Immunotherapy: ALLOGENEIC UMBILICAL CORD BLOOD REGULATORY T CELLS DECREASE INFLAMMATION AND PRESERVE ANTI-TUMOR ACTIVITY OF CAR T CELLS

Background & Aim: With larger accessibility and increased number of patients being treated with CART cell therapy, real-world toxicity continues to remain a significant challenge to its widespread adoption. We have previously shown that allogeneic umbilical cord blood derived (UCB) regulatory T cells (Tregs) can resolve uncontrolled inflammation and can treat acute and immune mediated lung injury in a xenogenic model as well as in patients suffering from COVID-19 acute respiratory distress syndrome. The unique properties of UCB Tregs including: i) lack of plasticity when exposed to inflammatory micro-environments;ii) no requirement for HLA matching;iii) long shelf life of cryopreserved Tregs;and iv) immediate product availability for on demand treatment, makes them an attractive source for treating acute inflammatory syndromes. Therefore, we hypothesized that add-on therapy with UCB derived Tregs may resolve uncontrolled inflammation responsible for CART cell therapy associated toxicity. Methods, Results & Conclusion(s): UCB Tregs were added in 1:1 ratio to CART cells, where no interference in their ability to kill CD19+ Raji cells, was detected at different ratios : 8:1 (80.4% vs. 81.5%);4:1 (62.0% vs. 66.2%);2:1 (50.1% vs. 54.7%);1:1 (35.4% vs. 44.1%) (Fig 1A). In a xenogenic B cell lymphoma model, multiple injections of Tregs were administered after CART injection (Fig 1B), which did not impact distribution of CD8+ T effector cells (Fig 1C) or CART cells cells (Fig 1D) in different organs. No decline in the CAR T levels was observed in the Tregs recipients (Fig 1E). Specifically, no difference in tumor burden was detected between the two arms (Fig 2A). No tumor was detected in CART+Tregs in liver (Fig 2B) or bone marrow (Fig 2C). A corresponding decrease in multiple inflammatory cytokines in peripheral blood was observed in CART+Tregs when compared to CART alone (Fig 2D). Here we show "proof of concept" for add-on therapy with Tregs to mitigate hyper-inflammatory state induced by CART cells without interference in their on-target anti-tumor activity. The timing of Tregs administration after CART cells have had sufficient time for forming synapse with tumor cells allows for preservation of their anti-tumor cytotoxicity, such that the infused Tregs home to the areas of tissue damage to bind to the resident antigen presenting cells which in turn collaborate with Tregs to resolve inflammation. Such differential distribution of cells allow for a Treg "cooling blanket" and lays ground for clinical study. [Figure presented]Copyright © 2023 International Society for Cell & Gene Therapy

Multisystem Inflammatory Syndrome in Children

Multisystem inflammatory syndrome in children (MIS-C) is an uncommon but emerging syndrome related to SARS-CoV-2 infection. While the presentation of MIS-C is generally delayed after exposure to the virus that causes coronavirus 2019, both MIS-C and Kawasaki disease (KD) share similar clinical features. Multisystem inflammatory syndrome in children poses a diagnostic and therapeutic challenge given the lack of definitive diagnostic tests and a paucity of evidence regarding treatment modalities. We review the clinical presentation, diagnostic evaluations, and management of MIS-C and compare its clinical features to those of KD.

Analysis of Quality Indicators in Molecular Laboratory of a Tertiary Care Hospital in India

Introduction: Quality indicators are important parameters to enhance the quality of the clinical laboratory services. Due to the extensive testing processes, errors cannot be completely avoided in a clinical laboratory. To minimize errors, however, adequate training, QC checks, and regular procedure evaluations are beneficial. Objective(s): The objective of the study was to establish and evaluate quality indicators on an ongoing basis as an effort to increase quality. Method(s): This retrospective study, different quality indicators in a molecular laboratory in northern Gujarat were assessed over the course of a year (September 2020-August 2021). Data of total 8176 samples were summarized. Each Quality indicator was examined at the end of the month after being divided into the pre, analytical, and post-analytical stages, respectively. Result(s): As summarization of total 8176 samples, we found a cumulative error rate for all quality indicators of 346 (4.23%). Preanalytical errors were the most common 180 (2.20%), followed by analytical errors 114 (1.39%), and post analytical errors 52 (0.63%). Conclusion(s): There is no question that by continuously striving to develop the outcome of these quality indicators through the adoption of corrective measures over time, the quality of laboratory services and patient care would be improved.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Is Remdesivir-Induced Symptomatic Bradycardia Persistent? A Two Case Report of COVID-19 Infection

As of May 2022, a total of over 528 million cases of coronavirus 19 disease (COVID-19) worldwide with over 6 million deaths. Remdesivir is a broad-spectrum antiviral medication approved worldwide;it acts by inhibiting the RNA-dependent RNA polymerase, used for moderate-to-severe COVID-19 which requires supplemental oxygen but not intubation. Not shown to improve mortality but shorten the recovery time, especially if given within the first 10 days of symptom initiation. Despite its worldwide use, its cardiovascular safety profile has not been determined as yet. Herein, we report two cases of COVID-19 infection who develop symptomatic bradycardia on a 5-day course of remdesivir.Copyright © 2022 Annals of Clinical Cardiology Published by Wolters Kluwer - Medknow.

Innovative Approaches to Managing Scale

Enrollments in computer science courses and majors are at or exceeding capacity at the college level. This context drives local innovations that may benefit individuals across the SIGCSE community. The panelists will share how, in the context of booming enrollments and COVID, they strive to protect faculty time, engage students in larger classes, take advantage of scale, improve student-TA interactions, motivate faculty to teach larger classes, and better monitor students in large classes. During the panel Q&A, attendees will be invited to share additional strategies live on Course.Care, which will then be disseminated through CSTeachingTips.org.

Symptomatic Myocarditis After Pfizer Covid-19 Vaccination

Widely considered safe, effective, and essential for pathogenic immunity, vaccines have proven to be one of the most important discoveries to date in medicine. Adverse reactions to vaccines are typically trivial but there have been extremely rare reports of vaccine induced myocarditis, particularly with the Tdap vaccine. This is thought to be due to a hypersensitivity reaction. In efforts to combat the SARS-CoV-2, prompt response from Pfizer-BioNTech and Moderna lead to vaccine development with a novel method, synthesized from modified messenger RNA. Despite minimal side effects on initial trials, reports of vaccine induced myocarditis have resulted. A majority of these cases occurred following subsequent doses for those previously inoculated. A descriptive study published in JAMA in January 2022 reviewed the Vaccine Adverse Event Reporting System (VAERS) in collaboration with the CDC described only 1626 cases of myocarditis, of which the majority occurred within days of the second dose. This review was limited by reviewing a passive reporting syndrome with variable quality data and without follow up data post diagnosis of myocarditis. Here we present a case of myocarditis occurring less than 24 hours after the second dose of Pfizer-BioNTech vaccine with 3 month follow up. A 23 year old man received his second dose of the COVID-19 vaccine in the morning. Within a few hours he experienced chest pain, chills, weakness, and fatigue. These dissipated by 7pm. He is a member of the National Guard and during drills the next day experienced stabbing substernal chest pain for which he sought evaluation. The pain radiated into his left jaw, worse with deep inspiration and worse in the left lateral decubitus position. He is a 1 PPD smoker with no personal or family history or cardiac disease. A friction rub was heard on physical exam. His troponin I peaked at 2.6ng/mL. His EKG showed normal sinus rhythm, a TTE showed a normal EF with no pericardial effusion. He was given aspirin 81 mg and started on a heparin drip for possible NSTEMI. The next day his pain decreased and a cardiac MRI demonstrated no inflammation. His serum coxsackie and parvovirus titers were negative. He was instructed to continue the aspirin, limit exercise for 8 weeks, and stop smoking. Upon follow up 3 months later the patient denied any recurrent chest pain and was advised to continue the aspirin. But the original bout of myocarditis limited his participation in the National Guard. Our case illustrates that exposure to an immunological trigger, the COVID-19 vaccine, leading to myocarditis was extremely short compared to typical cases of viral induced or vaccine hypersensitivity reaction. A proposed mechanism is molecular mimicry between the spike protein and myocardial contraction proteins. It also demonstrates that the vaccine can cause morbidity in patients, especially younger males. It also exemplifies that this may be a short lived phenomenon, long term follow up is still needed. With the rate of vaccination increasing, there needs to be a low threshold to consider myocarditis in young adults who have new chest pain after receiving an mRNA based vaccine.Copyright © 2022

Dupilumab efficacy and safety up to 52 weeks in adult and adolescent patients with eosinophilic esophagitis: Results from parts B and C of the randomized, placebo-controlled, three-part, phase 3 LIBERTY EoE TREET Study

Introduction (contexte de la recherche): In Parts A and B of the 3-part phase 3 LIBERTY EoE TREET study (NCT03633617), dupilumab 300 mg weekly (DPL qw) vs. placebo (PBO) demonstrated significant efficacy and acceptable safety up to 24 weeks (wks) in adults and adolescents with eosinophilic esophagitis (EoE). For patients (pts) who completed Parts A or B, Part C was an extended active treatment period for 28 wks. Objectif: To assess the safety and efficacy of DPL in pts who completed Part B and continued to Part C, up to 52 wks. Methodes: Of 80 DPL qw pts in Part B, 74 continued DPL qw in Part C (DPL/DPL). Of 79 PBO pts in Part B, 37 pts received DPL qw in Part C (PBO/DPL). Part B co-primary endpoints were proportion of pts achieving peak esophageal intraepithelial eosinophil (eos) count <= 6 eos/high power field (hpf) and absolute change from Part B baseline (BL) in Dysphagia Symptom Score (DSQ) score at Wk 24. Secondary endpoints included peak eos count, EREFS, and HSS grade and stage scores. In Part C, all co-primary and secondary endpoints were assessed at Wk 52 as secondary endpoints. Safety was also assessed. Resultats: Part B BL characteristics were similar across groups. At Wk 52 of Part C, 84.6% of DPL/DPL and 67.6% of PBO/DPL groups achieved peak eos count of <= 6 eos/hpf and mean (SD) absolute change from Part B BL in DSQ score was -30.26 (15.39) for DPL/DPL and -27.25 (11.46) for PBO/DPL pts. At Wk 52, peak eos count, EREFS, HSS grade and stage scores were reduced, compared with Part B BL, and EDP and T2 NESs were suppressed in DPL/DPL and PBO/DPL groups. Dupilumab demonstrated an acceptable safety profile in Part C;the most common (occurring >= 10%) treatment-emergent adverse events in DPL/DPL and PBO/DPL groups were injection-site reactions (13.5% and 10.8%), COVID-19 (9.5% and 10.8%) and nasopharyngitis (4.1% and 10.8%). Conclusion(s): As observed in Part A/C, dupilumab qw demonstrated persistent improvements in clinical, symptomatic, histologic, endoscopic and molecular features of EoE up to 52 wks and had an acceptable safety profile. PBO pts from Part B who received dupilumab in Part C showed similar efficacy to dupilumab qw pts of Part B.Copyright © 2023

Coronavirus infection in immediate post-renal transplant period: A case report

The novel coronavirus (severe acute respiratory syndrome coronavirus;SARS-CoV-2) has spread out to most of the world with the World Health Organization (WHO) classifying it as a global pandemic. There exists very little information on the infectious course of COVID- 19 in immunocompromised individuals, including transplant recipients. We report a case of a young adult who tested positive for SARS-CoV-2 in the immediate post-operative period following renal transplantation.

Impact of COVID-19 pandemic on gastrointestinal cancer patients: An emphasis on colorectal cancer

Gastrointestinal (GI) cancers originate in the GI track, ranging from the esophagus to rectum. Together, these cancers account for a quarter of cancer incidences and more than a third of cancer-related deaths. Of GI cancers, colorectal cancer (CRC) comprises the largest of GI cancer incidence and death burden. Due to the vast array of GI cancers, the survival rate and risk factors vary. The COVID-19 pandemic began in early December 2019 in Wuhan, China. Originally the virus was reported to the World Health Organization as multiple cases of pneumonia. It was later found to be a novel strain of the coronavirus. Since December, there have been more than 28.3 million cases worldwide spread over 214 countries, and this number is consistently increasing. The main method of transmission of COVID-19 is through respiratory droplets, which has made it very difficult to contain. The incidence of COVID-19 is highest among the adult population with the median age of patients between 34 and 59. However, COVID is more likely to affect those with chronic comorbidities and immunosuppression, such as cancer. Due to the novelty of coronavirus and the vagueness of symptoms (cough, congestion, fever, nausea, vomiting), many clinics have stopped doing unnecessary procedures such as endoscopies and colonoscopies. This has led to a decrease in CRC detection and screening. Delayed screenings can be detrimental to the survival of patients with CRC. It has been shown that surgical delays greater than 7-8 weeks have resulted in lower survival rates. It is vital that medical professionals implement safety protocols and provide safe ways for patients to receive routine checkups. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2021. All rights reserved.

Assessing the impact of an urgent dental care centre on the oral health-related quality of life of patients during the COVID-19 pandemic

Introduction: An urgent dental care centre (UDCC) was set up at Queen Mary's Hospital in Sidcup, in response to the COVID-19 pandemic. Alongside the reporting of clinical outcomes, it is important to determine the success of a service from a patient's perspective. The aim of this study was to ascertain patient reported outcome measures (PROMs) and patient reported experienced measures (PREMs) of our service. Method(s): The Oral Health Impact Profile 14 (OHIP-14) tool was used to assess the Oral Health-Related Quality of Life (OHRQoL) of patients, and completed before and after attending our UDCC for treatment. Patients were also asked to complete a patient satisfaction questionnaire. Result(s): 146 patients were recruited for our study, with 95 patients completing the OHIP-14 questionnaires pre- and post intervention at our UDCC and 136 patients completing a patient satisfaction questionnaire. A statistically significant reduction in OHIP score when comparing pre- and post-intervention was found across all OHIP-14 domains. The mean positive response rate (strongly agree or agree) for the patient satisfaction questionnaire was 97.1%. Conclusion(s): A significant improvement in OHRQoL was found after treatment at our UDCC, with the majority of patients reporting a positive experience. We conclude that PROMs and PREMs are vital tools to assess service efficacy, help with the planning of service provision and should remain at the forefront even during a crisis such as the COVID-19 pandemic.Copyright © 2021

COVID-19 vaccine-induced neutralising antibody responses against SARS-CoV-2 Omicron BA.4/5 are diminished in patients with inflammatory bowel disease on anti-TNF or JAK-inhibitor therapy

Background: Patients with Inflammatory bowel disease (IBD) receiving anti-TNF or JAK-inhibitor therapy have attenuated responses to COVID-19 vaccination. We aimed to determine how IBD treatments affect neutralising antibody responses against the currently dominant Omicron BA.4/5 variants. Method(s): We prospectively recruited 329 adults (68 healthy controls (HC) and 261 IBD) who had received three doses of COVID-19 vaccine at nine UK centres. The IBD population was established (>12 weeks therapy) on either thiopurine (n=60), infliximab (IFX) (n=43), thiopurine and IFX combination (n=46), ustekinumab (n=43), vedolizumab (n=46) or tofacitinib (n=23). Pseudoneutralisation assays were performed and the half maximal inhibitory concentration (NT50) of participant sera was calculated. The primary outcome was anti-SARSCoV-2 neutralising response against wild-type (WT) virus and the BA.4/5 variant after the second and third doses of anti-SARS-CoV-2 vaccine, stratified by immunosuppressive therapy, adjusting for prior infection, ethnicity, vaccine type and age. Result(s): Heterologous (two doses adenovirus vaccine, third dose mRNA vaccine) and homologous (three doses mRNA vaccine) vaccination strategies significantly increased neutralising titres against both WT SARS-CoV-2 virus and the BA.4/5 variants in HCs and IBD (fig 1). Antibody titres against BA.4/5 were significantly lower than antibodies against WT virus in both groups (Geometric Mean Ratio (GMR) [95% CI], 0.11 [0.09, 0.15], P<0.0001 in healthy participants;GMR 0.07 [0.06, 0.08], P<0.0001 in IBD patients). Multivariable models showed that neutralising antibodies against BA.4/5 after three doses of vaccine were significantly lower in IBD patients on IFX (GMR 0.44 [0.20, 0.97], P=0.042), IFX and thiopurine combination (GMR 0.34 [0.15, 0.77], P=0.0098) or tofacitinib (GMR 0.37 [0.15, 0.92], P=0.032), but not in patients on thiopurine monotherapy, ustekinumab or vedolizumab. Breakthrough infection was associated with lower neutralising antibodies against WT and BA.4/5 (P<0.05). Conclusion(s): A third dose of COVID-19 vaccine based on the WT spike glycoprotein boosts neutralising antibody titres in patients with IBD. However, responses are lower against the currently dominant variant BA.4/5, particularly in patients taking anti-TNF or JAK-inhibitor therapy. Breakthrough infections are associated with lower neutralising antibodies and immunosuppressed IBD patients may receive additional benefit from bivalent vaccine boosters which target Omicron variants. .

Smartphone Built-in Features: Do They Help Our Diabetic Patients?

Objective: To evaluate the pre-set features of smartphones and the inclusion of ADCES7 guidelines for Diabetes self-care during the COVID-19 era. Method(s): The pre-loaded applications of the iPhone 13 and Samsung S22 Ultra were tested with the ADCES7 parameters: 1) Healthy eating, 2) Being Active, 3) Monitoring, 4) Taking Medication, 5) Problem Solving, 6 )Healthy coping, 7) Reducing Risks. We evaluated the smartphones for the following subcategorties of the ADCES7 parameters: 1a) Nutrition, 1b) Calorie-counting;2a) Step-counting, 2b) Calorie-burning, 3a): Blood pressure, 3b) Blood glucose, 3c) HbA1c, 3d) Weight, 3e) Push notification, 4a) Med Log, 5a) Contact healthcare team, 5b) Contact family;6a) Mental health outreach, 7a) Goal-Setting, 7b) Graph analysis. We added additional categories 8) Insulin pumps and 9) Language. Result(s): 1. Nutrition facts= Apple(Yes), Samsung(No);2. Calorie counting= Apple(Yes), Samsung(Yes);3. Step counting= Apple(Yes), Samsung(Yes);4. Calorie Burning= Apple(No), Samsung(Yes);5. Monitoring BP= Apple(No). Samsung(Yes);6. Monitoring Blood Glucose= Apple(No), Samsung(Yes);7. Monitoring HbA1c= Apple(No), Samsung(Yes);8. Weight Monitoring= Apple(Yes), Samsung(Yes);9. Push Notifications and Med Reminders= Apple(Yes), Samsung(Yes);10. Goal setting= Apple(No), Samsung(Yes);11. Med Log= Apple(No), Samsung(Yes);12. Facetime, Samsung Video Call= Apple(Yes), Samsung(Yes);13. Healthy Coping= Apple(No), Samsung(No);14. Goal Setting for Steps= Apple(No), Samsung(Yes);15. Graph Analysis= Apple(Yes), Samsung(Yes);16. Insulin pumps= Apple(No), Samsung(No);17. Foreign languages= Apple(46), Samsung(187) Samsung provides more ADCES7 parameters and more language options than Apple. Conclusion(s): The smartphones have internal resources for patients to self-manage their Diabetes Mellitus. As MDs, we can continue to partner with our patients for diabetes management during COVID-19 and beyond.

Association of Lactate Dehydrogenase and C-reactive Protein Levels as Predictors of Respiratory Failure in Covid-19

Background and Aim: Inflammatory markers reproduce amount of disease development or revival. They are used to assess improvement or worsening of the illness. Hence the aim of the study was to determine the correlation of laboratory markers (LDH and CRP) and oxygen requirement with clinical severity in Covid 19 subjects. Material(s) and Method(s): There were 216 subjects admitted to the emergency department of the hospital. The incorporated subjects were divided into two groups: group I subjects had covid19 pneumonia and in group 2 subjects did not have covid 19 pneumonia. Blood count and serum values of lactate dehydrogenase (LDH) and C-reactive protein (CRP) were quantified in all subjects enrolled in the research. An automated hematology analyzer was utilized to perform blood count according to the manufacturer's protocol. Serum samples were analyzed on a fully automated clinical chemistry Instrument. Result(s): LDH was amplified in 82% of subjects, CRP resulted elevated in 98% of subjects, only 21% of subjects presented pathological values of white blood cell (WBC), but 18% had a neutrophils count above the upper normal range value, while 89% of subjects had lymphocytes count below the lower normal range value, as formerly reported. Conclusion(s): LDH and CRP could be helpful for the premature identification of subjects who are at elevated risk for acute respiratory failure. They should be considered a helpful test for the early recognition of subjects who need closer respiratory monitoring and more aggressive supportive therapies to avoid poor prognosis. These subjects could be benefited from a quick hospitalization, a closer observation and correct treatments. Copyright © 2022, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Increase in pediatric thrombotic amputations during the SARSCoV- 2 pandemic: manifestation of macrophage activation syndrome

Background. This study was inspired by the sudden unexplained increase in pediatric amputations during the SARSCoV- 2 pandemic. Method(s): With appropriate IRB approval, pathology files were searched for all amputations from Jan 2017 to May 2022. All available slides on thrombotic amputations of 2020 and 2021 were reviewed. Additional immunohistochemical stains for CD3, CD20 and CD163 were performed. Medical records were reviewed. Result(s): Total yearly amputations from 2017 to 2020 ranged from 17 to 19;they increased to 26 in 2021. They remained stable in etiologies such as oncologic, diabetic, traumatic, congenital anomalies, and infectious, but rose for thrombotic/ischemic etiology. Between Jan 2020 and Oct 2021, 10 children (M:F 1:1), ranging from 36 days to 19 years in age underwent lower extremity amputations secondary to large vessel thrombosis (compared to 2 in 2017 and 0 for 2018-2019). All except 3 were previously healthy. Five were African American, 3 Caucasian, and 2 Hispanic. At admission, 4 were SARS-CoV-2 positive (RT-PCR), 2 showed elevated SARS-CoV-2 IgM antibody suggestive of recent exposure/infection, and 4 were negative or non-tested. One was vaccinated 6 months prior (2 doses) with reported recent COVID-19 exposure. Four had co-existing viral positivity including Influenza B, parainfluenza virus type 3, Parvovirus B19, and HSV-1. Six had secondary bacterial sepsis during the course of illness. At presentation, 8/10 had cardiac, renal and/or respiratory failure;6/10 showed all three. Seven were started on ECMO at or immediately after presentation. Elevation in BNP was seen in 7, CRP in 9, and ferritin in 7. All were diagnosed with compartment syndrome and underwent multiple fasciotomies before amputations. Tissue was available as thrombectomy, amputation specimens, and autopsy. Admission to amputation interval ranged from 2 days to 3.5 months. Three patients died of multiorgan failure. Histopathology review showed microthrombi (10/10), medium/large vessel thrombi (10/10), intravascular macrophages (9/10), extravascular macrophages (9/10), vasculitis (6/10), and myositis (5/10). Histologic lympho- and hemophagocytosis was seen in 7/10 cases. Immunostains showed scant T and B cells with abundance of CD163 positive foamy macrophages. No such cases have been seen since Oct 2021 to May 2022. Conclusion(s): Sudden unexplained rise in pediatric amputations was noted during the SARS-CoV-2 pandemic. Histopathology showed large, medium and small vessel thrombosis. Clinical elevation of inflammatory markers in conjunction with histologic abundance of macrophages and occurrence of lympho- and hemophagocytosis suggests macrophage activation syndrome as a likely thrombotic etiology.

RSV-associated Hospitalizations in Adults Aged >=18 Years and the Impact of the COVID-19 Pandemic in the United States, October 2018 - February 2022

Background. Respiratory syncytial virus (RSV) is a significant cause of hospitalizations in older adults and typically circulates during the fall and winter in the United States. The COVID-19 pandemic and implementation of nonpharmaceutical interventions (NPIs) including masking, improved handwashing, and social distancing likely impacted RSV circulation. To explore the pandemic's impact on RSV seasonality and hospitalizations in adults aged >=18 years, we analyzed laboratory-confirmed RSV-associated hospitalizations through the RSV Hospitalization Surveillance Network (RSV-NET) across four seasons. Methods. RSV-NET is a population-based surveillance system that collects data on RSV-associated hospitalizations across 75 counties in 12 states. An RSV-NET case is a resident of a defined catchment area who tests positive for RSV through a clinician-ordered test within 14 days prior to or during hospitalization. Surveillance was conducted October-April for the 2018-19 and 2019-20 pre-pandemic seasons and October 2020-September 2021 (2020-21 season). Available data October 2021-February 2022 (ongoing 2021-22 season) are presented. Results. 2,536, 3,195, 618, and 1,758 laboratory-confirmed hospitalizations were identified in adults >=18 years in 2018-19, 2019-20, 2020-21, and 2021-22, respectively;case counts were 4.1 and 5.2 times higher in 2018-19 and 2019-20, respectively, than in 2020-2021. Hospitalizations peaked in January for pre-pandemic and 2021-22 seasons and in September for 2020-21 (Figure). For all years combined, 16.2%, 23.4%, 33.3%, and 27.1% of all RSV-associated hospitalizations were among those aged 18-49, 50-64, 65-79 and >=80 years, respectively. Laboratory-confirmed RSV-associated hospitalizations in adults >=18 years, October 2018 - February 2022 Conclusion. Laboratory-confirmed RSV-associated hospitalizations in adults were lower during the 2020-21 and 2021-22 seasons compared with pre-pandemic seasons, with a marked change in seasonal patterns in 2020-21, likely because of NPIs implemented during the pandemic. Continued monitoring of RSV-associated hospitalizations will be critical to understand ongoing changes in RSV circulation that resulted from the COVID-19 pandemic and associated NPIs. (Figure Presented).