Noa Dagan's research while affiliated with The Israel National Institute for Health Policy and Health Services Research and other places

Publications (48)

Article
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Over 10 million doses of Covid‐19 vaccines based on RNA technology, viral vectors, recombinant protein, and inactivated virus have been administered worldwide. Although generally very safe, post‐vaccine myocarditis can result from adaptive humoral and cellular, cardiac‐specific inflammation within days and weeks of vaccination. Rates of vaccine‐ass...
Article
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Background: The oral protease inhibitor nirmatrelvir has shown substantial efficacy in high-risk, unvaccinated patients infected with the B.1.617.2 (delta) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data regarding the effectiveness of nirmatrelvir in preventing severe coronavirus disease 2019 (Covid-19) outcomes from...
Article
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REGEN-COV, a combination of the monoclonal antibodies casirivimab and imdevimab, has been approved as a treatment for high-risk patients infected with SARS-CoV-2 within five days of their diagnosis. We performed a retrospective cohort study, and used data repositories of Israel’s largest healthcare organization to determine the real-world effective...
Article
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Background chronic kidney disease (CKD) is a risk factor for severe COVID-19. We aimed to evaluate real-life effectiveness of the BNT162b2 mRNA vaccine for a range of outcomes in patients with CKD compared to matched controls. Methods Data from Israel's largest healthcare organization were retrospectively used. Vaccinated CKD (eGFR<60ml/min/1.73m2...
Article
Background: Limited evidence is available on the real-world effectiveness of the BNT162b2 vaccine against coronavirus disease 2019 (Covid-19) and specifically against infection with the omicron variant among children 5 to 11 years of age. Methods: Using data from the largest health care organization in Israel, we identified a cohort of children...
Preprint
Introduction Throughout the SARS-CoV-2 pandemic, resources for various aspects of patient care have been limited, necessitating risk-stratification. The need for good risk-stratification tools has been enhanced by the availability of new Covid-19 therapeutics that are effective at preventing severe disease among high-risk patients if given promptly...
Article
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With the COVID-19 pandemic ongoing, accurate assessment of population immunity and the effectiveness of booster and enhancer vaccine doses is critical. We compare COVID-19-related hospitalization incidence rates in 2,412,755 individuals across four exposure levels: non-recent vaccine immunity (two BNT162b2 COVID-19 vaccine doses five or more months...
Article
Background: With large waves of infection driven by the B.1.1.529 (omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), alongside evidence of waning immunity after the booster dose of coronavirus disease 2019 (Covid-19) vaccine, several countries have begun giving at-risk persons a fourth vaccine dose. Methods: To ev...
Article
Cardiovascular disease (CVD) prediction models are widely used in modern medicine and are incorporated into prominent guidelines. Coronary artery calcium (CAC) is a marker of coronary atherosclerotic disease and has proven utility for predicting cardiovascular disease. Despite this, current guidelines recommend against including CAC scores in CVD p...
Preprint
Full-text available
REGEN-COV, a combination of the monoclonal antibodies casirivimab and imdevimab, has been approved as a treatment for high-risk patients infected with SARS-CoV-2 within 5 days of their diagnosis. We used the data repositories of Israel’s largest healthcare organization to determine the real-world effectiveness of REGEN-COV treatment against COVID-1...
Article
Children unvaccinated against SARS-CoV-2 may still benefit through protection from vaccinated contacts. We estimated the protection provided to children through parental vaccination with the BNT162b2 vaccine. We studied households without prior infection, consisting of two parents and unvaccinated children, estimating the effect of parental vaccina...
Article
Heart failure (HF) prevalence is increasing worldwide and is associated with significant morbidity and mortality. Guidelines emphasize prevention in those at-risk, but HF-specific risk prediction equations developed in United States population-based cohorts lack external validation in large, real-world datasets outside of the United States. The pur...
Preprint
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Introduction With the COVID-19 pandemic ongoing, accurate assessment of population immunity and the effectiveness of booster and enhancer vaccines is critical. Methods We compare COVID-19-related hospitalization incidence rate ratios, adjusted for potential demographic, clinical and health-seeking-behavior confounders, in 2,412,755 individuals (23...
Article
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Background Methodologically rigorous studies on Covid-19 vaccine effectiveness (VE) in preventing SARS-CoV-2 infection are critically needed to inform national and global policy on Covid-19 vaccine use. In Israel, healthcare personnel (HCP) were initially prioritized for Covid-19 vaccination, creating an ideal setting to evaluate early real-world V...
Article
Background: Emerging data suggest increased arterial thrombosis risk in the months preceding a cancer diagnosis. Objectives: Assess whether patients without documented vascular risk factors or pre-existent cardiovascular disease have a higher relative risk of cancer 12 months after arterial thrombotic events (ATE), compared to unselected patient...
Article
Background COVID-19 continues to spread throughout the world. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) is used to diagnose COVID-19, with its cycle threshold (Ct) value inversely related to the viral load. The association between Ct values and COVID-19 related outcomes has been studied in the hospital setting but less so i...
Article
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Evidence regarding the effectiveness of covid-19 vaccine in patients with impaired immunity, is limited. Initial observations suggest a lower humoral response in these patients. We evaluated the relative effectiveness of the mRNA BNT162b2 vaccine in patients with hematological neoplasms compared to matched controls. Data on patients with hematologi...
Article
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Background Reports have suggested an association between the development of myocarditis and the receipt of messenger RNA (mRNA) vaccines against coronavirus disease 2019 (Covid-19), but the frequency and severity of myocarditis after vaccination have not been extensively explored. Methods We searched the database of Clalit Health Services, the lar...
Article
Background Many countries are experiencing a resurgence of COVID-19, driven predominantly by the delta (B.1.617.2) variant of SARS-CoV-2. In response, these countries are considering the administration of a third dose of mRNA COVID-19 vaccine as a booster dose to address potential waning immunity over time and reduced effectiveness against the delt...
Article
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To evaluate the effectiveness of the BNT162b2 messenger RNA vaccine in pregnant women, we conducted an observational cohort study of pregnant women aged 16 years or older, with no history of SARS-CoV-2, who were vaccinated between 20 December 2020 and 3 June 2021. A total of 10,861 vaccinated pregnant women were matched to 10,861 unvaccinated pregn...
Preprint
Full-text available
Background Methodologically rigorous studies on Covid-19 vaccine effectiveness (VE) in preventing SARS-CoV-2 infection are critically needed to inform national and global policy on Covid-19 vaccine use. In Israel, healthcare personnel (HCP) were initially prioritized for Covid-19 vaccination, creating an ideal setting to evaluate real-world VE in a...
Article
Background Preapproval trials showed that messenger RNA (mRNA)–based vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had a good safety profile, yet these trials were subject to size and patient-mix limitations. An evaluation of the safety of the BNT162b2 mRNA vaccine with respect to a broad range of potential adverse e...
Article
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HLA haplotypes were found to be associated with increased risk for viral infections or disease severity in various diseases, including SARS. Several genetic variants are associated with COVID-19 severity. Studies have proposed associations, based on a very small sample and a large number of tested HLA alleles, but no clear association between HLA a...
Preprint
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Background: As mass vaccination campaigns against COVID-19 accelerate worldwide, there remains only limited evidence regarding vaccine effectiveness (VE) among pregnant women. Pregnant women have been shown to be at risk for severe COVID-19, resulting in adverse obstetrics outcomes, and their immune system is known to undergo alterations during pre...
Article
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This work presents a novel method for applying test-time augmentation (TTA) to tabular data. We used TTA along with an ensemble of 42 models to achieve higher performance on the MIT Global Open Source Severity of Illness Score dataset consisting of 131,051 ICU visits and outcomes. This method achieved an AUC of 0.915 on the private test set (19,669...
Article
Background: As mass vaccination campaigns against coronavirus disease 2019 (Covid-19) commence worldwide, vaccine effectiveness needs to be assessed for a range of outcomes across diverse populations in a noncontrolled setting. In this study, data from Israel's largest health care organization were used to evaluate the effectiveness of the BNT162b...
Article
Background: Pneumonia is more common in smokers compared with non-smokers. A high one-year prevalence of lung cancer following hospitalization for pneumonia was demonstrated in heavy smokers. Aim: To assess the association between hospitalization for pneumonia among ever-smokers and subsequent lung cancer risk. Design: Retrospective analysis....
Preprint
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HLA haplotypes were found to be associated with increased risk for viral infections or disease severity in various diseases, including SARS. Several genetic variants are associated with Covid-19 severity. However, no clear association between HLA and Covid-19 incidence or severity has been reported. We conducted a large scale HLA analysis of Israel...
Preprint
Full-text available
HLA haplotypes were found to be associated with increased risk for viral infections or disease severity in various diseases, including SARS. Several genetic variants are associated with Covid-19 severity. However, no clear association between HLA and Covid-19 incidence or severity has been reported. We conducted a large scale HLA analysis of Israel...
Article
Background Most studies estimate hepatitis C virus (HCV) disease prevalence from convenience samples. Consequently, screening policies may not include those at the highest risk for a new diagnosis. Methods Clalit Health Services members aged 25–74 as of 31 December 2009 were included in the study. Rates of testing and new diagnoses of HCV were cal...
Article
Objective To illustrate the problem of subpopulation miscalibration, to adapt an algorithm for recalibration of the predictions, and to validate its performance. Materials and Methods In this retrospective cohort study, we evaluated the calibration of predictions based on the Pooled Cohort Equations (PCE) and the fracture risk assessment tool (FRA...
Article
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At the COVID-19 pandemic onset, when individual-level data of COVID-19 patients were not yet available, there was already a need for risk predictors to support prevention and treatment decisions. Here, we report a hybrid strategy to create such a predictor, combining the development of a baseline severe respiratory infection risk predictor and a po...
Preprint
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Background: As many countries consider and employ various lockdown exit strategies, health authorities seek tools to provide differential targeted advice for social distancing based on personal risk for severe COVID-19. However, striking a balance between a scientifically precise multivariable risk prediction model, and a model which can easily be...
Preprint
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With the global coronavirus disease 2019 (COVID-19) pandemic, there is an urgent need for risk stratification tools to support prevention and treatment decisions. The Centers for Disease Control and Prevention (CDC) listed several criteria that define high-risk individuals, but multivariable prediction models may allow for a more accurate and granu...
Article
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Methods for identifying patients at high risk for osteoporotic fractures, including dual-energy X-ray absorptiometry (DXA)1,2 and risk predictors like the Fracture Risk Assessment Tool (FRAX)3–6, are underutilized. We assessed the feasibility of automatic, opportunistic fracture risk evaluation based on routine abdomen or chest computed tomography...
Article
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Currently, clinicians rely mostly on population-level treatment effects from RCTs, usually considering the treatment's benefits. This study proposes a process, focused on practical usability, for translating RCT data into personalized treatment recommendations that weighs benefits against harms and integrates subjective perceptions of relative seve...
Article
Objective: To evaluate whether a woman’s age at first birth is associated with cardiovascular risk and metabolic health outcomes (cardiometabolic outcomes) by age 45. Methods: This is a retrospective, population-based cohort study that uses electronic health record data from the largest health fund in Israel. Women aged 34–39 at baseline (2004-2006...
Article
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Objective To directly compare the performance and externally validate the three most studied prediction tools for osteoporotic fractures—QFracture, FRAX, and Garvan—using data from electronic health records. Design Retrospective cohort study. Setting Payer provider healthcare organisation in Israel. Participants 1 054 815 members aged 50 to 90 year...
Data
Supplementary information: Supplementary material includes detailed supporting methodological information, such as diagnoses codes used, and additional analyses conducted (preliminary and sensitivity analyses). It also includes comparative background information between the three tools and comparisons between the current study and previous studies’...
Article
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Background : The "September Epidemic" is a well-known phenomenon: there is an increased likelihood of asthma exacerbations among children during the first month of school. Likely triggers include a combination of factors such as the stress of starting a new school year, the exposure to classrooms and respiratory viruses from fellow classmates, and...

Citations

... The rate of myocarditis was 4.8 cases per 10000 vaccinated adolescents using mRNA products in the Israeli population. All cases were mild and hemodynamically stable, and only some of them needed short hospitalization [18]. Other, such as anaphylactic shock, was also described, but the frequency of the event, in some trials, did not differ from the placebo group [19]. ...
... Myocarditis was reported in many published case reports, case series, and retrospective studies following COVID-19 mRNA immunization in young people (18-25 years) after receiving the second vaccination dose; however, the incidence was rare [24,25]. Many factors must be considered when assessing the risk of myocarditis, including patient factors, medical history, and SarsCov2 infection history [26]. The Centers for Disease Control and Prevention (CDC) reported that infection with the Sars-cov2 virus increases the risk for myocarditis; therefore vaccine's benefits in preventing COVID-19 infection, hospitalization, and intensive admissions and death exceed the potential risk of myocarditis [27]. ...
... Several real-world observational studies in non-hospitalised COVID-19 patients during the Omicron era have shown effectiveness of Paxlovid compared with non-users [5,6], but those studies were likely to suffer from confounding by indication, given the large differences in the characteristics and clinical conditions between treated and untreated patients (e.g., untreated patients could have been either of low-risk of severe outcomes, or high-risk but with contraindications to Paxlovid). Comparative effectiveness analysis for treatments prescribed under similar clinical indications, with careful consideration of the contraindications and drug interactions for the use of Paxlovid [2], would tend to ensure comparability of participants, leading to more robust findings. ...
... Interestingly, REGN-COV showed a major efficacy in serum antibodynegative patients or when viral load was higher at baseline [26]. Moreover, a retrospective cohort study determined the real-world effectiveness of REGEN-COV against COVID-19related hospitalization, severe disease and death [27]. The effectiveness of REGEN-COV was 56.4% in preventing COVID-19 hospitalization, 59.2% in preventing severe COVID-1 and 93.5% in preventing COVID-19 death in the 28 days after treatment. ...
... 16,19 UNICEF estimates that approximately 17,000 children and adolescents have died from COVID-19. 20,21 There is evidence that available vaccines do not protect children adequately against SARS-CoV-2 Omicron infection, 22,23 and the waning of both natural infection and vaccine protection are well documented. [24][25][26] Against this background and the race for the development of a new generation of vaccines that protect against a wide range of variants, including new ones, 16 we aimed to provide estimates for the proportion of children with detectable antibodies and to identify sources of heterogeneity in SARS-CoV-2 seroprevalence in children for various regions of the world. ...
... By introducing and administering COVID-19 vaccines, studies on the stability of infection or vaccine-acquired antibodies aid policymakers in making sound decisions regarding the administration of booster doses of vaccines and setting priorities. Comparing the similarity of immunity induced by infection or COVID-19 vaccine, infection-induced immunity reveals more protection than non-recent vaccination, but less protection than a booster dose against hospitalization [20]. Additionally, previous infection with SARS-CoV-2 plays as a booster dose in fully vaccinated individuals [21]. ...
... We found that the reactogenicity in the PID cohort was overall lower than that of clinical trials data and from early post-authorization monitoring studies [19,20], similar or reduced to that reported in observational or real-world studies after two doses [14,21], and comparable or slightly reduced after boosters as well [22][23][24]. ...
... The COVID-19 pandemic has represented an unprecedented challenge for global public health, but mRNA vaccines have demonstrated strong clinical efficacy in protecting against severe disease [1][2][3] . Immune responses elicited by SARS-Cov-2 mRNA vaccines are typically assessed via titers of B cell-derived neutralizing antibodies, which rise rapidly after vaccination boosts but decline after 3-6 months [4][5][6][7] . ...
... Hayek et al. (41) evaluated the protective effect of parental COVID-19 vaccination provided to children. They studied two periods separately-an early period (Alpha variant), and a late period (Delta variant). ...
... 20 Furthermore, the PCP-HF model has also been validated in real-world data from electronic health records (with and without ECG QRS as a predictor to enhance generalizability), 21 and has been extended to large, nationally representative samples in the United States, Europe, and in Israel. 22,23 Based on the available data, the 2022 American College of 24 This advances the paradigm of prevention of HF moving beyond focus on individual risk factor control and towards absolute risk. [25][26][27] Patients in Stage A may have a lower risk of HF compared to those at Stage B. However, the association between HF risk factors and HF is variable (i.e., different patients at Stage A may have different risks of HF because of the different risk factors that they have). ...