Investigation of hospital discharge cases and SARS-CoV-2 introduction into Lothian care homes

Background The first epidemic wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Scotland resulted in high case numbers and mortality in care homes. In Lothian, over a third of care homes reported an outbreak while there was limited testing of hospital patients discharged to care homes. Aim Investigate hospital discharges as a source of SARS-CoV-2 introduction into care homes during the first epidemic wave. Methods A clinical review was performed for all discharges from hospitals to care homes starting 1st March 2020 to 31st May 2020. Episodes were ruled out based on coronavirus disease (COVID-19) test history, clinical assessment at discharge, whole genome sequencing (WGS) data and an infectious period of 14 days. Clinical samples were processed for WGS, and consensus genomes generated were used for analysis by cluster investigation and virus epidemiological tool (CIVET). Patient timelines were obtained using electronic hospital records. Findings In total 787 hospital discharges to care homes were identified. Out of these 776 (99%) were ruled out for hospital discharge introduction. However, for 10 episodes the results were inconclusive as there was low genomic diversity in consensus genomes or no sequencing data. Only one discharge episode had a genomic, time and location link to positive cases during hospital admission leading to 10 further positive cases in the care home. Conclusion Majority of hospital discharges were ruled out for introduction into Lothian care homes highlighting the importance of screening all new admissions when faced with a novel emerging virus and no vaccine available.

Investigation of hospital discharge cases and SARS-CoV-2 introduction into Lothian care homes.

BACKGROUND: The first epidemic wave of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Scotland resulted in high case numbers and mortality in care homes. In Lothian, over one-third of care homes reported an outbreak, while there was limited testing of hospital patients discharged to care homes. AIM: To investigate patients discharged from hospitals as a source of SARS-CoV-2 introduction into care homes during the first epidemic wave. METHODS: A clinical review was performed for all patients discharges from hospitals to care homes from 1st March 2020 to 31st May 2020. Episodes were ruled out based on coronavirus disease 2019 (COVID-19) test history, clinical assessment at discharge, whole-genome sequencing (WGS) data and an infectious period of 14 days. Clinical samples were processed for WGS, and consensus genomes generated were used for analysis using Cluster Investigation and Virus Epidemiological Tool software. Patient timelines were obtained using electronic hospital records. FINDINGS: In total, 787 patients discharged from hospitals to care homes were identified. Of these, 776 (99%) were ruled out for subsequent introduction of SARS-CoV-2 into care homes. However, for 10 episodes, the results were inconclusive as there was low genomic diversity in consensus genomes or no sequencing data were available. Only one discharge episode had a genomic, time and location link to positive cases during hospital admission, leading to 10 positive cases in their care home. CONCLUSION: The majority of patients discharged from hospitals were ruled out for introduction of SARS-CoV-2 into care homes, highlighting the importance of screening all new admissions when faced with a novel emerging virus and no available vaccine.

Relapse activity and disability progression in COVIDvaccinated patients with multiple sclerosis: homologous vs. heterologous vaccination scheme

Background: Vaccination reduces the likelihood of a severe COVID-19 disease course. Therefore, vaccination against COVID-19 is generally recommended, even for people with autoimmune diseases such as multiple sclerosis (MS). Nevertheless, some people with MS (PwMS) have concerns about the vaccinations due to fear of disease worsening after the vaccinations. Objective(s): We aimed to analyse relapse activity and disability progression of PwMS stratified by COVID-19 vaccination scheme (homologous [HOM] vs. heterologous [HET]). Method(s): This study is based on a longitudinal observational study regarding the safety and tolerability of COVID-19 vaccines in PwMS. Acquisition of socio-demographic, clinical and vaccination data was conducted via several pseudonymised online surveys. PwMS with a minimum age of 18 years, a diagnosis of MS and a basic immunisation (usually two vaccinations) as well as >=1 booster vaccination against COVID-19 were included (N=2062). Patients with HOM (same vaccines) and HET vaccination schemes (different vaccines) were compared regarding relapse activity following vaccination and disability status (patient-determined disease steps [PDDS]). Result(s): The 2062 PwMS analysed showed a mean age of 47.1+/-11.0 years and a female proportion of 78.5%. The most common MS course was relapsing-remitting MS (74.8%). Most PwMS were currently treated with a disease-modifying drug (73.9%). Relapses after any COVID-19 vaccination occurred in 5.8% of PwMS. Comparing the disability level following the first vaccination with the period after the booster vaccination, a PDDS decrease was reported by 16.4% of PwMS, an increase by 13.6% and no change by 70.0%. The majority of patients reported a HOM vaccination scheme (59.4%), while 40.6% received HET vaccination (28.0%: different mRNA vaccines [HET1], 12.6%: mRNA + vector vaccines [HET2]). The only significant difference (p=0.012) between patients stratified by vaccination scheme was related to the mean age: PwMS receiving HOM vaccination (46.5+/-11.2 years) were younger than patients with HET vaccination (HET1: 48.4 years, HET2: 48.1 years). These patient subgroups revealed no considerable difference regarding the frequency of relapses following vaccination (HOM: 4.7%, HET1: 5.2%, HET2: 6.9%;p=0.3). Conclusion(s): The frequency of relapses and disability progression following COVID vaccinations do not appear to be associated with the type of vaccination regimen administered.

TIMELY FOLLOW-UP OF ABNORMAL CANCER SCREENING TEST RESULTS IN TWO LARGE PRIMARY CARE PRACTICE NETWORKS

BACKGROUND: Timely follow-up of abnormal cancer screening test results (“abnormal screens”) is critical but often not achieved. As part of an NCI funded intervention trial (mFOCUS: multilevel Follow-up of Cancer Screening, ClinicalTrials.gov NCT03979495), we report on abnormal screens that were identified and tracked to identify eligible patients overdue for study inclusion. While not anticipated when this study was conceived, the COVID-19 pandemic resulted in a larger than anticipated backlog of patients in need of follow-up of abnormal screens. METHODS: Patients in two primary care practice networks affiliated with Mass General Brigham who had an abnormal screen for breast, cervical or lung cancer were identified using computerized algorithms and then tracked for completion of appropriate follow-up based upon the cancer type and the severity of the abnormal result. Since the intervention was designed as a “fail safe” system, additional time (2-6 months depending on the severity of the abnormal screen) was added after the recommended follow-up interval. We report the number of abnormal screens by cancer type and severity of the abnormality and the number of patients who completed follow-up based upon guideline and expert recommendations. RESULTS: Patient tracking and enrollment started with abnormal screens for breast and lung on 8/24/2020 and cervical cancer on 10/16/2020. Enrollment ended for all abnormal screens on December 15, 2021. Over the study period, 4003 abnormal breast, 5214 abnormal cervical, and 478 abnormal lung screens were identified. High risk abnormalities were most common for cervical (51.7%, recommended colposcopy or endometrial biopsy), lung (22.6%, LRADS 4B, 4X or 5), and lowest for breast (0.4%, BIRADS 5). Rates of completing recommended follow-up of abnormal screens by cancer type and severity of the result are shown in the table. CONCLUSIONS: Maximizing the benefits of cancer screening requires the timely follow-up of abnormal screening results. Though likely exacerbated by the COVID-19 pandemic, we identified that timely completion of abnormal screens is often not achieved. Rates of completion varied by cancer type and the severity of the abnormal result but highlight the need for systems based, multi-level interventions to identify, report and track abnormal results.

Remote Microwave Sterilization Applicable to Coronaviruses Using a Van-Atta Retrodirective Antenna Array with 2-D Tracking Capability

We propose a method for remote sterilization of surfaces which follows wireless power transmission principles. Using the self-steering tracking capability of retro-directive arrays (RDAs), an infected area of interest can be sterilized by radiating microwave power in a controlled and efficient manner, thus producing heat for pathogen deactivation. The employed antenna array system offers dual-circular polarization with isolation values of 55 dB which supports the co-location of the transmit and receive parts of the RDA. In particular, the paper reports the use of a 2 x 2 circularly polarized RDA system operating in the S-band, which is used to investigate the possible heat change of a water covered sample for sterilization, placed at different ranges from the transmitting point and rotated in the plane normal to the illumination. The time required to heat the area of interest up 60°C is numerically studied and the capabilities of inducing the needed temperature gradient over the samples is examined. In addition, measurements have been performed using biological samples of the coronavirus (strain Cov-229E-GFP) to demonstrate virus deactivation. The proposed methodology can also be made completely automated and with little operator interaction, representing a new and attractive option for microwave sterilization of pathogens such as those related to the severe acute respiratory syndrome coronavirus (SARS COVID-19). © 2022 European Microwave Association.

MOG encephalomyelitis after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2): case report and comprehensive review of the literature.

BACKGROUND: In around 20% of cases, myelin oligodendrocyte glycoprotein (MOG) immunoglobulin (IgG)-associated encephalomyelitis (MOG-EM; also termed MOG antibody-associated disease, MOGAD) first occurs in a postinfectious or postvaccinal setting. OBJECTIVE: To report a case of MOG-EM with onset after vaccination with the Pfizer BioNTech COVID-19 mRNA vaccine BNT162b2 (Comirnaty®) and to provide a comprehensive review of the epidemiological, clinical, radiological, electrophysiological and laboratory features as well as treatment outcomes of all published patients with SARS-CoV-2 vaccination-associated new-onset MOG-EM. METHODS: Case report and review of the literature. RESULTS: In our patient, MOG-IgG-positive (serum 1:1000, mainly IgG1 and IgG2; CSF 1:2; MOG-specific antibody index < 4) unilateral optic neuritis (ON) occurred 10 days after booster vaccination with BNT162b2, which had been preceded by two immunizations with the vector-based Oxford AstraZeneca vaccine ChAdOx1-S/ChAdOx1-nCoV-19 (AZD1222). High-dose steroid treatment with oral tapering resulted in complete recovery. Overall, 20 cases of SARS-CoV2 vaccination-associated MOG-EM were analysed (median age at onset 43.5 years, range 28-68; female to male ratio = 1:1.2). All cases occurred in adults and almost all after immunization with ChAdOx1-S/ChAdOx1 nCoV-19 (median interval 13 days, range 7-32), mostly after the first dose. In 70% of patients, more than one CNS region (spinal cord, brainstem, supratentorial brain, optic nerve) was affected at onset, in contrast to a much lower rate in conventional MOG-EM in adults, in which isolated ON is predominant at onset and ADEM-like phenotypes are rare. The cerebrospinal fluid white cell count (WCC) exceeded 100 cells/µl in 5/14 (36%) patients with available data (median peak WCC 58 cells/µl in those with pleocytosis; range 6-720). Severe disease with tetraparesis, paraplegia, functional blindness, brainstem involvement and/or bladder/bowel dysfunction and a high lesion load was common, and treatment escalation with plasma exchange (N = 9) and/or prolonged IVMP therapy was required in 50% of cases. Complete or partial recovery was achieved in the majority of patients, but residual symptoms were significant in some. MOG-IgG remained detectable in 7/7 cases after 3 or 6 months. CONCLUSIONS: MOG-EM with postvaccinal onset was mostly observed after vaccination with ChAdOx1-S/ChAdOx1 nCoV-19. Attack severity was often high at onset. Escalation of immunotherapy was frequently required. MOG-IgG persisted in the long term.

The effect of Covid-19 mRNA vaccine on serum anti-Müllerian hormone levels.

STUDY QUESTION: Does the administration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine have an association with ovarian reserve as expressed by circulating anti-Müllerian hormone (AMH) levels? SUMMARY ANSWER: Ovarian reserve as assessed by serum AMH levels is not altered at 3 months following mRNA SARS-CoV-2 vaccination. WHAT IS KNOWN ALREADY: A possible impact of SARS-CoV-2 infection or vaccination through an interaction between the oocyte and the somatic cells could not be ruled out, however, data are limited. STUDY DESIGN, SIZE, DURATION: This is a prospective study conducted at a university affiliated tertiary medical center between February and March 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: Study population included reproductive aged women (18-42 years) that were vaccinated by two Pfizer-BioNTech Covid-19 vaccines (21 days apart). Women with ovarian failure, under fertility treatments, during pregnancy, previous Covid-19 infection or vaccinated were excluded from the study. Blood samples were collected for AMH levels before the first mRNA vaccine administration. Additional blood samples after 3 months were collected for AMH and anti-Covid-19 antibody levels. Primary outcome was defined as the absolute and percentage change in AMH levels. MAIN RESULTS AND THE ROLE OF CHANCE: The study group consisted of 129 women who received two mRNA vaccinations. Mean AMH levels were 5.3 (±SD 4.29) µg/l and 5.3 (±SD 4.50) µg/l at baseline and after 3 months, respectively (P = 0.11). To account for possible age-specific changes of AMH, sub-analyses were performed for three age groups: <30, 30-35 and >35 years. AMH levels were significantly lower for women older than 35 years at all times (P = 0.001 for pre and post vaccination AMH levels versus younger women). However, no significant differences for the changes in AMH levels before and after vaccinations (Delta AMH) were observed for the three age groups (P = 0.46). Additionally, after controlling for age, no association was found between the degree of immunity response and AMH levels. LIMITATIONS, REASONS FOR CAUTION: Although it was prospectively designed, for ethical reasons we could not assign a priori a randomized unvaccinated control group. This study examined plasma AMH levels at 3 months after the first vaccination. It could be argued that possible deleterious ovarian and AMH changes caused by the SARS-CoV-2 mRNA vaccinations might take effect only at a later time. Only longer-term studies will be able to examine this issue. WIDER IMPLICATIONS OF THE FINDINGS: The results of the study provide reassurance for women hesitant to complete vaccination against Covid 19 due to concerns regarding its effect on future fertility. This information could be of significant value to physicians and patients alike. STUDY FUNDING/COMPETING INTEREST(S): The study was supported by Sheba Medical Center institutional sources. All authors have nothing to disclose. TRIAL REGISTRATION NUMBER: The study protocol was approved by the 'Sheba Medical Center' Ethical Committee Review Board (ID 8121-21-SMC) on 8 February 2021 and was registered at the National Institutes of Health (NCT04748172).

Clinical manifestations of SARS-CoV2 infections in children and adolescents with rheumatic and musculuskeletal diseases-survey data from Germany

Background: Although children and adolescents are less likely to develop COVID-19 and generally show milder disease courses, it is unclear what impact the SARS-CoV2 infection has on children and adolescents with rheumatic and musculoskeletal disease (RMD). Due to their underlying disease as well as therapeutic immunosuppression these patients may be at higher risk of being more severely affected by SARS-CoV2. Furthermore, SARS-CoV2 infection might trigger a flare of the underlying disease. Objectives: To evaluate clinical characteristics and disease course of COVID-19 in children and adolescents with RMD and to analyze possible effects of SARSCoV2 infection on the underlying disease under different therapeutic regimens. Methods: Data from juvenile patients with RMD recorded via the SARS-CoV2 questionnaire within the National Pediatric Rheumatology Database and the registry for hospitalized children and adolescents with COVID-19 of the German Society for Pediatric Infectious Diseases were analyzed. In addition to age, sex and diagnosis, information was collected about the date and method of a positive SARS-CoV2 testing, reason for testing, on clinical manifestations, disease course, treatment and outcome of COVID-19, on drug therapy at the time of virus detection, on disease activity (NRS 0 -10, 0 = best) of the underlying disease at the last visit before and after the SARS-CoV2 infection. Results: From April 17th 2020 until January 25th 2021, data of 67 patients with RMD and confirmed SARS-CoV2 infection were collected. Mean age was 13.5 ± 3.9 years with equal sex distribution. The majority of patients were diagnosed with juvenile idiopathic arthritis (JIA, 64%), 12 (18%) patients had an autoinflammatory disease (FMF, CAPS, PFAPA, TRAPS) and 5 (7%) a connective tissue disease. Fifty-two patients (78%) were treated with a disease modifying antirheumatic drug (DMARD), 39% with a biological DMARD and 9% systemic glucocorticoids at the time of SARS-CoV-2 infection. Nineteen patients (28%) were tested for SARS-CoV-2 because of typical symptoms, the majority (67%) because of contact to an infected person. PCR was used most often (in 60 %). 52 patients (78%) developed symptoms of COVID-19, 15 patients remained asymptomatic. The most common symptom of COVID-19 was rhinitis (42%) and fever (38%), followed by fatigue (34%), taste/smell disorder (33%), sore throat (27%) and cough (23%). Disease severity was graded as mild in 44 of 52 (85%) symptomatic patients, only two patients were hospitalized, one of whom required intensive care and died of cardiorespiratory failure 3 days after symptom onset. In 22 of 26 (85%) SARS-CoV2-positive patients, no relevant increase in disease activity (difference in NRS ≤ 1 before/after infection) of the underlying disease was observed 31 days after symptom onset (median, IQR 17-52 days). One patient, who had paused tocilizumab for 2 doses, experienced a flare of his seronegative polyarthritis 2 months after asymptomatic SARS-CoV-2 infection. Conclusion: In our cohort, the clinical picture of COVID-19 in children and adolescents with RMD was similar to that of healthy peers. The majority of patients showed mild disease course with good outcome under various medications, however, one patient with a severe course of COVID-19 died. In addition, SARSCoV2 infection does not appear to have a relevant impact on the underlying disease activity, whereas discontinuation of therapy might pose a risk of flare.