ABSTRACT
Wastewater-based epidemiology is now widely used as an indirect tool to monitor the spread of SARS-CoV-2. In this study, five different sample matrices representing diverse phases of the wastewater treatment process were collected during the second wave of SARS-CoV-2 from two wastewater treatment plants (WWTPs) serving the Civil Hospital and Sacca Fisola island in Venice, Italy. Positive SARS-CoV-2 detections occurred at both WWTPs, and data on viral genome detection rate and quantification suggest that the pellet (i.e., the particulate resulting from the influent) is a sensitive matrix that permits reliable assessment of infection prevalence while reducing time to results. On the contrary, analysis of post-treatment matrices provides evidence of the decontamination efficacy of both WWTPs. Finally, direct sequencing of wastewater samples enabled us to identify B.1.177 and B.1.160 as the prevalent SARS-CoV-2 lineages circulating in Venice at the time of sampling. This study confirmed the suitability of wastewater testing for studying SARS-CoV-2 circulation and established a simplified workflow for the prompt detection and characterization of the virus.
ABSTRACT
Background: The COVID-19 outbreak has had a huge impact on health care services worldwide. Previous studies projected delays in cancer diagnoses and excess mortality for cancer patients as a result of the pandemic. Little is known, however, on the impact of the pandemic on the functioning of cancer services. We aimed to fill this gap by using a region-wide, population-based administrative health care data repository. Methods: We obtained data for patients initiating a targeted molecular therapy during 2017-2020 (January-September, by quarter) in Veneto. Eligible treatments were those with lapatinib, pertuzumab, TDM-1 and trastuzumab for breast cancer;with afatinib, alectinib, crizotinib, erlotinib, gefitinib and osimertinib for lung cancer;with cobimetinib, dabrafenib, trametinib and vemurafenib for melanoma;and with niraparib, olaparib and rucaparib for ovarian cancer. Patients starting more than one targeted molecular therapy in a given calendar year were included only once. We estimated the normalised difference between the number of patients for a given quarter in 2020 and the mean number of patients for the corresponding quarter during 2017-2019. Statistical significance was calculated assuming a type I error probability of 5%. Results: The study included 3,180 patients. In 2020, patients starting a targeted molecular therapy were 361 in the first quarter, 260 in the second quarter and 268 in the third quarter. The normalised difference between the number of treatments in 2020 and the mean number of treatments during 2017-2019 for all cancer types combined was statistically significant only for the first quarter, with more therapies in 2020 than in 2017-2019. In a breakdown by cancer type, differences were unremarkable for breast, lung or ovarian cancer, while there were significantly more treatments for melanoma for all the three quarters in 2020 compared to 2017- 2019. Conclusions: We chose to use the rate of initiation of targeted molecular therapies as a proxy for the effectiveness of oncology services in managing cancer patients, because these therapies require that at least pathology and diagnostic facilities are fully operational. The study covered a population of nearly five million people, in a region where universal health coverage is available and where cancer care has been prioritised, by law, over non-cancer related health care services during the COVID-19 outbreak. Our findings suggest that provision of oncology care has not been substantially impacted by the pandemic in Veneto. Of note, label indications were unchanged for these drugs in 2020. The findings are also in line with the priority-based, adapted European Society for Medical Oncology recommendations. Further research is needed to assess whether delays at earlier stages of the route to cancer diagnosis (e.g. GP referrals for specialist care) may have occurred.
ABSTRACT
Background: Recent evidences suggest that SARS-CoV-2 neutralizing antibodies (Nabs) may persist over time, however lack of knowledge still regards the pediatric population. Methods: A single-centre, prospective observational study evaluated family clusters of COVID-19 attending the Pediatric Department, University Hospital of Padua (Italy). Confirmed COVID-19 was defined by positive SARS-CoV-2 molecular detection and/or serology;patients/family symptom's and virological positivity were considered to define the infection onset (baseline). Blood samples were analyzed in pair to detect Nabs through Plaque Reduction Neutralization Test (PRNT), and IgG through chemiluminescent immuneenzymatic assay (CLIA) MAGLUMI™ 2000 Plus;IgG >1.1 kAU/L and/or PRNT≥1:10 were considered positive. SARS-CoV-2 viral load (VL) was quantified by multiplex quantitative assay based on One-Step RT-ddPCR. Geometric mean titers (GMT) and 95% Confidence Intervals of IgG/PRNT were evaluated, stratified by age and time from baseline to sample collection. Trends over time of immune-virological response were assessed. P-value <0.05 was considered statistically significant. Results: Among 213 subjects (57 families) evaluated, 155 had confirmed COVID-19 including 73 (47%) children/older siblings of 8 years median age (IQR 4-13) and 82 (53%) parents aged 42 years (IQR 34-46);93.5% had asymptomatic/mild COVID-19. From the cumulative analysis of 194 blood samples, Nabs persisted over a median period of 95 days (IQR, 67-133) from baseline. Children showed significantly higher NAbs than older subjects, with children <3 years ranging from a 4-fold difference at 1-2 months to 8.8-fold difference at 3-6 months after baseline, compared to adults (table). The longitudinal assessment of 42 subjects sampled at 60 days (SD+/-9.9) and at 150 days (SD+/-24.2) showed a 2-fold increase in NAbs in children <6 years (PRNT 144, 95% C.I. 74.42-277.94 versus 303, 95% C.I. 196.43-468.57) and a substantial stability in Nabs among older subjects. CLIA IgG significantly decreased over time for all age classes, becoming negative in 13/42 subjects (31%), compared to 1/42 subjects detected by PRNT. Among 32 individuals checked for VL within 4 days from baseline, VL directly correlated with PRNT titers in subjects >15 years (Pearson Coefficient =0.70, p=0,0349) but not in pediatric cases. Conclusion: Asymptomatic/mild COVID-19 disease triggers in children a superior and persistent humoral response compared to adults.