ABSTRACT
Background. Vaccine-induced SARS-CoV-2 antibody responses are reduced in patients taking lymphocyte-depleting therapies, which are commonly prescribed for patients with idiopathic inflammatory myopathies (IIM). While a third vaccine dose (D3) augments the SARS-CoV-2 anti-spike response in some patients, there is a paucity of data on the humoral response following D3 in patients with IIM. Furthermore, the durability of antibody response is unknown. In this study, we evaluated serial antibody response for three months following a 3rd dose SARS-CoV-2 vaccination in IIM patients. Methods. Adults with a patient-reported diagnosis of idiopathic inflammatory myopathy who completed three-dose SARS-CoV-2 vaccination (two-dose BNT162b2 or mRNA-1273 followed by single mRNA or adenoviral vector dose) were recruited via social media campaign. Demographics and clinical characteristics were collected via patient report. Informed consent was provided electronically. Serial antibody responses were evaluated by the Roche Elecsys anti-SARS-CoV-2 S enzyme immunoassay, which measures total antibody to the SARS-CoV-2 S-receptor binding domain (RBD) protein (range 0. 4-2500U/ mL;positive >0.8U/mL). Poor antibody response was defined as anti-RBD titer <500U/mL based on predicted correlates of protective plasma neutralizing capacity. Those with prior COVID-19 infection were excluded. Associations were evaluated using Fisher's exact and Wilcoxon rank-sum tests as appropriate. Results. We evaluated serial anti-RBD titers in 59 participants (Table I). Most (93%) were female with median (IQR) age of 51 (41-62) years. Mycophenolate mofetil was the most frequently prescribed medication (45.6%). Participants completed primary vaccination with two-dose BNT162b2(54%) or mRNA-1273(46%). Median pre-D3 anti-RBD titer (IQR) was 65.8U/mL (4.6,473) at 158 (136-183) days following primary vaccination. Dose 3 included BNT162b2(47%), mRNA-1273(47%) or Ad.26.COV2.S (6%). Most (89.9%) received homologous D3 vaccination. 39% of participants reported holding peri-D3 immunosuppression with mycophenolate mofetil being the most commonly held medication in the peri-D3 period. Repeat anti-RBD testing was performed at a median (IQR) 30 (28-32) days post-D3. A higher antibody titer was seen in 89.9% participants following D3 with median (IQR) titer of 2500 U/mL (92,2500). Thirty-seven percent remained <500U/mL following D3;a greater proportion of these participants reported use of rituximab and greater number of immunosuppressive therapies compared to those with anti-RBD >=500U (72.7% versus 5.4%, p<0.001;3 therapies versus 2 therapies, p=0.03). Furthermore, 13.5% (8/59) remained below the threshold of positivity following D3;7/8 reported use of rituximab, 5/8 mycophenolate mofetil, or combination of these agents (4/8). There was not a significant difference in antibody titers among recipients of homologous/heterologous vaccination (p=0.22). Dose 3 was well tolerated with only 2 (3.4%) participants reporting disease flare requiring treatment within one month of vaccination;neither required intravenous therapy or hospital admission. Thirty-four (57.6%) participants underwent repeat anti-RBD testing three months following D3 with median (IQR) 2500U/mL (456,2500);73.53% (25/34) remained above threshold of >=500U/mL. Limitations of this study include small sample size and absence of healthy control group. Diagnosis was based on participant report and we did not routinely collect information on disease activity. Conclusion. We observed an augmented humoral response in most IIM patients following 3rd dose SARS-CoV-2 vaccination;antibody response was durable at three months. Dose 3 was well tolerated. Over 1/3 participants failed to develop adequate response following D3, namely those on rituximab therapy and on higher number of immunosuppressive therapies. These patients should be prioritized for prophylactic therapies to enhance protection against COVID-19 infection.
ABSTRACT
Background/Aim: Since the COVID-19 pandemic, emergency departments across the United States have seen an increase in patients seeking care for psychiatric complaints to include suicidal ideation and attempts. A recent national study reported that the suicide rate has decreased since 2018 but this decrease may not be equal across all age groups and ethnicities especially the younger aged. Using mortality data from the National Vital Statistics System (NVSS), we investigated the trends in the suicide death rate among those aged 10-19 by gender, ethnicity and mode of suicide between 2015-2020. Method(s): We identified individuals with intentional self-harm reported on death certificates as a leading cause of death or contributory cause of death from 2015-2020 using ICD-10 codes *U03,X60-X84,Y87.0. Annual percent change was calculated;ANOVA was used to determine differences. Result(s): From 2015 to 2020, overall, there were 16,600 (12,310 males;4,290 females) deaths from suicide among those aged 10-19;average age was 16.6+/- 2.1 males;16.02+/- 2.22 females, 84% of males had some college;77% females had some college;99% were single in both groups. Non-Hispanic whites accounted for over 50% of all suicides followed by Hispanics at >20%. The number of deaths by suicide increased over time for males but decreased for females- both groups' age at death decreased over time. By ethnicity, both non-Hispanic black males and females saw a significant increase in their suicide rates from 10.3% (2015) to 12.3% (2020, P=0.03) males and 11.1% to 13.9% (P=0.05) females. Similar findings were noted for Hispanic males (13.3% to 18.3%, P=0.0001) and females (18.7% to 23.4%, P=0.006) while suicide rates decreased for non-Hispanic whites and Asians. The top three most frequent modes of suicide for females were hanging, strangulation and suffocation (>50%);discharge of firearms (>20%) and intentional self-poisoning by and exposure to drugs and other biological substances (>15%). The largest increase of over 250% was intentional self-poisoning (suicide) by and exposure to other and unspecified solid or liquid substances and their vapors. For males the top three most frequent methods used for suicide were discharge of firearms (>50%);hanging, strangulation and suffocation (>35%) and intentional self-poisoning by and exposure to drugs and other biological substances (>15%) while the largest increase (100%) was the same as for females- intentional self-poisoning (suicide) by and exposure to other and unspecified solid or liquid substances and their vapors. Conclusion(s): Although suicide deaths have been reported to be decreasing, we found among those aged 10-19, suicide rates were increasing for both non-Hispanic blacks and Hispanic males and females but not for whites or Asians. The most vulnerable time may be when this age group starts college suggesting more support is needed for those transitioning from home for the first time. The large increase of 250% for females and 100% for males related to intentional self-poisoning and correlation with exposure and access to drugs and other biological substances requires further investigation as well. This includes evaluating the role of social media platforms particularly during the COVID-19 pandemic in promoting and facilitating access to drugs and biological substances. No, authors do not have interests to disclose Copyright © 2022
ABSTRACT
Background: An attenuated humoral response to SARS-CoV-2 vaccination has been observed in some patients with rheumatic and musculoskeletal diseases (RMD) (1). We sought to identify clinical factors associated with poor humoral response following primary (two-dose mRNA or single adenoviral vector dose) SARS-COV-2 vaccination in patients with RMD on immunosuppression. Objectives: To identify clinical predictors of an attenuated antibody response to primary SARS-CoV-2 vaccination in RMD patients on immunosuppression. Methods: We included patients ≥18 years old with RMD on immunosuppres-sion who received either two-dose mRNA or single dose Janssen/Johnson and Johnson (J&J) vaccination. Demographics, diagnoses, and therapeutic regimens were collected via participant report;those with prior COVID-19 infection were excluded. One month after vaccination, participants underwent SARS-CoV-2 antibody testing on the semi-quantitative Roche Elecsys anti-SARS-CoV-2 S enzyme immunoassay, which measures antibody to the SARS-CoV-2 S-recep-tor binding domain (RBD) protein (ceiling >250U/mL later expanded to >2500U/mL). Associations were evaluated using Fisher's exact and Wilcoxon rank sum tests. Logistic regression analyses were performed to evaluate for clinical factors associated with antibody response. We adapted survival methods to address right-truncation of titers;this methodology was used to calculate medians. Participants provided informed consent electronically and the study was approved by the local Institutional Review Board. Results: We studied 1138 RMD participants on immunosuppression;most were female (93%) and white (91%) (Table 1). One-hundred and ffteen (10%) had anti-RBD response in the negative range at a median (IQR) of 29 days (28-34) following completion of vaccine series. A greater proportion of participants with negative response were non-white, received J&J vaccine, reported use of myco-phenolate, rituximab, or glucocorticoids. Antibody response differed by immuno-suppressive regimen, with those receiving rituximab having poorest response (Figure 1). Use of mycophenolate (aOR 9.92, p=0.001), rituximab (aOR 56.99, p=0.001), glucocorticoids (aOR 2.99, p=0.001) or receipt of J&J (aOR 3.13, p=0.039) were associated with negative antibody response. Conclusion: Use of mycophenolate, glucocorticoids, rituximab and receipt of J&J vaccine were the strongest predictors of an attenuated antibody response to primary SARS-CoV-2 vaccination;these data support use of an additional primary dose in RMD patients.
ABSTRACT
The suicide rate in the Republic of Korea had peak rate in 2010 and has declined for seven years (2011-2017) before increase in last year (2018). The decline was due to a number of factors;1) some practical success in suicide prevention measures (paraquat ban and subway safety screen) by Suicide Prevention Law;2) progress in media guideline and national campaign;3) national level gatekeeper training(2 million) ;4) organization of national and local agencies for governing of suicide planning by suicide prevention Law. Suicide prevention in the Republic of Korea has been set as 100 Policy Tasks of new government at 2018 and the National congress passed new suicide prevention law that organize cross-governmental leadership led by Suicide Prevention policy committee headed by Prime Minister's Office. The government launched a new department of Suicide Prevention in Ministry of Health andWelfare, and published a new suicide prevention action national plan with 70% increase of suicide prevention budget with emphasis on collaboration at local and central level at 2018. Korea Suicide Prevention Center started supporting the emergency department-based case management program with 25 locations in 2013, and was expanded to 52 locations in 2018 and 85 locations in 2020 by central government budget. Disasters can increase suicide. According to the Korean National Police Agency statistics, the three main causes of suicide in Korea are mental health, economic, and health problems. Complex factors affect suicide rates, and according to a psychological autopsy at the Korea Psychological Autopsy Center in Korea, suicide deaths had an average of 3.9 stressors. We are concerned stress factors has aggravated during the COVID pandemic. In fact, according to Korea's online mental health survey by ministry of Health and welfare, the percentage of people who have thought about suicide has increased dramatically to 13.4% at NOV 2020. But fortunately, the provisional suicide death has been on the decline. The public-private mental health support group is promoting mental health during the COVID-19 pandemic. Mental Health Welfare Center and Specialist groups, including the Korean Neuropsychiatric Association, are also participating in telephone mental health counseling the counseling case has reached 1.4 million, which is in high demand. The 3T model, which led to the successful quarantine in Korea, should also be applied to suicide prevention. Increase non-face-to-face contact to identify high-risk groups and provide customized services quickly.