ABSTRACT
Although children have been largely spared from coronavirus disease 2019 (COVID-19), the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) with increased transmissibility, combined with fluctuating mask mandates and school reopenings, has led to increased infections and disease among children. Thus, there is an urgent need to roll out COVID-19 vaccines to children of all ages. However, whether children respond equivalently to adults to mRNA vaccines and whether dosing will elicit optimal immunity remain unclear. Here, we aimed to deeply profile the vaccine-induced humoral immune response in 6-to 11-year-old children receiving either a pediatric (50 mu g) or adult (100 mu g) dose of the mRNA-1273 vaccine and to compare these responses to vaccinated adults, infected children, and children who experienced multisystem inflammatory syndrome in children (MIS-C). Children elicited an IgG-dominant vaccine-induced immune response, surpassing adults at a matched 100-mu g dose but more variable immunity at a 50-mu g dose. Irrespective of titer, children generated antibodies with enhanced Fc receptor binding capacity. Moreover, like adults, children generated cross-VOC humoral immunity, marked by a decline of omicron-specific receptor binding domain, but robustly preserved omicron spike protein binding. Fc receptor binding capabilities were also preserved in a dose-dependent manner. These data indicate that both the 50-and 100-mu g doses of mRNA vaccination in children elicit robust cross-VOC antibody responses and that 100-mu g doses in children result in highly preserved omicron-specific functional humoral immunity.
ABSTRACT
Background: Emilia Romagna recordered a very high percentage of hospitalized COVID-19 patients out of the total number of COVID-19 affected people. Data reveal cancer to be a major risk factor for adverse outcomes and death for patients with Sars CoV2 infection. This increased susceptibility could be due to the chronic immunosuppression, exerted by the cancer itself and exacerbated by cytotoxic therapies. Material(s) and Method(s): We retrospectively evaluated 93 oncological patients, followed for cancer at the Sant' Anna University Hospital in Ferrara, and diagnosed with COVID-19 infection in 3 different pandemic periods (February 2020- September 2020;October 2020-August 2021;September 2021- March 2022). We analyzed demographic and clinical features of the population: Age at diagnosis, gender, tobacco consumption, comorbidities (according to the Charlson Comorbidity Index), cancer subtype and stage, therapy ongoing and ECOG PS before and after COVID-19 infection. We also described the severity of the infection through the symptoms developed and need for eventual hospitalization. Result(s): The gender distribution of the cohort was broadly equivalent (Female/Male, 49/44), with a median age at COVID-19 diagnosis of 71 years (35-99). Current or previous smoking was reported by 28% and 14% of patients, respectively. The most common comorbidity was hypertension (79%) VS pulmonary disease (14%);the median CCI was 6. A symptomatic infection was observed in 38% of patients. A worse clinical outcome was associated to higher ECOG PS (2-3) (p 0,013) and to the first pandemic period (p<0,0001). A mortality rate of 36% has been observed among hospitalized patients due to severity of infection (p<0,0001). Increased age at cancer diagnosis (median age 66 years) was a significant risk factor for severe COVID-19 disease. Eighty-six percent of the study population had an active disease that correlated with high proportion (21%) of death (p<0,003). The most prevalent malignancies were breast (19,4%) and lung (15%), and the diagnosis of lung cancer was associated with a worse outcome;in contrast, cancer stage, ongoing anticancer therapies and treatment toxicities had no effect on clinical outcome. Conclusion(s): This study highlights a high mortality rate related to COVID-19 infection among cancer patients. Worse outcomes are driven by features such as pandemic period, cancer status and subtype, ECOG PS and median age at cancer diagnosis.
ABSTRACT
Background: Rectal cancer treatment has evolved during the past 40 years thanks to the advancements in imaging, pathology, surgical treatments, radiotherapy, and chemotherapy, within a multidisciplinary team approach providing an optimum health care. Many studies have demonstrated how the social environment can affect the treatment and outcome in neoplastic patients. The primary endpoint of this study was to compare the Health Equity Audit (HEA) before and after the establishment of a structured pathway for the management of neoplasms of the rectum. Methods: This was a retrospective study carried out at the University Hospital of Ferrara, Italy, on selected patients with rectal cancer stage < IIIb, who were diagnosed and treated in the year 2012 (Group 1:35 patients), before the start of the rectal cancer multidisciplinary team, and in the year 2020 (Group 2: 35 patients), after the setting up of the rectal cancer multidisciplinary team. For each patient we considered different social variables: age at time of diagnosis, gender, distance in km from the centre of treatment, level of education. We analysed the following indicators: Indicator 1: time between the first symptoms and diagnosis;Indicator 1b: % of patients coming from screening programs;Indicator 2: time between the communication of diagnosis and the beginning of the treatment;Indicator 3: adherence to treatment;Indicator 4: time between the end of neoadjuvant treatment and surgery. Results: The characteristics of the patients at baseline were well balanced between the two groups. Indicator 1 goal was achieved in 64% of the patients in group 1 and in 73,9% of the patients in group 2. Indicator 2 goal was achieved in 35,3% of group 1 and 55,6 % of group 2. In group 1, 71% of patients who lived less than 30 km away from our center met the indicator 2 criteria while only 33% of patients who lived more than 30 kms away had the same result. In group 2, 53% of patients who lived less than 30 km away from our center met the indicator 2 criteria while none of the patients who lived more than 30 kms away did. In addition, we found out that in group 1 the rate of patients who met indicator 2 goal increased with level of education. These preliminary results demonstrated that equality seems to have improved after 8 years despite the Covid pandemic in 2020. Conclusions: The introduction of a dedicated treatment pathway appears to have improved Health Equity for patients with rectal cancer.
ABSTRACT
INTRODUCTION: Parkinson's disease (PD) is more frequent in the elderly and increases the risk of respiratory infections. Previous data on PD and SARS-CoV-2 are scarce, suggesting a poor prognosis in advanced disease and second-line therapies. METHODS: A retrospective case-control study comparing patients with PD and COVID-19 and patients with PD without COVID-19 was conducted during the pandemic period in Spain (March 1st-July 31st 2020) in a tertiary university hospital. RESULTS: Thirty-nine (COVID-19 +) and 172 (COVID-19-) PD patients were included. Fifty-nine percent were males in both groups, with similar age (75.9 ± 9.0 COVID-19 + , 73.9 ± 10.0 COVID-19-), disease duration (8.9 ± 6.2 COVID-19 + , 8.5 ± 5.6 COVID-19-) and PD treatments. COVID-19 was mild in 10 (26%), required admission in 21 (54%) and caused death in 8 (21%) patients. Dementia was the only comorbidity more frequent in COVID-19 + patients (36% vs. 14%, p = 0.0013). However, in a multivariate analysis, institutionalization was the only variable associated with COVID-19 + (OR 17.0, 95% CI 5.0-60.0, p < 0.001). When considering severe COVID-19 (admission or death) vs. mild or absent COVID-19, institutionalization, neoplasm, dementia and a lower frequency of dopamine agonists were associated with severe COVID-19. In multivariate analysis, only institutionalization [OR 5.17, 95% CI 1.57-17, p = 0.004] and neoplasm [OR 8.0, 95%CI 1.27-49.8, p = 0.027] remained significantly associated. CONCLUSION: In our experience, institutionalization and oncologic comorbidity, rather than PD-related variables, increased the risk of developing COVID-19, and impacted on its severity. These findings suggest that epidemiologic factors and frailty are key factors for COVID-19 morbidity/mortality in PD. Appropriate preventive strategies should be implemented in institutionalized patients to prevent infection and improve prognosis.