ABSTRACT
Objective: To examine the temporal trends of humoral and cell-mediated immune responses to SARS-CoV-2 mRNA vaccines among multiple sclerosis (MS) patients on different immunomodulatory therapies. Background: The impact of various MS medications on the immune responses to SARS-CoV-2 vaccine is of acute interest to patients and clinicians. Design/Methods: 22 MS patients treated with ocrelizumab (OCR, n=9), natalizumab (NTZ, n=8), fumarates (FUM, n=5;diroximel fumarate, 3 and dimethyl fumarate, 2) received BNT162b2 (Pfizer, n=15) or mRNA-1273 (Moderna, n=7) vaccines. Blood samples were collected before and after each of the two vaccine doses, and 2 months after second vaccine dose. AntiSARS-CoV-2 spike protein titers were measured using quantitative assay (Labcorp). Antibody neutralization was measured with a lentivirus-based pseudovirus particle expressing the D614 spike protein (Labcorp-Monogram Biosciences). T-cell reactivity was determined by measuring interferon-gamma and interleukin-2 in response to stimulation with SARS-CoV-2 peptides. Results: All patients in NTZ and FUM cohorts, but only 22% (2/9) of OCR cohort developed anti-spike and neutralizing antibodies. The highest titers were measured after the second vaccine dose, without significant difference between the NTZ and FUM cohorts in anti-spike IgG (69.7+/-55.1 vs 56.0+/-36.7 arbitrary units/ml) or neutralizing ID50 (1513+/-1317 vs 942+/ -566). Two months after the second vaccine, the antibody titers and neutralizing ID50 decreased by 72% and 79% in NTZ cohort, respectively, and by 45% and 49% in FUM cohort. T-cell reactivity was observed in all cohorts as early as 7 days after the first vaccine, and further increased following the second vaccine. Conclusions: Patients on NTZ and FUM mounted robust antibody responses to SARS-CoV-2 mRNA vaccines, in contrast to OCR-treated patients. T-cell responses were comparable among all three treatment cohorts. Two months after the second vaccine, the serological responses decreased by 45-79%. These findings may inform the optimal timing of additional vaccine doses for MS patients.
ABSTRACT
Objective: To investigate the occurrence of medical staff leaving the COVID-19 isolation room due to discomforts and to provide reference for clinical prevention and treatment. Methods: Stratified sampling method was used to investigate the occurrence of medical staff from Shanghai medical team leaving isolation room earlier due to discomforts, as well as the main symptoms and signs of theirs. Logistic regression was used for risk factor analysis. Results: Among the 227 medical staff working in Leishenshan Hospital in Wuhan, Hubei Province, who were assisted by Shanghai, 69 (30.4%) staff left earlier due to discomforts while working in the isolation room. Two of them had syncope, and sixty-seven of them had symptoms and signs related to presyncope. Symptoms of presyncope include headache, nausea, sweating, dyspnea, and palpitations, etc. Univariate analysis revealed statistically significant differences in occupation (P=0.002), gender (P=0.006), and standing time (P=0.002). Logistic regression analysis showed that occupation (P=0.000), standing time (P=0.025), and hunger (P=0.029) were statistically significant. Conclusion: Different occupation, gender and standing time have different effects on the situation of medical staff leaving the isolation room due to discomforts. Occupation, standing time and feeling of hunger are the influencial factors for medical staff leaving the isolation room earlier.