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Among 843,208 participants in Israel who were 50 years of age or older and had received two doses of the BNT162b2 vaccine at least 5 months earlier, those who received a booster had 90% lower mortality due to Covid-19 than those who did not receive a booster. The study period was 54 days; adverse effects were not recorded.

The rapid emergence of the B.1.1.529 (Omicron) variant of SARS-CoV-2 led to a global resurgence of coronavirus disease 2019 (COVID-19). Israeli authorities approved a fourth COVID-19 vaccine dose (second booster) for individuals aged 60 years and over who had received a first booster dose 4 or more months earlier. Evidence for the effectiveness of a second booster dose in reducing hospitalizations and mortality due to COVID-19 is warranted. This retrospective cohort study included all members of Clalit Health Services who were aged 60–100 years and who were eligible for the second booster on 3 January 2022. Hospitalizations and mortality due to COVID-19 in participants who received the second booster were compared with those for participants who received one booster dose. Cox proportional hazards regression models with time-dependent covariates were used to estimate the association between the second booster and hospitalization and death due to COVID-19 while adjusting for demographic factors and coexisting illnesses. A total of 563,465 participants met the eligibility criteria. Of those, 328,597 (58%) received a second booster dose during the 40 day study period. Hospitalization due to COVID-19 occurred in 270 of the second-booster recipients and in 550 participants who received one booster dose (adjusted hazard ratio, 0.36; 95% confidence interval (CI): 0.31–0.43). Death due to COVID-19 occurred in 92 second-booster recipients and in 232 participants who received one booster dose (adjusted hazard ratio, 0.22; 95% CI: 0.17–0.28). This study demonstrates a substantial reduction in hospitalizations and deaths due to COVID-19 conferred by a second booster in Israeli adults aged 60 years and over. A retrospective analysis of data from a large healthcare insurance provider in Israel shows that a second booster shot (fourth dose) of BNT162b2 in people aged 60 years and over results in a substantial reduction in hospitalizations and deaths due to COVID-19.

In a retrospective cohort study from Israel, 149,032 patients who had recovered from SARS-CoV-2 infection were followed over a 270-day period to assess the rate of reinfection according to whether they had subsequently received a Covid-19 vaccine or had remained unvaccinated. The reinfection rate was 10.21 cases per 100,000 persons per day among unvaccinated patients and 2.46 cases among vaccinated patients.

In late 2022, the SARS-CoV-2 omicron (B.1.1.529) BA.5 sublineage accounted for most of the sequenced viral genomes worldwide. Bivalent mRNA vaccines contain an ancestral SARS-CoV-2 strain component plus an updated component of the omicron BA.4 and BA.5 sublineages. Since September, 2022, a single bivalent mRNA vaccine booster dose has been recommended for adults who have completed a primary SARS-CoV-2 vaccination series and are at high risk of severe COVID-19. We aimed to evaluate the effectiveness of a bivalent mRNA vaccine booster dose to reduce hospitalisations and deaths due to COVID-19. We did a retrospective, population-based, cohort study in Israel, using data from electronic medical records in Clalit Health Services (CHS). We included all members of CHS who were aged 65 years or older and eligible for a bivalent mRNA COVID-19 booster vaccination. We used hospital records to identify COVID-19-related hospitalisations and deaths. The primary endpoint was hospitalisation due to COVID-19, which we compared between participants who received a bivalent mRNA booster vaccination and those who did not. A Cox proportional hazards regression model with time-dependent covariates was used to estimate the association between the bivalent vaccine and hospitalisation due to COVID-19 while adjusting for demographic factors and coexisting illnesses. Between Sept 27, 2022, and Jan 25, 2023, 569 519 eligible participants were identified. Of those, 134 215 (24%) participants received a bivalent mRNA booster vaccination during the study period. Hospitalisation due to COVID-19 occurred in 32 participants who received a bivalent mRNA booster vaccination and 541 who did not receive a bivalent booster vaccination (adjusted hazard ratio 0·28, 95% CI 0·19–0·40). The absolute risk reduction for hospitalisations due to COVID-19 in bivalent mRNA booster recipients versus non-recipients was 0·089% (95% CI 0·075–0·101), and the number needed to vaccinate to prevent one hospitalisation due to COVID-19 was 1118 people (95% CI 993–1341). Participants who received a bivalent mRNA booster vaccine dose had lower rates of hospitalisation due to COVID-19 than participants who did not receive a bivalent booster vaccination, for up to 120 days after vaccination. These findings highlight the importance of bivalent mRNA booster vaccination in populations at high risk of severe COVID-19. Further studies with longer observation times are warranted. None.

The recent global outbreak of the monkeypox (mpox) virus in humans was declared a public health emergency by the World Health Organization in July 2022. The smallpox and mpox vaccine (JYNNEOS; Modified Vaccinia Ankara-Bavarian Nordic; MVA-BN), provided as a two-dose regimen, is currently the primary vaccine utilized against mpox. However, the efficacy of MVA-BN against mpox has never been demonstrated in clinical trials to date. Due to the limited supply of vaccines, the World Health Organization has recommended prioritizing the vaccination of high-risk groups. We evaluated the real-world effectiveness of a single, subcutaneous dose of MVA-BN in this observational, retrospective cohort study, which included the analysis of electronic health records of all members of Clalit Health Services eligible for the vaccine on 31 July 2022. We used a Cox proportional hazards regression model with time-dependent covariates to estimate the association between vaccination and mpox while adjusting for sociodemographic and clinical risk factors. In an analysis of 2,054 male individuals who met vaccine eligibility criteria, 1,037 (50%) were vaccinated during the study recruitment period and completed at least 90 d of follow-up. During the study period, 5 and 16 infections were confirmed in vaccinated and unvaccinated individuals, respectively. The adjusted vaccine effectiveness was estimated at 86% (95% confidence interval, 59–95%). Our results suggest that a single dose of subcutaneous MVA-BN in this high-risk cohort is associated with a significantly lower risk of MPXV infection. Effectiveness of one subcutaneous dose of MVA-BN, the smallpox and mpox vaccine, was estimated to be 86% in a cohort of vaccine-eligible males in Israel, supporting its use to curtail the outbreak of mpox virus.

Measures employed to combat COVID-19 included public lockdowns and vaccination campaigns. Israel’s extensive public health system produced data demonstrating the real-world results of these measures. Our objective was to evaluate the health and economic outcomes of the measures to cope with COVID-19. Publicly available datasets from the Israeli Ministry of Health were used to model the parameters of the pandemic in Israel. The Oxford COVID-19 Government Response Tracker was used for quantitative data on government policies. Data on the Israeli economy were taken from the Central Bureau of Statistics. Our models demonstrate that the first lockdown prevented 1022 COVID-19 deaths at the cost of 36.4–38.6 billion NIS. The second lockdown prevented 1970 COVID-19 deaths and cost 18–21 billion NIS. These lifesaving effects were observed with a time lag from the declaration of lockdown. The primary vaccination campaign cost 1 billion NIS and prevented 4750 COVID-19 deaths. The first vaccination booster campaign prevented 650 COVID-19 deaths and cost 51.1 million NIS. Therefore, the cost per prevented COVID-19 death is 10–36 million NIS with a national lockdown versus 210,000 NIS in the primary vaccination campaign and 79,000 NIS in the first booster campaign. In conclusion, both lockdowns and vaccination campaigns effectively lower COVID-19 deaths, but the cost to avoid one COVID-19 death with effective vaccination is 50–466 times lower than with a lockdown.

Objective: Pediatric overweight and obesity represent a growing public health concern with significant long-term implications. In children diagnosed with attention-deficit/hyperactivity disorder (ADHD), stimulant medications may alter appetite, potentially impacting body weight and growth patterns. However, real-world data on the effect of these treatments on body mass index (BMI) classification remains scarce. We aimed to evaluate the effect of ADHD stimulant therapy on transitions in the BMI categories among children. Study Design: We conducted a large-scale observational cohort study assessing longitudinal changes in BMI classification following the initiation of stimulant treatment, utilizing data from Clalit Health Services, Israel’s largest healthcare provider. BMI was categorized into four groups: normal weight, overweight, obesity, and severe obesity. Subgroup analysis was performed by sex and age groups: <7 years; >7 <13 years and >13 <18 years. Results: At baseline, 26,930 children met the study inclusion criteria. 12,448 (46%) were classified as overweight or obese. Most children with normal weight at baseline maintained their BMI classification (90%). 48% of children with overweight, 42% with obesity, and 29% with severe obesity transitioned to a lower BMI category. 39% of children with underweight transitioned to normal weight. Similar patterns in BMI category transitions were observed between sexes. Transition to a lower BMI category was more prevalent in the younger age group. Conclusions: Stimulant therapy for ADHD is associated with significant shifts in BMI classification among pediatric patients. While many children, especially younger with higher baseline BMI, experienced improvements in weight status, a notable minority exhibited weight gain. These findings underscore the importance of routine BMI monitoring and weight management strategies during ADHD treatment.

Objective To compare maternal characteristics and risk factors associated with intrapartum and postpartum preeclampsia in relation to pregnancies without preeclampsia. Study Design This retrospective cohort study used data from 265,068 pregnancies (2013–2024) categorized into three groups: no preeclampsia (96.9%), intrapartum preeclampsia (2.8%), and postpartum preeclampsia (0.2%). Multivariate logistic regression models identified risk factors associated with intrapartum preeclampsia and postpartum preeclampsia, with no preeclampsia as the reference group. Results Postpartum preeclampsia shared remarkably similar risk factors with intrapartum preeclampsia after adjusting for confounders. Key associations included maternal age (adjusted odds ratio (aOR) = 1.03, 95% confidence interval (CI): 1.02–1.03 for intrapartum pre-eclampsia and aOR = 1.03, 95% CI: 1.03–1.04 for postpartum preeclampsia); obesity (aOR = 1.50, 95% CI: 1.41–1.59 for intrapartum preeclampsia and aOR = 1.51, 95% CI: 1.43–1.61 for postpartum preeclampsia), and nulliparity (aOR = 2.20, 95% CI: 2.05–2.35 for intrapartum preeclampsia and aOR = 2.12, 95% CI: 1.99–2.27 for postpartum preeclampsia). Additional associations included diabetes (aOR = 1.55, 95% CI: 1.36–1.76 for intrapartum preeclampsia; aOR = 1.51 and 95% CI: 1.33–1.71 for postpartum preeclampsia); hypertension (aOR = 4.02, 95% CI: 3.50–4.59 for intrapartum preeclampsia and OR = 4.01, 95% CI: 3.51–4.56 for postpartum preeclampsia), and gestational hypertension (aOR = 2.46, 95% CI: 2.21–2.74 for intrapartum pre-eclampsia and aOR = 2.46, 95% CI: 2.22–2.73 for postpartum preeclampsia. Conclusion Postpartum and intrapartum preeclampsia share similar clinical and demographic risk factors, suggesting postpartum preeclampsia may be a continuation of preeclampsia rather than a distinct clinical entity. Identifying shared risk factors can facilitate early diagnosis and intervention, critical for reducing maternal morbidity and mortality.

Background and Aim: Dapagliflozin and empagliflozin have demonstrated favorable clinical outcomes among patients with chronic kidney disease (CKD). However, their comparative monetary value for improving outcomes in CKD patients is unestablished. We examined the cost-per-outcome implications of utilizing dapagliflozin as compared to empagliflozin for prevention of renal and cardiovascular events in CKD patients. Methods: For calculation of preventable events we divided the allocated budget by the cost needed to treat (CNT) for preventing a single renal or cardiovascular event. CNT was derived by multiplying the annualized number needed to treat (aNNT) by the annual therapy cost. The aNNTs were determined based on data from the DAPA-CKD and EMPEROR-KIDNEY trials. The budget limit was defined based on the threshold recommended by the United States’ Institute for Clinical and Economic Review. Results: The aNNT was 42 both dapagliflozin (95% confidence interval [CI]: 34-59) and empagliflozin (CI: 33-66). The CNT estimates for the prevention of one primary event for dapagliflozin and empagliflozin were comparable at$201,911 (CI: $ 163,452- $283,636) and $ 209,664 (CI:$164,736-$ 329,472), respectively. However, diabetic patients had a higher CNT with dapagliflozin ( $201,911 [CI: $ 153,837- $346,133]) than empagliflozin ($ 134,784 [CI:$109,824-$ 214,656]), whereas non-diabetic patients had lower CNT for dapagliflozin ( $197,103 [CI: $ 149,029- $346,133]) than empagliflozin ($ 394,368 [CI:$219,648-$ 7,093,632]). The CNT for preventing CKD progression was higher for dapagliflozin ( $427,858 [CI: $ 307,673- $855,717]) than empagliflozin ($ 224,640 [CI:$169,728-$ 344,448]). For preventing cardiovascular death (CVD), the CNT was lower for dapagliflozin ( $1,634,515 [CI: $ 740,339-∞]) than empagliflozin ( $2,990,208 [CI: $ 1,193,088-∞]). Conclusion: Among patients with CKD, empagliflozin provides a better monetary value for preventing the composite renal and cardiovascular events in diabetic patients while dapagliflozin has a better value for non-diabetic patients. Dapagliflozin provides a better monetary value for the prevention of CVD, whereas empagliflozin has a better value for the prevention of CKD progression.