CASCADIA: A prospective community-based study protocol for assessing SARS-CoV-2 vaccine effectiveness in children and adults utilizing a remote nasal swab collection and web-based survey design
Authors: Babu Tara M. , Feldstein Leora R. , Saydah Sharon , Acker Zachary , Boisvert Cassandra L. , Briggs-Hagen Melissa , Carone Marco , Casto Amanda , Cox Sarah N. , Ehmen Brenna , Englund Janet A. , Fortmann Stephen P. , Frivold Collrane J. , Groom Holly , Han Peter , Kuntz Jennifer L. , Lockwood Tina , Midgley Claire M. , Mularski Richard A. , Ogilvie Tara , Reich Sacha , Schmidt Mark A. , Smith Ning , Starita Lea , Stone Jeremy , Vandermeer Meredith , Weil Ana A. , Wolf Caitlin R. , Chu Helen Y. , Naleway Allison L. 
Published: January 2023

Introduction

Although SARS-CoV-2 vaccines were first approved under Emergency Use Authorization by the FDA in late 2020 for adults, approval for young children 6 months to < 5 years of age did not occur until 2022. Understanding real world vaccine effectiveness in the setting of emerging variants is critical. The primary goal of this study is to evaluate SARS-CoV-2 vaccine effectiveness (VE) against infection among children aged >6 months and adults aged <50 years.

Methods

CASCADIA is a four-year community-based prospective study of SARS-CoV-2 VE among adult and pediatric populations aged 6 months to 49 years in Oregon and Washington. At enrollment and regular intervals, participants complete a sociodemographic questionnaire. Individuals provide a blood sample at enrollment and annually thereafter, with additional, optional blood draws after infection and vaccination. Participants complete weekly self-collection of anterior nasal swabs and symptom questionnaires. Swabs are tested for SARS-CoV-2 and other respiratory pathogens by RT-PCR, with results of selected pathogens returned to participants; nasal swabs with SARS-CoV-2 detected will undergo whole genome sequencing. Participants who report symptoms outside of their weekly swab collection and symptom survey are asked to collect an additional swab. Participants who test positive for SARS-CoV-2 undergo serial swab collection every three days for three weeks. Serum samples are tested for SARS-CoV-2 antibody by binding and neutralization assays.

Analysis

Cox regression models will be used to estimate the hazard ratio associated with SARS-CoV-2 vaccination among the pediatric and adult population, controlling for demographic factors and potential confounders, including clustering within households.

Ethics and dissemination

All study materials including the protocol, consent forms, participant communication and recruitment materials, and data collection instruments were approved by the Kaiser Permanente Northwest (KPNW) Institutional Review Board, the IRB of record for the study.

Strengths/Limitations

CASCADIA will include a large sample of children and adults that will contribute to estimation of vaccine effectiveness.

The study will generate a data repository that can be used to address many research questions, such as duration of SARS-CoV-2 serologic results, post-acute sequelae of COVID-19, and re-infection rates.

Retention and compliance may be challenging given the four-year duration of the study.

Annual blood collection for assessment of humoral immunity may be a potential deterrent for participation, particularly among younger children.