ABSTRACT
Relevance. Since the beginning of the epidemic in China, there have been reports of nosocomial cases of SARS-CoV-2 infection, including among medical workers. Studies of the intensity of humoral immune response to the SARS-CoV-2 virus among medical workers who are much more likely to have professional contact with COVID-19 patients than are of particular importance. The aim is to study the seroprevalence and features of the humoral immune response to SARS-CoV-2 among medical workers. Materials and methods. The study included 61 medical workers from a multidisciplinary hospital in Kazan, which was redesigned to provide medical care to patients with new coronavirus infection, using the method of random sampling. The control group consisted of 60 non-medical workers. For the determination of IgG, a solid-phase ELISA was used. Statistical processing of the results was carried out using MS Excel software. The error of the relative value (M±m) was calculated, and the 95% confidence interval of the frequency of occurrence. To assess the significance of differences, the Student's test (t-test) was used for independent samples. Results. The proportion of those seropositive to SARS-CoV-2 in the study group was 45.9%, compared with 21.7% in the control group. Among medical workers seropositive to the SARS-CoV-2 virus, the proportion of asymptomatic forms was 18.5%, mild forms - 53.6%, moderate forms and severe forms 25%. Two forms of the formation of a humoral immune response among seropositive ones were revealed: the first is characterized by the gradual elimination of specific IgG antibodies to SARS-CoV-2 after 8 weeks from the onset of the first symptoms of COVID-19, the second form is an increase in specific IgG to SARS-CoV-2 and a higher value of the coefficient level of IgM positivity to SARS-CoV-2 after 8-10 weeks from the onset of the first symptoms. The group of seropositive, “raising antibodies”, prevailed over the group of individuals “eliminating antibodies”. Among seropositive medical workers, two forms of the formation of a humoral immune response were revealed: synchronous with the parallel elimination of IgG and IgM antibodies and a parallel increase in IgG and IgM. Conclusion. The study of the level of humoral immunity to COVID-19 in medical workers is important in terms of planning both anti-epidemic measures and predicting the effectiveness of the response to vaccination to SARS-CoV-2.
ABSTRACT
The results of long-term follow-up of patients (pts) with chronic myeloid leukemia (CML) do not lose their importance. Data from routine clinical practice are of particular interest. The use of 1 st (imatinib, IM) and 2nd generation TKI (2G TKI) led to a significant increase in survival, so the probability of death associated with CML could be significantly lower than the probability of death due to common causes of death other than CML. To analyze the overall survival (OS) and causes of mortality in CML pts treated in routine clinical practice in Russian Federation for a long period (>15 years) of time. The long-term follow-up data of the Russian part of the European LeukemiaNet (ELN) OSP EUTOS multicenter observational study were evaluated. The analyzed cohort consisted of 678 Ph/BCR-ABL-positive CML pts from 35 regions of Russia diagnosed in 2002-2006 with IM therapy initiation ≤6 months (mo) after diagnosis. Median (Me) age was 47(range 18-81) years (y), 47% males. Chronic phase, accelerated phase and blast crisis at diagnosis was in 631 (93%), 41(6%) and 6(1%) pts, respectively. The annual number of newly diagnosed pts was as follows: 2002 - 15 pts, 2003 - 38 pts, 2004 - 46 pts, 2005 - 206 pts, 2006 - 302 pts. The last update for 209 pts was done in Jun. 2021;last contact for 100 pts - in 2020, for 39pts - in 2019, for the other - before 2018. The date of the last contact/death could not be established for 14 pts. Statistical analysis included 661 pts, the OS was evaluated by Kaplan-Mayer method using the SAS 9.4 package. In total, 331 (50%) pts of the analyzed cohort were alive with the Me follow-up of 180 (range 2-232) mo or 15 y (range 2 mo-19,3 y). All pts started therapy with IM with 25% switched to 2G TKI in subsequent therapy lines. In total, 218 (66%) pts achieved MR4, 183 (55%) pts got MMR;46 (21%) of these pts with deep molecular response (DMR) were observed in hematology centers of Moscow. The 15-y OS in the total cohort was 63% (CI 59-70%)(fig.1). The OS by age groups was as follows: 18-40yy-75% (CI 73-82%), 40-60yy- 63% (CI 59-70%), 60-80yy- 37% (CI 30-45%). The most complete information was provided by Moscow centers (2 centers, 113 pts). The 15-y OS of pts receiving treatment in Moscow was significantly higher vs pts from other regions (32 centers, 548 pts): 75% vs 60%, p=0,0030 (fig.2). The mortality in the whole cohort of 661 pts was 35% (233 pts). Of these 233 pts, 112(48%) pts deaths were due to CML progression to AP or BP (including non-compliant cases);3pts (1,5%) died after allogenic stem cell transplantation (infection complications);the cause of death was unknown in 50 (21,5%) pts. The highest death rate from CML progression was at 4-9 y of follow-up. Deaths caused by concomitant diseases were in 68 (29%) pts: coronary artery disease/myocardial infarction/heart failure in 42 (62%) of 68 pts, acute ischemic stroke in 10 (15%) pts, second malignancies (Cr- cancer) in 10 (15%) pts (lung tumor, metastatic esophageal Cr, stomach Cr, brain tumor, sigmoid colon Cr, rectal colon Cr, melanoma, renal Cr, breast tumor, other hematological malignancies), accidents - 1 pt, liver cirrhosis - 2 pts, in 2 cases - respiratory virus infections complicated with pneumonia, 1 pt died due to Covid-19. Conclusions. The long-term follow-up of the multicenter study EUTOS OSP in 35 regions of Russian Federation allows not only to characterize the 15-y OS in CML pts but also provides the long-term outlook of the routine clinical practice. Probably, better OS of CML patients receiving treatment in Moscow (2 centers) may be related to organizational issues of interaction with the federal center, better monitoring and timely switching to 2G TKI therapy. The organization and support of multicenter studies may improve the situation with the treatment of diseases of the blood system. [Formula presented] Disclosures: Chelysheva: Novartis Pharma: Speakers Bureau;Pfizer: Speakers Bureau;Pharmstandart: Speakers Bureau;Bristol Myers Squibb: Speakers Bureau. Vinogradova: Pharmstandart: Speakers Bureau;Novartis Phar a: Speakers Bureau;Pfizer: Speakers Bureau;Bristol Myers Squibb: Speakers Bureau. Lomaia: Novartis: Honoraria;Pfizer: Honoraria;BMS: Honoraria;Pharmstandard: Honoraria. Voloshin: Abbvie: Consultancy, Speakers Bureau;Novartis: Consultancy, Speakers Bureau;Astra Zeneca: Consultancy, Speakers Bureau;Pfizer: Consultancy;Biacad: Consultancy, Speakers Bureau. Turkina: Pharmstandart: Speakers Bureau;Pfizer: Speakers Bureau;Bristol Myers Squibb: Speakers Bureau;Novartis Pharma: Speakers Bureau.
ABSTRACT
Relevance. Since the beginning of the epidemic in China, there have been reports of nosocomial cases of SARS-CoV-2 infection, including among medical workers. Studies of the intensity of humoral immune response to the SARS-CoV-2 virus among medical workers who are much more likely to have professional contact with COVID-19 patients than are of particular importance. The aim is to study the seroprevalence and features of the humoral immune response to SARS-CoV-2 among medical workers. Materials and methods. The study included 61 medical workers from a multidisciplinary hospital in Kazan, which was redesigned to provide medical care to patients with new coronavirus infection, using the method of random sampling. The control group consisted of 60 non-medical workers. For the determination of IgG, a solid-phase ELISA was used. Statistical processing of the results was carried out using MS Excel software. The error of the relative value (M +/- m) was calculated, and the 95% confidence interval of the frequency of occurrence. To assess the significance of differences, the Student's test (t-test) was used for independent samples. Results. The proportion of those seropositive to SARS-CoV-2 in the study group was 45.9%, compared with 21.7% in the control group. Among medical workers seropositive to the SARS-CoV-2 virus, the proportion of asymptomatic forms was 18.5%, mild forms - 53.6%, moderate forms and severe forms 25%. Two forms of the formation of a humoral immune response among seropositive ones were revealed: the first is characterized by the gradual elimination of specific IgG antibodies to SARS-CoV-2 after 8 weeks from the onset of the first symptoms of COVID-19, the second form is an increase in specific IgG to SARS-CoV-2 and a higher value of the coefficient level of IgM positivity to SARS-CoV-2 after 8-10 weeks from the onset of the first symptoms. The group of seropositive, "raising antibodies", prevailed over the group of individuals "eliminating antibodies". Among seropositive medical workers, two forms of the formation of a humoral immune response were revealed: synchronous with the parallel elimination of IgG and IgM antibodies and a parallel increase in IgG and IgM. Conclusion. The study of the level of humoral immunity to COVID-19 in medical workers is important in terms of planning both anti-epidemic measures and predicting the effectiveness of the response to vaccination to SARS-CoV-2.
ABSTRACT
Background: Patients (pts) with acute leukemia (AL) are at high risk of COVID-19 severe and lethal course. Intensive chemotherapy and immunosuppression in these patients are the possible causes of high mortality. Emerging data on risk factors and outcomes in this vulnerable patient population is aimed to support strategies of their medical care. Aims: To evaluate treatment outcomes and risk factors in pts with AL and COVID-19 in a real-world setting. Methods: CHRONOS19 [NCT04422470] is an ongoing nationwide observational cohort study of adult (≥18 y) pts with hematologic disease (both malignant and non-malignant) and lab-confirmed or suspected (based on clinical and/or CT findings) COVID-19. We performed a subgroup analysis of pts with AL and COVID-19. Primary objective was to evaluate treatment outcomes and identify risk factors associated with higher mortality in this group of pts. Primary endpoint was 30-day all-cause mortality. Long-term follow-up was performed at 90 and 180 days. Data from 14 centers was collected on a web-based platform and managed in a deidentified manner. Results: As of data cutoff on January 27, 2021, 575 pts were included in the registry, 132 of them with AL were eligible for primary endpoint assessment n(%): AML - 86(65%), ALL - 37(28%), APL - 9(7%);M/F 55(42%)/77(58%), median age 45 [18-79] years, induction phase/R/R/ treatment in remission 49(37%)/27(21%)/ 54(42%), agranulocytosis in 55(42%) pts, 68(53%) pts were transfusion dependent, comorbidities - in 58(45%) pts. Complications developed in 98(74%) pts: pneumonia (71%), sepsis (9%), CRS (8%), ARDS (6%). One-third of pts had severe COVID-19, 30% were admitted to ICU, 26% required mechanical ventilation. We performed comparative analysis of characteristics between a group of pts with AL and other hematologic diseases (lymphomas, chronic leukemia, multiple myeloma, and other malignant and non-malignant diseases): pts with AL had significantly more frequent agranulocytosis (42% vs 20%, p<0,001), transfusion dependence (53% vs 33%, p<0,001), and a higher rate of admission to ICU (30% vs 20%, p=0,036). All-cause mortality at 30 days was 24% in pts with AL vs. 15% in pts with other hematologic diseases (p=0,03);70% of deaths were due to COVID- 19 complications in pts with AL. At 90 days, one additional death due to COVID-19 occurred. At 180 days, 5 more deaths due to leukemia progression were registered. Risk factors that were significantly associated with overall survival (OS) are listed in Table 1. In multivariate analysis, ICU + mechanical ventilation, HR, 70.258 (19.5-270.0) and age >60 years HR, 3.340 (1.08-10.9) were the most significant risk factors of death. Overall, AL were associated with a higher risk of death, HR, 2.40 (1.28-4.51), compared to less aggressive diseases (CML, CLL, MM, lymphomas, non-malignant), HR, 0.54 (0.37-0.80). COVID-19 affected treatment of AL in 65% of pts, 58% experienced treatment delay for a median of 4 [1-10] weeks. In 11 of 103 (10,7%) pts with AL early relapse/refractory disease was detected, but the association of relapses with affected treatment is unknown. COVID-19 re-infection was described in 2 patients. Summary/Conclusion: Thirty-day all-cause mortality was significantly higher in SARS-CoV-2-infected pts with AL than in those with other hematologic diseases. Longer-term follow-up (180 days) for AL outcomes and OS will be presented.
ABSTRACT
The aim was to study SARS-CoV-2 immunity among medical workers in Kazan. Materials and methods. Studied were serum samples from 348 medical workers from 10 medical organizations in Kazan, divided into groups according to the level of the alleged risk of infection of employees. To determine IgG, a two-stage direct version of the solid-phase ELISA and the test-system “SARS-CoV-2-IgG-ELISA-BEST” (Russia) were used. Results and discussion. At the time of the study and over the previous three months, the examined medical workers had no symptoms of acute respiratory viral infection or respiratory tract infections;there were negative results of examining nasopharyngeal/ oropharyngeal swabs for the presence of SARS-CoV-2 RNA. Seroprevalence for IgG to SARS-CoV-2 virus for different medical organizations in Kazan ranged within the scope of 3.3–30.8 % and averaged 16.4 %. The wide variation in seroprevalence values in medical workers of different medical organizations may indicate different levels of intensity of professional contacts and the effectiveness of anti-epidemic measures in these medical organizations. Among medical workers with seropositive results, the prevalence of persons with a very high coefficient of positivity (49.1 %) is observed, which characterizes high level of antiviral antibodies. The presence of a high proportion of seropositive individuals among medical workers, who have had an asymptomatic form of COVID-19 confirms the high intensity of the latent epidemic process, which must be taken into account when organizing preventive measures, including vaccination. © 2021 Russian Research Anti-Plague Institute. All rights reserved.
ABSTRACT
Relevance. Age-related and occupational aspects of SARS-CoV-2 seroprevalence in healthcare workers are not well understood. Aims:Conduct a selective study of seroprevalence to the SARS-CoV-2 virus among 348 medical workers of 10 medical organizations in Kazan: seven multidisciplinary hospitals that have been re-profiled to provide medical care to patients with coronavirus infection, an ambulance station, a medical organization that carries out outpatient activities and a specialized clinic. Materials and methods. Among those surveyed on a professional basis, the groups «Doctors», «Nurses», «Junior medical personnel», «Other medical workers» were identified. The age structure of seroprevalence was studied in groups of 18–29, 30–39, 40–49, 50–59 and 60–69 years. For the determination of IgG, a solid-phase ELISA was used. Results. The proportion of medical workers (MR) of various medical organizations in Kazan seropositive for IgG to the SARS-CoV-2 virus is 16.4%. The wide variation in the seroprevalence value of MR groups of different medical organizations (3.3–30.8%) may indicate a different level of effectiveness of anti-epidemic measures in these institutions. The maximum rate was noted in the age groups – 18–29 years (21%) and 60-69 years (18.2%). According to the professional criterion, a comparable level of seroprevalence is shown for the categories «Doctors» and «Nurses» with a wide variation in indicators in professional groups, depending on a particular medical organization. The obtained results indicate the presence among medical workers who have suffered or have an asymptomatic course of infection caused by SARS-CoV-2, and confirm the relevance of further serological monitoring in medical organizations of various profiles. The results of serological monitoring, taking into account age and professional aspects, can serve as the basis for adjusting preventive measures on the basis of individual medical organizations, and taking into account the recommendations of Rospotrebnadzor and the selection of contingents for vaccination against SARS-CoV-2. Conclusions: For the MR of various medical institutions in Kazan, the seroprevalence for antibodies to the SARS-CoV-2 virus is 16.4%;Age aspects affect the level of seroprevalence in MR;The obtained results indicate the presence of persons among MR who have had or have an asymptomatic course of infection caused by SARS-CoV-2, and confirm the relevance of further serological monitoring in medical organizations of various profiles. © 2021, Numikom. All rights reserved.