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BackgroundUnderstanding the dynamics of humoral immunity after COVID-19 vaccination is crucial in developing vaccination strategies. Antibody response patterns are more complex in patients with rheumatoid arthritis (RA) because of their underlying autoimmunity and immunosuppressive medications. The kinetics of vaccine response in RA patients are not well understood.ObjectivesTo construct a model of antibody response to COVID-19 vaccination in patients with RA.MethodsTwo patient groups were included for the study. The first group was composed of RA patients who were enrolled for influenza vaccination study between Oct 6, 2021 and November 3, 2021, in whom serial serum samples were obtained 0, 4, 16 weeks after vaccination. The second group was consecutively enrolled from outpatient clinic between October 6, 2021 and June 3, 2022, in whom serum sample was obtained once. After collecting data on demographics, vaccination and infection history of COVID-19 were obtained by self-report via questionnaire and data from Korean center for disease control. We then measured antibody titers against receptor binding domain of spike protein (anti-RBD) and nucleocapsid (anti-N), using Chemiluminescence microparticle immunosaasy (Abbott, USA) and Electrochemiluminescence immunoassay (Roche, Germany) respectively. The anti-RBD titer was log-transformed to improve normality. Time from vaccination and log of anti-RBD titer was modeled using fractional polynomial. Covariates including age, sex, BMI, underlying disease and immunosuppressive drugs were analyzed using Generalized Estimating Equations to account for repeated measured from a subject.ResultsA total of 736 patients (1042 samples) were enrolled. After excluding patients who experienced COVID-19 infection before sampling (n=84), those unvaccinated (n=44) and uncertain COVID-19 infection history (n=59), the data on 778 samples from 549 patients were analyzed (Group 1: 125, Group 2: 424). Antibody titer reached peak at 12 days after vaccination and decreased exponentially (Figure 1) which fell to 36.5% from peak after 2 months. Compared to the first vaccination, the 3rd and 4th vaccination significantly shifted anti-RBD antibody response curve (28 times, 95% CI 4~195;32 times 95% CI 4~234, respectively). However, there was no significant shift after the 4th vaccination from the 3rd vaccination (p=0.6405). Multivariable analysis showed that number of vaccinations and sulfasalazine (coefficient: 0.40, 95% CI 0.12~0.68) increased vaccine response but age (coefficient: -0.03, 95% CI -0.04~-0.02), abatacept (coefficient: -2.07, 95% CI -3.30~-0.84) and, JAK inhibitor (coefficient: -0.82, 95% CI -1.34~-0.31) decreased vaccine response.ConclusionAnti-RBD response to COVID-19 vaccination showed a peak at 12 days after vaccination and then exponentially decreased in patient with RA. The antibody response is affected by age and medications used for the treatment of RA.Table 1.ln[RBD (U/ml)]coefficient (univariable)95% CIp-valuecoefficient (multivariable)95% CIp-valuesex (female)0.17-0.22, 0.550.393---age-0.02-0.03, -0.01<.001**-0.03-0.04, -0.02<.001**DM0.11-0.27, 0.500.568---HTN-0.38-0.69, -0.070.018*---CKD0.680.07, 1.290.030*---RA duration (yr)-0.04-0.06, -0.010.001**---Pd (mg/d)-0.06-0.11, 0.000.035*---MTX use-0.23-0.52, 0.050.105---HCQ use0.01-0.28, 0.290.965---SSZ use0.450.07, 0.840.022*0.400.12,0.680.005**LEF use0.00-0.37, 0.370.988---TNF inhibitors use0.29-0.16, 0.730.208---Abatacept use-2.07-3.14, -0.99<.001**-2.07-3.30, -0.840.001**JAK inhibitors use-0.88-1.52, -0.240.007**-0.82-1.34, -0.310.002**Time (months)log(t)-1.96-2.37, -1.54<.001**-1.90-2.29, -1.50<.001**t
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Objectives: We would like to report a case in which a COVID-19 patient who was transferred to our hospital due to a lack of medical resources due to the COVID-19 outbreak in Daegu, South Korea, on February, 2020, underwent double lung transplantation after 110 days with VV-ECMO support and performed double lung re-transplantation 865 days after lung transplantation. Method(s): ECMO was performed on a total of 69 patients with COVID-19-related acute circulatory/ respiratory failure from February 2020 to December 2022. Among them, 16 patients were registered for lung transplantation, and 5 out of 16 registered patients performed lung transplants. One in five people who performed lung transplantation performed retransplantation on the 865thday after transplantation. Result(s): A 52-year-old female patient was transferred to our hospital, and VV-ECMO was performed the next day. The double lung transplantation was performed 112 days after hospitalization and was discharged 238 days after surgery. 668 days after lung transplantation, home O2 was applied as bronchitis obliterans syndrome, and her lung function deteriorated rapidly later, and re-transplantation was decided. In the patient;s HLA test, HLA class I cPRA% was 32% and HLA class II cPRA% was 100%. Desensitization was performed six times plasmapheresis with administrating Botezomib and immunoglobulin, and then re-transplantation was performed on the 865th day after lung transplantation. The patient has maintained her daily life without any special complications other than the occurrence of central DI after surgery. The pathological findings of the lung previously transplanted to the patient were acute rejection (ISHLT grade A2), chronic airway rejection (ISHLT grade C1, B0), and chronic vascular rejection (ISHLT grade D1). Conclusion(s): The long term result of patients who performed lung transplantation with COVID 19 related respiratory failure is still unknown. Therefore, even patients who have undergone long-term VV-ECMO support due to COVID 19 related respiratory failure are expected to achieve good results if lung transplantation is needed by carefully approaching and treating with a multidisciplinary approach.
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Background. There is limited information describing the clinical characteristics and prognosis of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy. The clinical features and the predictive factors for development of hypoxemia were investigated in SARS-Cov-2 infected women during pregnancy. Methods. From August 2020 to February 2022, 410 pregnant women were infected with SARS-CoV-2 who admitted to two hospitals, the National Health Insurance Service Ilsan Hospital in Goyang or the Wonju Severance Christian Hospital in Wonju, Korea. The clinical characteristics and prognosis were compared between pregnant women who required oxygen or not during hospitalization. Results. The mean age of the patients was 33.3 years. The hospitalized pregnant women were categorized into two groups such as no oxygen group and oxygen group. Of 410 patients, 100 (24.4%) required oxygen therapy (81 low-flow, 15 high-flow oxygen and 4 mechanical ventilation including 2 extracorporeal membrane oxygenation). In oxygen group, the symptoms such as fever [163 (52.6%) vs 81 (81.0%), p< 0.001] and cough [172 (56.4%) vs 73 (73.0%), p=0.003] were frequently observed. In oxygen group, the frequency of whom were not vaccinated was more [264 (85.2%) vs 98 (98.0%), p=0.003], however, that of the SARS-CoV-2 omicron variant infected patients was lower [98 (31.6%) vs 18 (18.0%), p=0.009]. The risk for the development of hypoxemic respiratory difficulty was increased if the SARS-CoV-2 infection during third trimester (OR 5.083, 95% CI 1.095-23.593, p=0.038) and elevated C-reactive protein (>=1.0 mg/ dL) at admission (OR 5.878, 95% CI 3.099-11.146, p< 0.001) in the SARS-CoV-2 infected pregnant women. However, the risk was decreased with vaccination (OR 0.186, 95% CI 0.041-0.838, p=0.028) and omicron variant infection (OR 0.498, 95% CI 0.258-0.961, p=0.038). Conclusion. A quarter of SARS-CoV-2 infected women during pregnancy developed hypoxemic respiratory difficulty. The SARS-CoV-2 infection during third trimester and no vaccination increased the risk for the development of hypoxemic respiratory difficulty in pregnant women.
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Background: Subacute thyroiditis typically occurs a few weeks after a viral infection and is the most common cause of painful thyrotoxicosis. Cases of subacute thyroiditis have been reported following both inactivated and live-attenuated vaccines, such as the influenza vaccine. We describe a case of subacute thyroiditis in the setting of the Pfizer-BioNTech mRNA COVID-19 vaccination. Clinical Case: A 40-year-old man with no significant medical history presented with signs and symptoms of thyrotoxicosis after receiving the Pfizer COVID-19 vaccine. Symptoms began 3 days after receiving the second vaccine dose and included 9 kg unintentional weight loss, arthralgia in both knees, palpitations, fatigue, bilateral thigh weakness, and diffuse neck swelling, pain, and tenderness. Initial treatment with antibiotics for presumed upper respiratory infection did not improve symptoms, and PCR testing for COVID-19 infection was negative. Thyroid ultrasound obtained 15 days after symptoms onset revealed a 4 cm nodule in the left lobe of the thyroid gland. Testing 30 days after onset of symptoms demonstrated TSH<0.005 uIU/mL (ref: 0.45-4.50 uIU/mL), elevated free T4 of 2.53 ng/dL (ref: 0.82-1.77 ng/dL), and elevated erythrocyte sedimentation rate of 42 mm/hr (ref: 0-15 mm/hr). Repeat labs and imaging 9 days later demonstrated improvement with a TSH of 0.071 uIU/mL and free T4 of 1.04 ng/dL as well as decreased nodule size (2.5 cm). At this time, the patient reported resolution of all symptoms and return to baseline weight. Thyroid ultrasound obtained 3 months after symptoms onset demonstrated normal thyroid without detectable nodules or enlargement, and complete normalization of TSH and free T4 levels to 4.250 uIU/mL and 1.22 ng/dL, respectively. Conclusion: This is the second documented case of subacute thyroiditis following the Pfizer-BioNTech vaccine for COVID-19 in a male patient. A literature review demonstrates 12 other cases of subacute thyroiditis following the Pfizer-BioNTech mRNA COVID-19 vaccine, 3 cases following the Moderna mRNA COVID-19 vaccine, 8 cases following the AstraZeneca recombinant COVID-19 vaccine (one male patient), 4 cases following the CoronaVac inactivated SARS-CoV-2 COVID-19 vaccine, 1 case following the Covaxin inactivated SARS-CoV-2 COVID-19 vaccine, and 3 cases following the Janssen viral vector SARS-CoV-2 COVID-19 vaccine. Albeit uncommon, providers should be aware that transient thyrotoxicosis following COVID-19 vaccination may occur. Similar to subacute thyroiditis due to viral infection, the clinical course is generally self-limited with patients returning to a euthyroid state within a few months. Usual management of subacute thyroiditis with symptomatic management and watchful waiting is appropriate.Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
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In the originally published manuscript, the affiliation for co-author Dr Arati Maleku contained an error. This should read: College of Social Work instead of College only. This error is now corrected in the article online. © 2022 Oxford University Press. All rights reserved.
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The Republic of Korea has faced an unprecedented crisis owing to the COVID-19 pandemic. This study aims to investigate the emergence of COVID-19-related risks in Korea since 2020 and identify key lessons for formulating better response measures. The authors explore Korea's response to COVID-19 from January 2020 to March 2021, and find that its successful response relies on keeping to the principles of openness, transparency, and citizenry participation, as well as, adopting a Three-T Strategy consisting of strong diagnostic testing capabilities, contact tracing using ICT tools, and rigorous treatment. Crisis leadership also plays a critical role in combating COVID-19 through identifying emerging risks, making evidence-based decisions, and unifying administrative efforts. In addition, a national response manual is useful in delineating the roles of responsible agencies since the earliest stage. Finally, the authors find that understanding the features of the pandemic's systemic risk is essential to respond to COVID-19 effectively. © 2022 Elsevier Inc. All rights reserved.
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This study examined the associations between substance use and socio-demographic characteristics, mental health and preventive behaviours amongst US undergraduate and graduate social work students. Data were collected via an online survey from 457 social work students studying in various programmes, between July and August 2020. The survey was designed to elicit information on students' use of alcohol, cigarettes, vaping products and marijuana over the previous thirty days. Patterns of substance use and the associated behaviours were assessed using univariate and bivariate analyses. The outcomes revealed that a significant number of the students drank alcohol (71 per cent), engaged in binge drinking (35 per cent) and used marijuana (25 per cent). The outcomes also revealed significant associations amongst socio-demographic characteristics, substance use and mental health. This study's findings could inform the development of social work programmes that assist students in adopting positive coping strategies and mitigating health risk behaviours, both during the current COVID-19 pandemic and beyond. During the COVID-19 pandemic, health risk behaviours related to substance use have been recognised as a significant public health concern amongst university students. Understanding the mechanisms of substance use behaviours, including those used to cope with COVID-19-related stressors, is imperative to curate targeted prevention efforts. To that end, we examined substance use prevalence and its associations with socio-demographic characteristics, preventive behaviours, and mental health amongst US social work students. We collected data from 457 students across all degree levels (BSW, MSW and PhD) from July to August 2020 through an online survey, to examine thirty-day patterns of substance use behaviours related to cigarettes, electronic vapour products, alcohol, binge drinking and marijuana. Univariate and bivariate analyses revealed high rates of substance use behaviours, particularly alcohol use (71 per cent), binge drinking (35 per cent) and marijuana use (25 per cent). Findings also revealed significant associations amongst substance use, socio-demographic characteristics, and mental health. Amongst other implications, our study should encourage social work programmes to promote positive coping strategies amongst students and foster substance abuse prevention efforts, both to mitigate health risk behaviours and to enhance student well-being, both during and after the COVID-19 pandemic.
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SETTING: Five referral hospitals, South Korea.OBJECTIVE: To assess epidemiological changes in TB before and during the COVID-19 pandemic.DESIGN: This was a multicentre cohort study of 3,969 patients diagnosed with TB.RESULTS: We analysed 3,453 patients diagnosed with TB prior to the COVID-19 pandemic (January 2016-February 2020) and 516 during the pandemic (March-November 2020). During the pandemic, the number of patients visits declined by 15% from the previous 4-year average, and the number of patients diagnosed with TB decreased by 17%. Patients diagnosed during the pandemic were older than those diagnosed before the pandemic (mean age, 60.2 vs. 56.6 years, P < 0.001). The proportion of patients to have primary TB at a younger age (births after 1980) among those diagnosed with TB was significantly lower during the pandemic than before (17.8% in 2020 vs. 23.5% in 2016, 24.0% in 2017, 22.5% in 2018, 23.5% in 2019; P = 0.005).CONCLUSIONS: The COVID-19 pandemic resulted in a reduction in the number of visits to respiratory departments, leading to fewer patients being diagnosed with TB. However, our results suggest that universal personal preventive measures help to suppress TB transmission in regions with intermediate TB burden.
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COVID-19 , Cohort Studies , Humans , Middle Aged , Pandemics , Republic of Korea/epidemiology , SARS-CoV-2ABSTRACT
Purpose: Common human coronaviruses (HCoVs) are relatively understudied due to the mild nature of HCoV infection. Given the lack of local epidemiology data on common HCoVs, we aimed to describe clinical and epidemiological characteristics of common HCoVs in children. Methods: Respiratory viral test results from 9,589 respiratory samples from Seoul National University Children's Hospital were analyzed from January 2015 to December 2019. Viral detection was done by the multiplex reverse transcription polymerase chain reaction. Demographics and clinical diagnosis were collected for previously healthy children tested positive for HCoVs. Results: Of the 9,589 samples tested, 1 or more respiratory viruses were detected from 5,017 (52.3%) samples and 463 (4.8%) samples were positive for HCoVs (OC43 2.8%, NL63 1.4%, 229E 0.7%). All 3 types co-circulated during winter months (November to February) with some variation by type. HCoV-OC43 was the most prevalent every winter season. HCoV-NL63 showed alternate peaks in late winter (January to March) and early winter (November to February). HCoV-229E had smaller peaks every other winter. Forty-one percent of HCoV-positive samples were co-detected with additional viruses;human rhinovirus 13.2%, respiratory syncytial virus 13.0%, influenza virus 4.3%. Common clinical diagnosis was upper respiratory tract infection (60.0%) followed by pneumonia (14.8%), croup (8.1%), and bronchiolitis (6.7%). Croup accounted for 17.0% of HCoV-NL63-positive children. Conclusions: This study described clinical and epidemiological characteristics of common HCoVs (OC43, NL63, 229E) in children. Continuing surveillance, perhaps by adding HKU1 in the diagnostic panel can further elucidate the spectrum of common HCoV infections in children. © 2021 The Korean Society of Pediatric Infectious Diseases.
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China's shutdown due to COVID-19 in 2020 reduced air pollutant emissions, which is located on the windward side of South Korea. The positive temperature anomaly and negative zonal wind anomaly from northern Mongolia to South Korea through eastern China presented warm and stationary air masses during January and February 2020. Decreased concentrations of PM10, NO2, and O-3 were measured at Seokmo-ri and Pado-ri, located in the central-western region of South Korea, due to decreased emissions in China from January to March 2020. After China's shutdown from January to March 2020, in Pado-ri, the ratio of monthly average concentrations in that period with those of PM10 and O-3 in the last four years decreased by approximately 0.7-4.7% and 9.2-22.8%, respectively. In January 2020, during the Lunar New Year holidays in China, concentrations of PM10, NO2, and O-3 at Seokmo-ri and Pado-ri decreased just as much as it did during the same period in the last four years. However, average concentrations in January 2020 decreased before and after the Lunar New Year holidays in China when compared with those in January of the last four years. In Seokmori, ratios of actual and predicted values ((O) over bar (s)/M) for PM10, NO2, and O-3 concentrations were calculated as 70.8 to 89.7%, 70.5 to 87.1%, and 72.5 to 97.1%, respectively, during January and March 2020. Moreover, those of Pado-ri were 79.6 to 93.5%, 67.7 to 84.9%, and 83.7 to 94.6%, respectively. In January 2020, the aerosol optical depth (AOD) data showed a higher distribution than that of the last four years due to photochemical reactions in regions from northern Mongolia to eastern China and the Korean Peninsula. However, the decrease in AOD values compared with those of the last four years was attributed to the decrease in emissions of precursors that generate secondary aerosols in China during March 2020.