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Background. Protection offered by five different forms of immunity, combining natural and vaccine immunity, was investigated against symptomatic SARS-CoV-2 infection from Omicron BA.1 or BA.2, and severe, critical, or fatal COVID-19 from BA.1 or BA.2, in Qatar, between December 23, 2021 and February 21, 2022. Methods. Six national, matched, test-negative case-control studies were conducted on a sample of 272,861 PCR-positive tests and 669,628 PCR-negative tests to estimate effectiveness of BNT162b2 (Pfizer-BioNTech) vaccine, mRNA-1273 (Moderna) vaccine, natural immunity due to prior infection with pre-Omicron variants, and hybrid immunity from prior infection and vaccination. Results. Effectiveness of prior infection alone against symptomatic BA.2 infection was 46.1% (95% CI: 39.5-51.9%). Effectiveness of two-dose BNT162b2 vaccination alone was negligible at -1.1% (95% CI: -7.1-4.6), but nearly all individuals received their second dose >6 months earlier. Effectiveness of three-dose BNT162b2 vaccination alone was 52.2% (95% CI: 48.1-55.9%). Effectiveness of hybrid immunity of prior infection and two-dose BNT162b2 vaccination was 55.1% (95% CI: 50.9-58.9%). Effectiveness of hybrid immunity of prior infection and three-dose BNT162b2 vaccination was 77.3% (95% CI: 72.4-81.4%). Meanwhile, prior infection, BNT162b2 vaccination, and hybrid immunity all showed strong effectiveness ( >70%) against severe, critical, or fatal COVID-19 due to BA.2. Similar patterns of effectiveness were observed for BA.1 and for the mRNA-1273 vaccine. Conclusion. There are no discernable differences between BA.1 and BA.2 in the effects of prior infection, vaccination, and hybrid immunity. Vaccination enhances the protection of those with a prior infection. Hybrid immunity resulting from prior infection and recent booster vaccination conferred the strongest protection.
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Purpose: Kidney transplant recipients are vulnerable to develop severe form of COVID19 Infection. Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine has significantly improved incidence of COVID19, seroconversion rates in immunosuppressed patients post vaccine is variable and unpredictable. We aim to evaluate the rates of antibody response to SARS-CoV-2 mRNA vaccine and identify factors affecting immunogenicity among kidney transplant recipients Methods: We retrospectively reviewed 327 kidney transplant recipients who received 2 doses of mRNA Vaccine and did not develop COVID19 prior to antibody testing. SARS- CoV- 2 antibody response and risk factors associated with negative serology were evaluated after 2 doses of mRNA vaccine. Patients who tested positive were divided into four quartiles based on titers and analyzed using ANOVA. Result(s): 250 (76.5%) recipients had positive titers and 77 (24%) did not. Poor response was associated with older age (p=0.06) and male gender(p=0.03). Race, immunosuppression regimen and trough levels were not significant. Analysis of recipients who developed antibody revealed age, time from transplant, history of diabetes and steroid as factors affecting titer level (Table 1). Conclusion(s): Understanding immunologic response to SARS-CoV-2 vaccine in kidney transplant recipient is important to prevent life threatening infection. Identification of transplant recipients at risk of low vaccine response can be a guide to formulate personalized therapy.
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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and its impact on disease outcome in patients with autoimmune rheumatic disease (ARD) are lacking. Also, whether patients with ARD receiving immunomodulators have different viral loads compared to the general population is unknown. Objectives: To compare the viral load of SARS-CoV-2 and its trending between patients without and with ARD. Methods: Retrospectively, patients with ARD infected with SARS-CoV-2 were matched by age and sex at a ratio of 1:2 to patients without ARD and not receiving immunosuppression or immunomodulator drugs. Viral load was determined by the cycle threshold (CT) value measured by a number of platforms: (a) Automated Platforms-the Roche Cobas 6800 system using the Cobas SARS-CoV-2 Test targeting the E and orf1a/b genes (Roche, Switzerland) and the Xpert Xpress SARS-CoV-2 targeting the E and N genes (Cepheid, USA);(b) Manual platforms-EZ1 (QIAGEN, USA), QIAsymphony (QIAGEN, USA), and Bioneer ExiPrepTM 96 Virus DNA/RNA kits Catalogue No K4614 (Bioneer, South Korea) extraction with thermal cycling using TaqPath™ PCR COVID-19 Combo Kit targeting the N, S and orf1a/b genes (Thermo Fisher Scientific, USA) on ABI 7500 thermal cyclers. Independent samples t-test was used to compare the mean CT values of the study groups at baseline and at 5 subsequent intervals (1-5.9, 6-11.9, 12-17.9, 18-23.9 and 24-30 days). Results: Mean age (SD) of 197 cases and 420 controls were 45.2 (11.8) and 44.1 (12.3) years, respectively. Females were predominant in both groups 60% vs. 52%, P=0.053. The most common ARD was rheumatoid arthritis in 82 cases (41.6%), followed by spondyloarthropathy in 33 (16.8%) and systemic lupus ery-thematosus in 31 (15.7%). Of the cases, 67% were on conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), 15.2% on biological DMARDs and 4.6% patients were on rituximab. The mean CT values was signifcantly lower in the ARD group at baseline and persisted till day 24. Conclusion: Compared to patients without ARD, the viral load of SARS-CoV-2 in patients with ARD is signifcantly higher at baseline testing and persists till day 24. This fnding may indicate that patients with ARD are at higher risk of severe SARS-CoV-2 infection and prolonged potential transmission. Clinical outcome correlation is needed.
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Introduction: Ofatumumab is a self-administered subcutaneous CD20 monoclonal antibody approved in the United States (US) in August 2020 (in the pandemic era) for the treatment of relapsing multiple sclerosis (MS) in adults. Since US approval, there is a lack of information available on the real-world utilisation of ofatumumab. Objectives: To understand the overall profile of MS patients initiating ofatumumab in the real-world clinical practice using data from a nationally representative claims database in the first 6 months post-approval. Aims: To evaluate patient demographics, treatment status, geographical distribution, premedication use, claims-based disability levels, disease-modifying therapy (DMT) use in the year prior, and corresponding median time to transition (treatment gap) for patients initiating ofatumumab. Methods: This retrospective cohort study used IQVIA opensource claims data. Adults with a diagnosis of MS who initiated ofatumumab from August 2020-February 2020 were included. The index date was defined based on the first prescription fill for ofatumumab, and the baseline period was 1-year prior to the index date. Results: Overall, 1015 patients initiating ofatumumab were included in the study. Mean (± standard deviation [range]) age was 48.2±12.3 (18-85) years, and 72.5% were females. Approximately, 33% of patients were ≥55 years of age. Most patients were from the Southern and Western regions of the US. Ofatumumab was mostly prescribed by neurologists (86.8%) vs PCP/NP/PAs. The proportion of patients with moderate to severe MS disability was 38.2%. Common comorbidities among patients were osteoarthritis (31.3%), hypertension (16.7%), and depression (12.2%). Overall, 54.8% were not on any DMT in the year prior to initiating ofatumumab. Patients commonly switched from ocrelizumab (24.2%), dimethyl fumarate (23.3%), platform injectables (19.3%) and teriflunomide (14.8%). The median transition period for dimethyl fumarate, teriflunomide, and ocrelizumab was 62, 51, and 174 days, respectively. Patients received ofatumumab pre-and post-COVID and influenza vaccine. Steroid and antihistamine use as premedication was minimal (≤2.5% of patients). Conclusions: In the real-world pandemic environment, ofatumumab was prescribed, also beyond the trial population. Most patients newly initiated ofatumumab had no treatment in the prior year. Understanding patient profile, prior DMT use in the realworld may help stakeholders guide treatment decisions.
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COVID-19 has surfaced as a multi-organ disease predominantly affecting the respiratory system. Detection of the viral RNA through reverse transcriptase-PCR (RT-PCR) from a nasopharyngeal or throat sample is the preferred method of diagnosis. Recent evidence has suggested that COVID-19 patients can shed the SARS-CoV-2 for several weeks. Herein, we report six cases of COVID-19 who had persistently positive SARS-CoV-2 on repeat RT-PCR testing reaching up to 9 weeks. The spectrum of cases described ranges from asymptomatic infection to severe COVID-19 pneumonia. A full understanding of the virus's transmission dynamics needs further research. Prolonged viral shedding currently has unclear implications on the management and isolation decisions - the role of the cycle threshold (Ct) value in guiding therapeutic decisions is yet to be clarified. More data on the relationship between Ct values and viral cultivation are needed, especially in patients with prolonged viral shedding, to understand the virus's viability and infectivity.
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Objectives: Middle East respiratory syndrome coronavirus (MERS-CoV) surveillance in Qatar is guided by WHO recommendations and based on the assumption the virus circulates throughout the Gulf region and all cases of pneumonia need to be tested. The objectives of the study were to collect and analyze laboratory data on MERS-CoV in humans in Qatar and verify the usefulness of testing respiratory samples for MERS-CoV in all pneumonia cases without considering case definitions. Method(s): The retrospective study was based on monthly data extracted from the database of the reference laboratory, Virology and Molecular Biology Section, Department of Laboratory Medicine and Pathology at the Hamad Medical Corporation. Commercial real-time PCR was used for MERS-CoV testing. The period covered ran from September 2012 to June 2019. Result(s): A total of 106 315 tests for MERS-CoV were conducted. To date, 24 laboratory confirmed MERS-CoV cases have been identified, the most recent in December 2017. Requests for MERS-CoV testing were made for respiratory infection investigation and only rarely to specifically target MERS-CoV. The number of requests for MERS-CoV testing peaked with no visible correlation to the number of MERS-CoV cases confirmed in Qatar or in countries with high MERS-CoV prevalence. The peaks did, however, match with influenza virus' requests. Nor was the distribution of Qatari cases correlated to the activity recorded in countries where MERS-CoV is highly prevalent. Conclusion(s): Though this preliminary study suggested MERS-CoV is not circulating in Qatar's human population, more detailed data needs to be collected and the results of epidemiological investigations of the virus in the animal population considered before more concrete conclusions can be drawn.