ABSTRACT
Background: Knowledge about SARS-CoV2 infection in pregnancy and exposed newborns is deficient. We performed a longitudinal analysis of innate immune system status and determined soluble cytokines of women infected with SARS-CoV2 during pregnancy and their newborns Methods: Women with confirmed SARS-CoV2 infection (RT-PCR+ or SARS-CoV2 anti-IgM/IgG+) (COVID MOTHER group, CM n=29, median age of 31 years) and their SARS-CoV2 exposed uninfected newborns were recruited from Hospital Gregorio Marañón, Spain. Peripheral blood mononuclear cells (PBMCs), cord cells and plasma were collected at birth and 6 months later (n=15). The immunophenotyping of innate components (natural killer cells [NK] and monocytes) was studied on cryopreserved PBMCs and cord cells by multiparametric flow cytometry. Up to 4 soluble pro/anti-inflammatory cytokines were assessed in plasma and cord plasma by ELISA assay. CM was compared to a healthy non-SARS-CoV2 infected mothers' group matched by age (SARS-CoV2 PCR-and SARS-CoV2 anti-IgM/IgG-)(Uninfected Mothers, UM n=16) and their newborns (n=16) Results: On NK cell assays, CM show at baseline lower percentage of CD16++ subset, higher NKG2D and lower NKG2A expression on CD16++ and CD56++ subsets and reduced CD57 expression compared to UM;proportion of CD16++ subset and percentage of NKG2D reverted after 6 months(A). Regarding monocytes, CM show increased levels of CD62L and decreased CD49d expression on classical subset, elevated intermediate monocytes proportion and decreased CD40 expression on patrolling subset(B). No differences were found 6 months later. No newborn was infected by SARS-CoV2 and the phenotype analyzed on cord cells shows lower frequency of NK subsets compared with unexposed children and increased CD16++ subset after 6 months(C). In monocytes distribution, exposed children present lower frequency of total monocytes and its subsets than unexposed. Classical monocytes show significant changes at follow-up time-point(D). Increased TNFα and IL10 levels were found on CM compared to UM. Strong and direct correlations were observed between the age and IL6(E). No differences were observed in soluble cytokine levels comparing both groups of newborns Conclusion: SARS-CoV2 infection during pregnancy shows differences in activation, maturation and endothelial markers on innate immune system that could lead newborns clinical implications at birth. However, altered cell proportions and phenotypes found at SARS-CoV2 at birth time and on their exposed newborns is later reverted.
ABSTRACT
Background: SARS-CoV2 infection severity during pregnancy and posible consequences for exposed newborns information is still unknown. The objective of this study is to analyse clinical and epidemiological characteristics of a SARS-CoV2 infected women during pregnancy and their newborns cohort. Methods: Multicentric observational study from the Spanish GENEO-COVID cohort (participating in RECLIP). Infected pregnant women and their newborns born from 15 March to 31 July with a 15 days follow up were included. Data regarding epidemiological, clinical, virological and immunological characteristics of the patients was collected. Results: Globally, 105 pregnant women with a median age of 34 (IQR: 29-37) years old and 107 newborns were included in the study. Median gestational age at diagnosis was 36.9 (IQR-33.4-39.2) weeks, and 6.7% os women were diagnosed in the second trimester. More than 34% of the women presented at least one comorbidity and almost 65% of women had COVID19 symptoms and 43% of them were treated for the infection. Overall, 30.8% had COVID-19 pneumonia and 4.8% were admitted to the intensive care unit (ICU) needing invasive mechanical ventilation. The rate of positive RT-PCR at delivery was 61.9%. There was a 36.2% rate of caesarean sections, associated with pneumonia during pregnancy OR:4.2 (95% CI 1.5,12.0) and lower gestational age at delivery OR:0.7 (95% CI: 0.6,0.9). Regarding newborns, 46.7% were male, 66.4% breastfed, with median Apgar 1' of 9 and Apgar 5' of 10. Almost 6% were small for gestational age and 16.8% needed admission to the neonatal ICU. Oxygen was needed by 12.1% and surfactant by 5.6% newborns. Prematurity rate was 20.6%, associated with pneumonia during gestation OR:7.0 (95% CI: 2.3,22.8) and with a positive RT-PCR at delivery OR:6.5 (95% CI: 1.8,31.8). No associations were found with age, comorbidities or blood group. No vertical transmission was reported but one newborn was horizontally infected. Two newborns died, one due to prematurity causes and another of unexpected sudden death during early skin-to-skin contact after delivery. Conclusion: Even there is no vertical transmission reported in this cohort, we found a case of horizontal transmission. SARS-CoV2 infection could produce COVID19 pneumonia during pregnancy, that increases caesarean sections and prematurity rates worsening exposed newborns prognosis. (Figure Presented).
ABSTRACT
Since the worldwide COVID-19 pandemic was declared a year ago, the search for vaccines has become the top priority in order to restore normalcy after 2.5 million deaths worldwide, overloaded sanitary systems, and a huge economic burden. Vaccine development has represented a step towards the desired herd immunity in a short period of time, owing to a high level of investment, the focus of researchers, and the urge for the authorization of the faster administration of vaccines. Nevertheless, this objective may only be achieved by pursuing effective strategies and policies in various countries worldwide. In the present review, some aspects involved in accomplishing a successful vaccination program are addressed, in addition to the importance of vaccination in a pandemic in the face of unwillingness, conspiracy theories, or a lack of information among the public. Moreover, we provide some updated points related to the landscape of the clinical development of vaccine candidates, specifically, the top five vaccines that are already being assessed in Phase IV clinical trials (BNT162b2, mRNA-1273, AZD1222, Ad26.COV2.S, and CoronaVac).
ABSTRACT
OBJECTIVE: The aim of this study is to assess the value of systematic screening in asymptomatic women admitted for spontaneous delivery with a combination of reverse transcription polymerase chain reaction (RT-PCR) and cycle threshold (Ct) and serum antibodies. METHODS: Since May 6 all women admitted for spontaneous delivery underwent RT-PCR in nasopharyngeal swabs and specific antibodies IgG of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in serum that were performed as part of routine clinical care in our institution. Ct of the PCR was recorded. We analyzed the first 100 women consecutively admitted for spontaneous delivery at our institution. RESULTS: Nine women were positive for SARS-CoV-2 in nasopharyngeal samples (9%) and 13 (13%) presented positive specific antibodies of the coronavirus. Overall, SARS-CoV-2 prior exposure was 15%. The Ct determination (RT-PCR test) of our 9 positive patients ranged from 36 to 41 cycles with a median of 40. Vaginal delivery occurred in 94% of the cases and only 6% underwent a cesarean section, always for obstetric reasons. No fetal transmission was observed and maternal and neonatal prognosis was excellent. CONCLUSIONS: During epidemic episodes in asymptomatic women in labor, universal testing with RT-PCR (considering Ct determination), and the detection of antibodies, permits a better interpretation of the results and avoid unnecessary isolation procedures.