0&#46;64 &#40;0&#46;40&#8211;1&#46;01&#41;&#46; Vaccination status did not change the length of admission in both waves&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We observed a decreased risk for 30-day mortality among vaccinated patients during the Delta and Omicron waves in Israel&#46; This association&#44; even though consistent&#44; was of a lesser magnitude during the Omicron wave&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La iniciaci&#243;n de la vacunaci&#243;n global redujo significativamente la morbilidad y la mortalidad de la COVID-19&#46; Durante la ola de &#243;micron&#44; aproximadamente 70&#37; de la poblaci&#243;n adulta israel&#237; estaba completamente vacunada&#44; pero se cuestion&#243; la eficacia de la vacuna&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Realizamos un estudio de cohorte retrospectivo de todos los pacientes adultos ingresados en los departamentos de COVID-19 en el Centro M&#233;dico Rabin&#44; durante las olas de delta y &#243;micron&#46; Los pacientes fueron emparejados en las dos olas utilizando el m&#233;todo de ponderaci&#243;n inversa de probabilidad de tratamiento &#40;IPTW&#41; y se evalu&#243; el riesgo de ventilaci&#243;n mec&#225;nica y la mortalidad por todas las causas a los 30 d&#237;as&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La vacunaci&#243;n tuvo un efecto significativo en la mortalidad a los 30 d&#237;as en las olas de delta y &#243;micron con <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; ajustadas de 0&#44;35 &#40;0&#44;17-0&#44;70&#41; y 0&#44;5 &#40;0&#44;27-0&#44;95&#41;&#44; respectivamente&#46; Sin embargo&#44; la tasa de ventilaci&#243;n mec&#225;nica fue similar entre los grupos con OR de 0&#44;75 &#40;0&#44;52-1&#44;09&#41; y 0&#44;64 &#40;0&#44;40-1&#44;01&#41;&#46; El estado de vacunaci&#243;n no cambi&#243; la duraci&#243;n del ingreso en ambas olas&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Observamos un menor riesgo de mortalidad a los 30 d&#237;as entre los pacientes vacunados durante las olas de delta y &#243;micron en Israel&#46; Esta asociaci&#243;n&#44; aunque constante&#44; fue de menor magnitud durante la ola de &#243;micron&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
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      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Characteristic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Delta wave No&#46; &#40;&#37;&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Omicron wave No&#46; &#40;&#37;&#41;</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Unvaccinated &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>92&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vaccinated &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>170&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Unvaccinated &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vaccinated &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>200&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sex&#44; female</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">48 &#40;52&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;38&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">43 &#40;50&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">83 &#40;41&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age&#44; median &#40;IQR&#41;&#44; y</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">65 &#40;62&#8211;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;75&#8211;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 &#40;75&#8211;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;75&#8211;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Severity</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">23 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">39 &#40;22&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">23 &#40;27&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">91 &#40;45&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">19 &#40;20&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">28 &#40;16&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;12&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">26 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Severe&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">50 &#40;54&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">103 &#40;60&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83 &#40;41&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Functional status&#44; dependent</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;28&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89 &#40;52&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;60&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Resident of long-term care facility</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;32&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;34&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;9&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47 &#40;23&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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              "identificador" => "bib0030"
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                0 => array:1 [
                  "referenciaCompleta" => "Covid gov blackboard &#91;Internet&#93;&#46; Available from&#58; <a target="_blank" href="https://datadashboard.health.gov.il/COVID-19/general">https&#58;&#47;&#47;datadashboard&#46;health&#46;gov&#46;il&#47;COVID-19&#47;general</a> &#91;cited 27&#46;12&#46;21&#93;&#46;"
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                    0 => array:2 [
                      "titulo" => "Association between 3 doses of mRNA COVID-19 vaccine and symptomatic infection caused by the SARS-CoV-2 omicron and delta variants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;K&#46; Accorsi"
                            1 => "A&#46; Britton"
                            2 => "K&#46;E&#46; Fleming-Dutra"
                            3 => "Z&#46;R&#46; Smith"
                            4 => "N&#46; Shang"
                            5 => "G&#46; Derado"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1001/jama.2022.0470"
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                        "tituloSerie" => "JAMA"
                        "fecha" => "2022"
                        "volumen" => "327"
                        "paginaInicial" => "639"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35060999"
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                      "titulo" => "Omicron extensively but incompletely escapes Pfizer BNT162b2 neutralization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Cele"
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                            2 => "D&#46;S&#46; Khoury"
                            3 => "K&#46; Khan"
                            4 => "T&#46; Moyo-Gwete"
                            5 => "H&#46; Tegally"
                          ]
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                      "doi" => "10.1038/s41586-021-04387-1"
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                        "tituloSerie" => "Nature"
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                        "volumen" => "602"
                        "paginaInicial" => "654"
                        "paginaFinal" => "656"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35016196"
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                      "titulo" => "Duration of effectiveness of vaccines against SARS-CoV-2 infection and COVID-19 disease&#58; results of a systematic review and meta-regression"
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                          "etal" => true
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                            0 => "D&#46;R&#46; Feikin"
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                            2 => "L&#46;J&#46; Abu-Raddad"
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ISSN: 00257753
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos