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Background Immunocompromised individuals are at increased risk of severe COVID-19 outcomes, underscoring the importance of COVID-19 vaccination in this population. The lack of comprehensive real-world data on vaccine uptake, effectiveness and safety in these individuals presents a critical knowledge gap, highlighting the urgency to better understand and address the unique challenges faced by immunocompromised individuals in the context of COVID-19 vaccination. Methods We analysed data from 12,274,946 people in the UK aged > 12 years from 01/12/2020 to 11/04/2022. Of these, 583,541 (4.8%) were immunocompromised due to immunosuppressive drugs, organ transplants, dialysis or chemotherapy. We undertook a cohort analysis to determine COVID-19 vaccine uptake, nested case–control analyses adjusted for comorbidities and sociodemographic characteristics to determine effectiveness of vaccination against COVID-19 hospitalisation, ICU admission and death, and a self-controlled case series assessing vaccine safety for pre-specified adverse events of interest. Results Overall, 93.7% of immunocompromised individuals received at least one COVID-19 vaccine dose, with 80.4% having received three or more doses. Uptake reduced with increasing deprivation (hazard ratio [HR] 0.78 [95%CI 0.77–0.79] in the most deprived quintile compared to the least deprived quintile for the first dose). Estimated vaccine effectiveness against COVID-19 hospitalisation 2–6 weeks after the second and third doses compared to unvaccinated was 78% (95%CI 72–83) and 91% (95%CI 88–93) in the immunocompromised population, versus 85% (95%CI 83–86) and 86% (95%CI 85–89), respectively, for the general population. Results showed COVID-19 vaccines were protective against intensive care unit (ICU) admission and death in both populations, with effectiveness of over 92% against COVID-19-related death and up to 95% in reducing ICU admissions for both populations following the third dose. COVID-19 vaccines were generally safe for immunocompromised individuals, though specific doses of ChAdOx1, mRNA-1273 and BNT162b2 raised risks of specific cardiovascular/neurological conditions. Conclusions COVID-19 vaccine uptake is high in immunocompromised individuals on immunosuppressive drug therapy or who have undergone transplantation procedures, with documented disparities by deprivation. Findings suggest that COVID-19 vaccines are protective against severe COVID-19 outcomes in this vulnerable population, and show a similar safety profile in immunocompromised individuals and the general population, despite some increased risk of adverse events. These results underscore the importance of ongoing vaccination prioritisation for this clinically at-risk population to maximise protection against severe COVID-19 outcomes.

The role of the gut microbiota in carcinogenesis is increasingly being acknowledged. Recent studies in multiple breast cancer mouse models have found that antibiotics, by altering the gut microbiota, can accelerate tumour growth. In humans, a recent cohort study restricted to triple negative breast cancer showed that breast cancer patients using a greater number of antibiotics had markedly worse survival. These studies have raised concerns about repeated antibiotic use in breast cancer patients. In this Registered Report, we investigated whether breast cancer patients using oral antibiotics had increased breast cancer-specific mortality. In population-based cohorts (n = 44,452), we did not observe a statistically significant association between antibiotic prescriptions after diagnosis and breast cancer-specific mortality (adjusted HR = 1.07 95% CI 0.87, 1.33) apart from prescriptions of 12 or more antibiotics (adjusted HR = 1.62 95% CI 1.31, 2.01). This association was weaker after adjustment for infections (adjusted HR = 1.44 95% 1.14, 1.81), when restricted to antibiotics within five years (adjusted HR = 1.33 95% 0.95, 1.84), and was similar for deaths from other causes (adjusted HR = 1.69 95% 1.19, 2.41). Frequent antibiotic users had higher cancer-specific mortality but the attenuation of associations in sensitivity analyses, and similar findings for other causes of death, suggest this increase may reflect residual confounding. Protocol registration: The Stage 1 protocol for this Registered Report was accepted in principle on 7 November 2023. The protocol, as accepted by the journal, can be found at https://doi.org/10.6084/m9.figshare.24746721.v1 . Studies in mouse models have suggested a link between antibiotic use and breast cancer but epidemiological evidence in human populations is inconsistent. Here, the authors use linked electronic health records from England and Wales to investigate the association between oral antibiotic use and survival in women with breast cancer.

Background: Lower socioeconomic groups and disadvantaged populations across the world suffer disproportionately from the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to examine the impact of health- and social-inequality–related factors on well-being in order to further distinguish each of their effects during the pandemic. Methods: A nationally-representative sample of 5077 UK respondents aged 18 years or older was recruited through an online survey panel during the COVID-19 pandemic. Their subjective well-being was measured using the 11-point Cantril Ladder of Life Scale. The impact of inequality-related health and social factors (pre-existing medical conditions, household size and occupation), as well as COVID-19–related risk factors (symptoms, confirmed infections, and social distancing behaviours) on well-being were analysed using multiple linear regression models. The associations between the COVID-19–related risk factors and well-being according to the respondents’ household size and occupation were modelled in order to test the differences by their socioeconomic profile. Results: We identified inverted V-shaped associations between household size and subjective well-being during the COVID-19 pandemic. Compared to single-person households, respondents from households of two to four persons showed better well-being (β = 0.57; CI (0.44, 0.72)), whereas living in crowded households of five persons or more was associated with decreased well-being (β = −0.48; CI (−0.71, −0.25)). Furthermore, lower-skilled occupations (elementary occupations: β = −0.31; CI (−0.58, −0.03); logistics and transport services: β = −0.37; CI (−0.74, −0.01)) and chronic medical conditions (cardiometabolic or respiratory diseases: β = −0.25; CI (−0.41, −0.1); and mental health conditions: β = −1.12; CI (−1.28, −0.96)) were factors associated with reduced well-being during the pandemic. Interactions between a positive COVID-19 diagnosis, symptoms, and crowded households were identified (β = −0.95; CI (−1.76, −0.14) and β = −4.74; CI (−9.87, −1.61), respectively). Conclusions: In a national sample, the levels of general subjective well-being during the COVID-19 pandemic and lockdowns were disproportionately distributed across different groups within society. Preventive policies should explicitly focus on reaching lower socioeconomic groups; more emphasis should be placed on the coordination of multisectoral support in order to tackle existing health and social inequalities.

Introduction: The relationship between current cigarette and electronic cigarette (e-cigarette) dual use, exclusive use and COVID-19-related measures are still unclear. This study aims to assess the association between different tobacco use patterns and coronavirus disease 2019 (COVID-19) symptoms, testing, self-reported infection and social distancing behaviors in the United Kingdom (UK). Methods: Data come from the first wave of the Centre for Longitudinal Studies (CLS) COVID-19 survey, comprising four birth cohorts (N = 13,077, aged 20–63 years) surveyed between 2 to 31 May 2020, during the COVID-19 pandemic. Sociodemographic characteristics and COVID-19-related outcomes (symptoms, testing, diagnosis and social distancing behaviors) were compared across different product user groups (non-users, exclusive cigarette users, exclusive e-cigarettes users and dual use) using Cochran–Mantel–Haenszel χ2 test. Multivariable logistic regression models were used to explore associations between COVID-19-related outcomes and different smoking patterns. Results: Across all four cohorts, 12.6% and 4.9% of the respondents were current exclusive cigarette and e-cigarette users, respectively, with approximately 3% of the respondents being dual users. Significant differences in prevalence were observed between different tobacco use patterns and COVID-19 symptoms (p = 0.02), self-reported infection (p = 0.04) and social distancing behaviors (p < 0.001). Current cigarette and e-cigarette dual use was associated with 2.15-fold higher odds for reporting COVID-19 infection (aOR = 2.15; CI [1.15–4.05]). Compliance of social distancing behaviors were the lowest for current dual users (aOR = 0.58; CI [0.41–0.83]) and exclusive cigarette users (aOR = 0.72; CI [0.63–0.92]). Conclusions: The findings highlight dual users’ higher prevalence of having COVID-19 symptoms, infection and incompliance of social distancing behaviors. Self-reported infection was associated with dual product use; dual users and exclusive cigarette users were linked to poor adherence to social distancing behaviors. Smoking cessation support and further monitoring on multiple tobacco use among these populations should be reinforced as preventive measures to tackle the pandemic.

Renal cell carcinoma (RCC) presents significant therapeutic challenges due to its resistance to conventional treatments. Natural compounds with photodynamic properties, such as chlorophyll derivatives, offer potential for novel interventions. This study investigates the apoptotic effects of a chlorophyll-enriched green propolis compound activated by daylight-mediated photodynamic therapy (PDT) on RCC cells. A novel compound formulated from standardized ethanol extracts of Taiwanese green propolis, wheatgrass, and mulberry leaves was characterized using high-performance liquid chromatography (HPLC). Human RCC 786-O cells were treated with varying concentrations of the compound, with or without daylight PDT (570 nm). Cell viability was assessed via MTT assay, and median effective concentrations (EC50) were calculated. HPLC analysis identified Artepillin C as the major constituent. The compound induced dose-dependent cytotoxicity, which was significantly enhanced by daylight PDT. EC50 values dropped from 3.027 µL (compound alone) to 1.728 µL (with PDT), indicating synergistic efficacy. Cell viability significantly decreased in PDT-treated cells compared to non-treated controls (p < 0.05) indicating apoptosis. Daylight-activated PDT significantly amplifies the anticancer efficacy of the compound against RCC cells. Preliminary data suggest the potential of chlorophyll-enriched green propolis photodynamic activation (GPDT) as a natural adjunctive strategy for RCC, warranting further in vivo investigation.