ABSTRACT
Introduction and Objectives: Long-term use of highly effective disease modifying treatments (DMT) can cause secondary immunodeficiency and consecutive, potentially life-threatening infectious complications. The main objective of this study is to identify factors for increased susceptibility to infections and to establish a prospective infection risk stratification tool for people with MS (pwMS). Methods: InRIMS is a monocentric, prospective, observational and comparative study, enrolling regularly followed pwMS from two cohort studies in Switzerland (SMSC and SUMMIT) since September 2019. Extending a validated infection questionnaire from the large population-based Airway Infection Susceptibility (AWIS) study, we developed an adapted survey with MS-specific items (MS-AWIS questionnaire). At baseline, all participants complete this MS-AWIS questionnaire, which allows calculating an infection risk (IR) score of weighted questionnaire items indicative for increased susceptibility to infections. In analogy to the AWIS study, IR scores ≤4, >4 to <17, and ≥17 correspond to a low, intermediate or high risk for airway infections, respectively. To assess the prognostic value of the IR score, frequency and severity of infections is prospectively recorded over two years using monthly, standardized infection diaries. In response to the SARS-COV2 pandemic, we also document cases of COVID-19 by an additive questionnaire. Results: By May 2021, 297 pwMS were enrolled in InRIMS (9 drop-outs). In a first interim-analysis we included 245 patients with baseline questionnaires (67% female, 87% under DMT, mean age of 48 years (SD ± 12,3 years), mean disease duration 13,3 years (SD ± 9,3 years), median BMI 21,5 (IQR 18,3:24,2)). The mean calculated IR score was 6,8 (SD± 5,5). 6,1% of the InRIMS study population had an IR score ≥17, which was indicative for an increased susceptibility to infections according to results of the population-based AWIS study. Discussion: The InRIMS study assesses risk factors for infections in the real world-setting of a well-defined MS cohort. In the first study phase, most participants enrolled before onset of the SARSCOV2 pandemic in Switzerland - enabling prospective infectious risk assessment. We envisage that the results of the InRIMS study will help to inform counselling of MS patients in clinical practice and support personalized treatment choices as well as preventive measures.
ABSTRACT
Background: Freiburg was among the most heavily affected German cities during the first wave of Sars-Cov-2 infections in spring 2020. Consequently, the University Medical Center Freiburg was one of the first hospitals in Germany to treat Covid19 patients. Objectives: To assess the proportion and characteristics of health care workers (HCW) that have been infected during that first wave SARS-CoV-2 serum IgG and IgM antibodies were measured. Methods: HCW (n=902, mean age: 40.7 years) participated in this study, and filled out an epidemiological questionnaire. Serum samples were analysed for SARS-Cov-2 IgG/IgM antibodies via rapid diagnostic test (RT) and via ELISA. Statistical analyses were performed using STATA 14.2. An exposure prevention score was developed to quantify the adherence to preventive measures in everyday life. Results: 902 HCW were tested by RT, and 499 by ELISA. In total, 11.5% of recruited HCW were antibody-positive in the RT, 12.2% in the ELISA. 87.5% of RT positives, 98% of ELISA-positives reported symptoms, compared to 74.6% and 78% of negatives, respectively. Symptoms such as cough (57%/46%), loss of smell and taste (34%/5.2%), fatigue (68%/45%), fever (48%/24%), body aches (45%/22%), and headaches (58%/46%) were reported by significantly more RT positives compared to negatives. The respective differences were even more pronounced (p<0.001) among ELISA-positives compared to negatives with >50% of those positive reported impaired smell or taste compared to less than 7% among the group of ELISA-negatives (p<0.00001). In logistic regression models, shift work and belonging to the lowest quartile of the exposure prevention score were significantly associated with seropositivity in both tests. Exposure towards children was inversely associated with seropositivity, however, in the finally adjusted model only significant for those that were RT-positive, but not ELISA-positive, reflecting the lower specificity of the former. Conclusion: The endemic infection rate in HCW was high. HCW adhering to preventive measures in everyday life had lower infection rates. Disclosure of Interests: Manuel Beck: None declared, Alexandra Nieters: None declared, Marta Rizzi: None declared, Ulrich Salzer: None declared, Jens Thiel Speakers bureau: BMS, Nils Venhoff Speakers bureau: Novartis, Nicole Peter: None declared, Hermann Eibel: None declared, Reinhard Voll Speakers bureau: Novartis, Grant/research support from: BMS, Pfizer, Novartis, Stephanie Finzel Speakers bureau: Novartis.