BNT162b2 mRNA SARS-CoV- 2 vaccination does not cause upregulation of endothelial activation markers or hypercoagulability: A prospective, single-arm, longitudinal study

Background: Reports of thrombosis post COVID-19 mRNA vaccination have sparked concerns about safety. Aim(s): We prospectively evaluated blood samples of 18 participants who had received 2 doses of the BNT162b2 mRNA vaccine to determine if vaccination results in endothelial activation or hypercoagulability. Method(s): 18 participants who received the BNT162b2 vaccine were enrolled. Participants completed a questionnaire on their cardiovascular and thrombotic risk factors. Blood samples were collected at three time points: Pre-vaccination (day of vaccination), a median of 17 (IQR 16-18) days after the first dose and a median of 9 (IQR 7.5-14.5) days after the second dose of BNT162b2 vaccine. Endothelial markers included ICAM-1, VCAM-1 and P-selectin. Coagulation tests included PT and aPTT with clot waveform analysis, von Willebrand factor levels, Factor VIII and D-dimer levels. Statistical tests of association between endothelial and coagulation parameters were performed with repeated measures ANOVA and Mauchly's test of sphericity. Result(s): The median age of the participants was 35 years (IQR 31 -44), and 14 (78%) were female. 15 did not have any cardiovascular risk factors. There was a statistically significant increase in median ICAM levels post first (66.1ng/ml) and second dose of vaccination (69.5ng/ml)(p = 0.04), although this remained within the normal limit of ICAM levels. A statistically significant decrease in median PT (p = 0.005) and aPTT (p = 0.03) was observed post vaccination, with a corresponding statistically significant increase in aPTT clot waveform analysis (CWA) for maximum acceleration (max2)(p = 0.03) and maximum deceleration (max2)(p = 0.04) post first and second dose of vaccination. However, all evaluated endothelial and coagulation parameters remain within the reference ranges (Table 1). Conclusion(s): Our findings provide reassuring preliminary data that BNT162b2 vaccination does not result in endothelial activation or hypercoagulability. Mild variations in endothelial markers and coagulation parameters, though statistically significant, remain within the reference ranges and may be related to an inflammatory immune response to vaccination. (Table Presented).

Serving Los Angeles County Patients with Teleneurology, A Clinical Tool Here to Stay

Objective: To demonstrate the benefits of teleneurology visits for a vulnerable epilepsy population served at the epilepsy clinic in Los Angeles County Medical Center servicing the greater Los Angeles metropolitan area Background: We are a large safety-net hospital in Los Angeles county, providing Level 4 epilepsy care to patients who are uninsured/under-insured. Most are drug-resistant and have physical, social, and/or economic factors that limit their ability to receive healthcare, including epilepsy care. One main factor is that none can drive, and many have difficulties arriving to their in-person appointments due to limited transportation means (i.e. walking, public transportation). The current COVID-19 pandemic further limits their access to healthcare with reduced public services. However, the recent expanded access to teleneurology has been a significant change for this population by improving their access to healthcare and follow up. Regular follow up infers improved compliance leading to better quality of care. We readily and aggressively implemented teleneurology services for our patients. Teleneurology appointments (including phone and video) for our patients began March 20, 2020 with all appointments prior to this date being in-person appointments only. Design/Methods: We compared the rates of no-show appointments 12 months before (no teleneurology) and 12 months after (with teleneurology) March 20, 2020 by assessing significance using a z-test. Results: The rate of no-show appointments significantly falls from 33.7% (of 1711 patients) before to 15.3% (of 1684 patients) after the implementation of teleneurology (p<0.05). Conclusions: Teleneurology is a critical and effective clinical tool for improving patient compliance with clinic visits and continuing therapy. Teleneurology ensures justice in distribution of medical care even for an underserved population of patients with epilepsy in Los Angeles County.

SARS-CoV-2-specific antibodies and neutralization capacity in breast milk following infection vs vaccination.

Anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies have been found in breast milk following both natural SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) vaccination. This was a prospective study to evaluate the temporal changes in amount and neutralization capacity of anti-SARS-CoV-2 antibodies in breast milk stimulated by natural infection and by vaccination. Serial breast milk samples were collected from postnatal women who were recruited through convenience sampling. We found a rapid increase in neutralizing SARS-CoV-2-specific antibodies in breast milk from both study groups. Amongst the infection group, the median immunoglobulin A (IgA) level was 16.99 (range, 0-86.56) ng/mL and median binding capacity was 33.65% (range, 0-67.65%), while in the vaccination group these were 30.80 (range, 0-77.40) ng/mL and 23.80% (range, 0-42.80%), respectively. In both groups, both binding capacity and IgA levels decreased progressively over time after peaking. Neutralizing activity had become undetectable by about 150 days after the first dose of the vaccine, but a vaccine booster dose restored secretion of neutralizing IgA, albeit with different levels of response in different individuals. This highlights the importance of the vaccine booster dose in sustaining neutralizing antibody levels in breast milk, which may potentially provide protection for very young children, who cannot receive the COVID-19 vaccine. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

ILLUMINATING THE GAP: DEFINING CHILDCARE NEEDS FOR CANCER PATIENTS AND THEIR FAMILIES

Purpose: One in two Canadians will be diagnosed with cancer in their lifetime. With a growing proportion of patients under the age of 60, it is estimated that upwards of 25% of cancer patients are managing the demands of childbearing and parenting alongside their diagnosis. There is a paucity of research detailing how parents with cancer balance their needs with the needs of their children. This study aims to more completely define the childcare needs and perspectives of cancer patients with dependent children. Materials and Methods: Between December 2020 and February 2021, cancer patients at one major Canadian Cancer Centre, who identified as primary caregiver to at least 1 dependent (<18 years of age) were invited to partake in a survey study. The survey was developed through consultation with a multidisciplinary team and best survey practices, and consisted of 34 closed and open-ended questions designed to assess childcare needs and the experiences of cancer patients with dependent children. Specific questions were also designed to assess the impact of COVID-19 on childcare needs. Eligible participants were identified by a research assistant and presented the opportunity to complete an electronic or paper-based survey. This study was approved by the local Research Ethics Board. Results: As of February 2021, 42 patients had been contacted and 29 had completed the survey in full (69%) Participants were an average age of 44.7 years ± 4.8 years and 97% female (28/29). Twenty-two participants (76%) reported diagnoses of breast cancer. Participants reported caring for two (18/29), one (10/29), or three (1/29) children. The average age of participants' children was 8.4 years, and ranged from 8 months to 18 years. Fourteen participants (48%) indicated having to reschedule appointments due to issues with childcare (nine of 14 rescheduling 1-3 appt.;4/14, 4-6 appt.;one of 14, 10+ appt.). Additionally, 11 participants (38%) reported bringing their child or children to their appointments as a solution for issues with childcare (seven of 11 for 1-3 appt.;three of 11, 4-6 appt.;one of 11, 10+ appt.). Fourteen of 26 respondents (54%) indicated that balancing childcare throughout their cancer journey has had a moderate (eight of 26) or extreme (six of 26) impact on their stress levels. Sixty-one percent (17/28) reported that the COVID-19 Pandemic has impacted their childcare needs and impacted their stress levels moderately (10/17) or extremely (three of 17). Seventy-eight percent (21/27) reported that a flexible childcare service would allow them to more regularly attend their appointments. The preferred delivery of such a program was onsite (hospital or cancer centre) (13/20, 65%), followed by in-home (seven of 20, 35%). Narrative analysis noted themes of increased stress and childcare responsibilities associated with the COVID-19 Pandemic and reduction of childcare resources and support. Conclusions: These preliminary results indicate that childcare issues are broadly impactful for parents battling cancer. The lack of supportive childcare negatively impacts the emotional psychological well-being of patients and their children, as well as impacts system efficiency and treatment compliance. Survey accrual is continuing and complete findings will aid in defining the childcare needs and perspectives of parents with cancer, as well as highlight potential solutions to support these individuals.

Role of Nutritents for COVID-19 recovery: an integrative approach

Introduction: Many patients (“long-haulers”) suffer lingering illness following COVID-19. The aim of this presentation is to evaluate the evidence of nutrient deficiencies affecting immune function and chronic symptoms from covid19 infection in a subgroup of patients. We will discuss the potential benefit of supplementing with multi-nutrients as an integrative approach to reducing long-hauler symptoms. Methods: A narrative review followed a search of Medline/Pubmed, CINAHL, Google Scholar for studies published between January 2000 and March 2021, using key terms “coronavirus”, “COVID-19”, “immune system”, “inflammation”, “microbiome”, “oxidative stress”, “mitochondrial function”, “micronutrients”, “vitamin”, “minerals”, and “antioxidants”. Six reviews were selected which examined on the role of nutrients in immune and neurological function, including inflammatory processes, microbiome homeostasis, and mitochondrial function. Results: Symptoms of long-haulers may be similar to myalgic encephalomyelitis/chronic fatigue syndrome associated with mitochondria dysfunction due to oxidative stress. Similar findings of chronic inflammation and microbiome dysbiosis associated with mood disorders also suggest the association between nutrient deficiencies and immuno-neurological functions. Nutrients required for optimal immune function included: antioxidants such as CoQ10 is required for mitochondrial function and is depleted quickly during acute immune response. Vitamins C and E and selenium also have antioxidant properties that can decrease proinflammatory cytokines and increase leukocyte and NK cell function. The B vitamins are involved in decrease pro-inflammatory cytokines and increase NK cell activities. Similarly, these nutrients are required for optimal neurological functioning in the CNS. Conclusion: Initial evidence suggests chronic inflammatory processes in the CNS may contribute to the symptoms of covid-19 long-haulers. Given the complementary roles of different nutrient in immune response and CNS pathways, integrating multiple nutrients as treatment for long-haulers warrants further study. Keywords: post-covid syndrome, long hauler, micronutrient treatment;narrative review

Relationship between viral load, infection-to-delivery interval and mother-to-child transfer of anti-SARS-CoV-2 antibodies.

OBJECTIVE: To investigate the association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and infection-to-delivery interval with maternal and cord serum concentrations of anti-SARS-CoV-2 immunoglobulin G (IgG) antibodies and transplacental transfer ratio in pregnant women with active or recovered SARS-CoV-2 infection. METHODS: This was a prospective case series of consecutive pregnant women with laboratory-confirmed SARS-CoV-2 infection between 27 March 2020 and 24 January 2021. We collected information regarding deep throat saliva or nasopharyngeal swab (NPS) reverse transcription polymerase chain reaction (RT-PCR) test results, serial cycle threshold (Ct) values at and after diagnosis, demographic, clinical and outcome data, and neonatal NPS RT-PCR results. Qualitative and quantitative analysis of IgG and immunoglobulin M (IgM) antibodies against SARS-CoV-2 was performed in maternal and cord blood serum samples obtained at delivery. Correlation of maternal Ct values, infection-to-delivery interval, infection duration and viral load area under the curve (AUC) with gestational age (GA) at diagnosis, maternal and cord serum IgG concentrations and transplacental transfer ratio of IgG were evaluated using Pearson's correlation. RESULTS: Twenty pregnant women who consented to participate and who had delivered their babies by 31 January 2021 were included in the study, comprising 14 who had recovered from coronavirus disease 2019 (COVID-19) and six with active infection at delivery. The median GA at clinical manifestation was 32.7 (range, 11.9-39.4) weeks. The median infection-to-delivery interval and infection duration were 41.5 (range, 2-187) days and 10.0 (range, 1-48) days, respectively. The median GA at delivery was 39.1 (range, 32.4-40.7) weeks and the median seroconversion interval was 14 (range, 1-19) days. Of 13 neonates born to seropositive mothers with recovered infection at delivery, 12 tested positive for anti-SARS-CoV-2 IgG. All neonatal NPS samples were negative for SARS-CoV-2 and all cord sera tested negative for IgM. The median transplacental transfer ratio of IgG was 1.3 (interquartile range, 0.9-1.6). There was a negative correlation between infection-to-delivery interval and anti-SARS-CoV-2 IgG concentrations in maternal (r = -0.6693, P = 0.0087) and cord (r = -0.6554, P = 0.0068) serum and a positive correlation between IgG concentration in maternal serum and viral load AUC (r = 0.5109, P = 0.0310). A negative correlation was observed between transfer ratio and viral load AUC (r = -0.4757, P = 0.0409). CONCLUSIONS: In pregnant women who have recovered from COVID-19, anti-SARS-CoV-2 IgG concentrations at delivery increased with increasing viral load during infection and decreased with increasing infection-to-delivery interval. The median transplacental transfer ratio of IgG was 1.3 and it decreased with increasing viral load during infection. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.