ABSTRACT
Background: Late presentation to care remains a major public health problem in Brazil, despite the countrys longstanding commitment to universal access to ART to all PLWH. The COVID-19 pandemic severely hit the country and further impacted the HIV care continuum, with worse disparities observed by gender and sexual orientation. By December 28th 2022, Brazil reported 10,493 and 14 mpox cases and deaths ranking second globall. Although mpox lethality is low, HIV-related immunosuppression may negatively impact mpox outcomes, increasing hospitalizations and fatalities. We aim to describe mpox hospitalization rates and explore the impact of HIV-infection on mpox-related hospitalizations and clinical outcomes. Method(s): Prospective, observational cohort study of individuals with confirmed mpox infection followed at the major mpox referral center in Rio de Janeiro, Brazil. Demographic and clinical data including reasons for hospitalization were systematically collected. Chi-squared or Fisher's exact tests for qualitative variables and the Moods median test for quantitative variables were used. Result(s): From June 12 to December 12, 2022, 402 participants had a laboratory-confirmed mpox diagnosis. Median age was 34 years, 365 (91%) were cisgender men, and 197 (49%) were PLWH. Overall, 39 (10%) participants were hospitalized due to mpox-related causes;20 (51%) were PLWH. All PLWH with CD4 counts< 200 cells/mm3 required hospitalization. Compared to nonhospitalized PLWH, a higher proportion of hospitalized PLWH had concomitant opportunistic infections (4/20 [20%] vs. 1/177 [0.6%];p< 0.001), were not virologically suppressed (7/20 [35.0%] vs. 22/177 [15.3%];p=0.1) and were not on ART (4/20 [20%] vs. 15/177 [7.6%];p=0.03). Among all hospitalized participants, PLWH were more frequently hospitalized due to severe proctitis than HIV-negative participants (12/20 [60%] vs. 5/19 [26.3%];p=0.03), with no differences regarding hospitalizations for pain control (Table). PLWH accounted for all cases of hospitalized individuals who required intensive care support (n=4), had deep tissue involvement (n=3) and had a mpox related death (n=2). Conclusion(s): Our findings suggest an association between worse outcomes in the HIV care continuum and mpox-related hospitalizations. Advanced immunosuppression (CD4< 200) contributed to more severe clinical presentations and death. Public health strategies to mitigate HIV late presentation and the negative impact of the COVID-19 pandemic to the HIV care continuum are urgently needed. Sociodemographic and clinical characteristics of mpox cases according to HIV and hospitalization status.
ABSTRACT
Background: Mastocytosis is a disorder characterized by an accumulation of mast cells in one or more organ systems and increased risk for severe anaphylaxis. Coronavirus disease 2019 (COVID-19) is associated with a relatively high rate of severe lung disease and mortality. During 2020, vaccines against COVID-19 were developed. The reported frequency of severe side effects appears to be low even in patients with severe allergies and mastocytosis. The aim of this study was to evaluate the safety of vaccines against COVID-19 in patients with mastocytosis. Method(s): Retrospective analysis of patients with a diagnosis of mastocytosis who have been vaccinated against COVID-19 in our department, from January to December 2021. Demographic data, history of anaphylactic reactions, COVID-19 vaccines used, premedication with antihistamines and hypersensitivity reactions were reviewed. Result(s): This study included 14 patients (64% (n = 9) were female, median age 51 +/- 18 years). Twelve (86%) patients had indolent systemic mastocytosis and two (14%) had cutaneous mastocytosis. Four (29%) patients had a history of idiopathic anaphylaxis, three (21%) reported anaphylaxis to hymenoptera venoms and one (7%) anaphylaxis to NSAID. The median basal serum tryptase level was 38.9 ng/ml, with a range from 12.7 to 91 ng/ml. Thirteen (93%) patients received an mRNA vaccine, and one adenoviral vector vaccine (7%), 2 doses each (28 administrations in total). None of the patients received premedication with antihistamines before the vaccination. None of the patients presented hypersensitivity reactions after the vaccine against COVID-19. Conclusion(s): As reported in recent studies, vaccination against COVID-19 in adult patients with mastocytosis is safe. Some authors recommend premedication in patients with mastocytosis at high risk for anaphylaxis. In our study, none of the patients received premedication and no hypersensitivity reactions were observed. More studies are needed, but in our sample, as observed for other vaccines, the vaccine against COVID-19 in patients with mastocytosis was safe.
ABSTRACT
Introduction: During the pandemic, all pregnant women underwent a nasopharyngeal swab for SARS-CoV-2. Objective: To describe the clinical characteristics and evolution of pregnant women with a positive PCR study for SARS-CoV-2 and their newborns in a hospital population. Materials and methods: This was an ambispective observational, cohort follow-up study, in the maternity ward of the Social Security Institute Hospital between March 01, 2020 to May 31, 2021. Third trimester pregnant women admitted for delivery, with a positive result for SARS-CoV-2, were included. Variables: age, symptoms, pregnancy complications, COVID-19 classification, admission to intensive care, neonatal anthropometry, follow-up of the mother-neonate pair up to 7 days postpartum. The data was analyzed in SPSS using descriptive statistics. The protocol was approved by the research ethics committee. Results: 136 pregnant women and 139 newborns (3 twins) were admitted. 78.6% were symptomatic, 8.1% had severe forms. 10.3% presented pre-eclampsia, 10.3% entered intensive care and 2.2% died. 86.4% were born by cesarean section, there were 2 stillbirths. 29.2% were preterm, 18.2% had low birth weight, 24.8% were hospitalized. 3/137 died before 7 days of age. The neonatal swab was positive in 3. 78% were breastfed. Conclusions: 15.5% of positive pregnant women were admitted with moderate to severe forms of COVID 19, 10.3% were admitted to the ICU and 3 died. The percentage of caesarean section, prematurity and neonatal hospitalization was very high. There were 2 stillbirths and 2.9% of live births died. The neonatal swab was positive in 2.2%.
ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) was first identified in December 2019 in Wuhan, China. The WHO declared the outbreak a Public Health Emergency of International Concern in January 2020 and a pandemic in March 2020. Until March 28 2021, more than 125 million cases have been confirmed, with more than 2.7 million deaths attributed to COVID-19. On December 21, 2020, the EMA issued an Emergency Use Authorization for Pfizer-BioNTech COVID-19 vaccine to prevent COVID-19, to be administered in 2 separate doses 21 days apart. The aim of this study was to identify and describe the suspected allergic reactions to first dose of Pfizer-BioNTech COVID-19 vaccine in health care professionals of our center. We also aimed to know if these reactions interfered with the compliance of vaccination protocol. Method: All health care professionals that receipt the vaccine were included. A prospective study was carried out using an online questionnaire to access the demographic data, personal allergic history and description of reaction to the vaccine. Results: In our hospital, the vaccination began on December 29, 2020. A total of 3040 first doses were administered. A total of 2095 (69%) questionnaire responses were collected. It was reported 1649 (79%) adverse events. Among these, 16 (1%) were identified as suggestive allergic reaction. These reactions occurred in professionals, 13 cases (81%) female, with a median age of 41 years (28-52y). The median interval from vaccine administration to symptom onset was 6 hours (5 min-48h). Eight professionals had late cutaneous reactions: 6 had mild reactions and tolerated the second dose;and 2 had severe reactions and it was decided not to administer the vaccine. The other 8 professionals had immediate reactions: 7 performed allergological study that was negative. The second dose vaccine was administered with vigilance and it was observed cutaneous reaction similar to prior reaction in only one case. Conclusion: In our study population, only 0.8% (16 of 2095) had a suggestive allergic reaction to first dose of the Pfizer-BioNTech COVID-19 vaccine. Half of them had immediate reactions and only 1 professional had a reproducible episode with the second dose;the other had late reactions and only 2 (0.1%) professionals did not complete the vaccination protocol. We can conclude that this vaccine has a good safety profile. and that mild reactions do not interfere with compliance with vaccination schedule.