Anti-SARS-CoV-2 antibody immunoreactivity profiles during COVID-19 recurrence.

BACKGROUND: This study aimed to evaluate IgG and IgM levels in COVID-19 recurrence. METHODS: The serum antibody levels and clinical data from 73 healthcare workers with SARS-CoV-2 divided into seroconverted (n=51) and non-seroconverted (n=22) groups were assessed. The presence of specific anti-nucleocapsid (anti-N) IgM and IgG for SARS-CoV-2 was evaluated. IgG antibodies to the SARS-CoV-2 spike receptor-binding domain were used to confirm non-seroconversion in all negative anti-N. RESULTS: Four recurrent cases displayed mild symptoms and were non-seroconverted until the recurrence of symptoms. CONCLUSIONS: Undetectable anti-nucleocapsid IgM and IgG levels may be correlated with symptomatic COVID-19 recurrence.

Adult-onset Still's disease after ChAdOx1 nCoV-19 vaccine: a possible association.

With emergent Sars-Cov-2, a highly transmissive virus that caused millions of deaths worldwide, the development of vaccines became urgent to combat COVID-19. Although rare, important adverse effects had been described in a hypothetical scenario of immune system overstimulation or overreaction. Still's disease is a rare inflammatory syndrome of unknown etiology. It manifests as a cytokine storm, mainly IL-18 and IL-1ß, and presents itself with fever spikes, joint pain, maculopapular evanescent salmon-pink skin rash, and sore throat, among other symptoms. Here, we report a case of a 44-year-old healthy male who developed adult-onset Still's disease (AOSD) with atypical symptoms after both doses of ChAdOx1 nCoV-19 vaccine with 3 months of dose interval. The medical team suspected Still's disease and started prednisone 1 mg/kg (40mg). The next day the patient showed a marked improvement in articular and chest pains and had no other fever episodes. Therefore, he was discharged to continue the treatment in outpatient care. On the six-month follow-up, the patient was free of complaints, and the progressive corticoid withdrawal plan was already finished.

Effectiveness, safety, and immunogenicity of half dose ChAdOx1 nCoV-19 COVID-19 Vaccine: Viana project.

Fractional dose is an important strategy to increase access to vaccines. This study evaluated the effectiveness, safety, and immunogenicity of half dose of ChAdOx1 nCoV-19 vaccine. A non-inferiority non-randomized controlled trial compared a half dose of ChAdOx1 nCoV-19 with the full dose, with an interval of 8 to 10 weeks, in individuals aged 18-49 years. The primary endpoints were the incidence rate of new cases/1,000 person-year at 90 days after 14 days of the second dose, confirmed by RT-PCR and new cases registered at SUS National Health Surveillance Database (e-SUS VS). The anti-SARS-CoV-2 spike (S) protein receptor binding domain (RBD) by chemiluminescence and the neutralizing antibodies by plaque reduction neutralization test (PRNT) were titrated. The soluble biomarkers were quantified with a multiplex immunoassay. Follow-up was 90 days after 14 days of the second dose. A total of 29,598 individuals were vaccinated. After exclusion, 16,570 individuals who received half a dose and 6,402 who received full doses were analyzed. The incidence of new cases confirmed by RT-PCR of half dose was non-inferior to full dose (23.7 vs. 25.7 cases per 1,000 persons-year [coefficient group -0.09 CI95%(-0.49 to 0.31)], even after adjusting for age and sex. There were no deaths or hospitalization after immunization of either group. Immunogenicity was evaluated in a subsample (N=558) compared to 154 healthcare workers who received a full dose. The seroconversion rate in seronegative individuals at baseline half dose was 99.8%, similar to that of the full dose (100%). Geometric mean concentration (95% CI; BAU/mL) were half dose = 188 (163-217) and full dose = 529 (423-663) (p < 0.001). In seropositive subjects at baseline (pre-immune individuals), the first dose induced very high and similar IgG-S in half dose 1,359 (1,245-1,483) and full dose 1,354 (1,048-1,749) BAU/mL. A half dose induced a high increase in plasma chemokines, pro-inflammatory/regulatory cytokines, and growth factors. The frequency of adverse events was similar. No serious adverse events or deaths were reported. A half dose of ChAdOx1 nCoV-19 is as effective, safe, and immunogenic as the full dose. The immune response in pre-immune (seropositive in the baseline) individuals indicates that the half dose may be a booster dose schedule.

Pulmonary function evaluation after hospital discharge of patients with severe COVID-19.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) may be associated with prolonged symptoms and post-recovery health impairment. This study aimed to evaluate the persistence of symptoms, lung function, and pulmonary diffusion for carbon monoxide (DLCO) in patients between 15 and 30 days after hospital discharge after admission for severe COVID-19. METHODS: The evaluation consisted of 1) comparative analysis between the initial symptoms and symptoms still present at the post-discharge evaluation 2) analysis of the chest images obtained during hospitalization, and 3) conducting spirometry, plethysmography, and DLCO assessment. RESULTS: Forty-one patients who were hospitalized for 16±8 days with severe COVID-19 were included. Patients were predominantly men (73%) and had a mean age of 51±14 years. The most frequent comorbidities were arterial hypertension (51%) and diabetes mellitus (37%). Pulmonary evaluation was performed a mean of 36 days after the onset of symptoms, with the most frequent persistent symptoms being dyspnea (83%) and coughing (54%). Approximately 93% of patients still had at least one symptom, and 20% had more than five symptoms. Chest imaging revealed a typical pattern of COVID-19 on X-ray (93%) and computer tomography (95%). Lung function test results showed a restrictive pattern with a reduction in forced vital capacity (FVC) in 54% of individuals, with an average FVC of 78±14%. A reduction in DLCO was observed in 79% of patients. CONCLUSIONS: We observed a high prevalence of symptoms, in addition to a significant change in lung function and DLCO, in the post-discharge assessment of patients requiring hospitalization after admission for COVID-19.