SARS-CoV-2 mRNA vaccine generates a CD8 T cell memory response in patients with haematological malignancies

Patients with haematological malignancies are prioritized for COVID-19 vaccine due to their high risk for SARS-CoV-2 infection related disease severity and mortality. Immune defects associated with malignancy and their treatment could influence vaccine driven immune response in these cancer patients. Thus, to understand T cell immunity, its long-term persistence, and correlation with antibody response, we evaluated the BNT162b2 SARS-CoV-2 mRNA vaccine-specific immune response in chronic lymphocytic leukaemia (CLL) and myeloid dysplastic syndrome (MDS) patients. Longitudinal analysis of CD8+ T cells using DNA-barcoded peptide-MHC multimers covering the full SARS-CoV-2 spike-protein showed vaccine-specific T cell activation and persistence of memory T cells up to 6 months post-vaccination. Surprisingly, a higher frequency of vaccine-induced antigen-specific CD8+ T cell was observed in the patient group compared to the healthy donor group. Furthermore, and importantly, immunization with the second booster dose significantly increased the frequency of antigen-specific CD8+ T cells as well as the total number of T cell specificities. Altogether, 23 immunogenic epitopes were identified and a strong immunodominance was observed for the two of the spike-specific T cell epitopes restricted to HLA-A24 (NYNYLYRLF) and HLA-A2 (YLQPRTFLL) with a prevalence of 100% and 80% respectively. In summary, we mapped the vaccine-induced antigen-specific CD8+ T cells and showed a booster-specific activation and enrichment of memory T cells that could be crucial for long-term disease protection for this patient group.

Implementation study: Challenges of rapid telemedicineimplementation into a small community pediatric allergy-asthma practice

Telemedicine is utilized in the United States, but its acceptance has been limited. In the environment of apandemic, the healthcare industry is forced to alter the delivery of care to contain the virus' spread. Utilizingtelemedicine in small community settings may ensure continuity of care and deliver healthcare advice whilereducing the risk of exposure. Program Goals: review the challenges, benets, and limitations of rapidlyimplementing telemedicine into one small Pediatric Allergy practice in response to the COVID-19 pandemic.Implementation resources included education via online webinars and online research. Evaluation: Care wasdelivered by a physician and nurse practitioner via real-time audiovisual teleconference. Platforms utilizedincluded Zoom and Doxy.me. Preparation included evaluating telemedicine platforms, staff training, andpatient education in the setting of quickly changing regulatory and nancial policies. During the rst month oftelemedicine implementation, clinicians perceived several frustrations. These included reviewing test results without parents possessing the test result copies. Concerns of HIPAA privacy limited document sharing withfamilies. Parents were also visualized writing their child's results which may have impaired their ability toabsorb information provided by the clinician. It was also perceived that direct interaction with the pediatricpatient was decreased due to a lack of engagement with the child. Many younger children were distracted bytheir home setting and did not stay focused on the conversation. Adolescents did actively engage. Despitethese limitations, within 2 weeks, the office successfully provided care for disorders including food allergy,allergic rhinitis, asthma, urticaria and atopic dermatitis. Partial physical exams were conducted, includingassessments of patient appearance, quality of conversation, face/eyelid/skin, chest excursion & chest wallsymmetry, respiratory effort, mental status, and mood/affect. Counseling, education and gross patientassessments were effectively accomplished with parents expressing satisfaction with remote care. Limitations were noted in the setting of an acute asthma exacerbation. These included restrictions in patient assessment,such as vital signs and auscultation of breath sounds. Despite counseling and medication prescriptionprovided via telemedicine, the patient later sought emergency care via ED. Discussion: rapid deployment wasachieved in a community small-office setting. Successes included effective patient counseling and educationand delivery of patient care for non-emergent conditions. These could be accomplished with the partialphysical exam available through audiovisual interface. Limitations included decreased engagement of youngerchildren and the lack of document sharing, which can be addressed via other HIPAA-compliant technologyplatforms. Asthma exacerbation was not effectively managed and illustrates the limitations of remotehealthcare in acute situations. However, many patient encounters can be effectively managed with theassistance of telemedicine and may allow for maintaining healthcare delivery in the setting of an acutepandemic.

Visual Exploratory Data Analysis of COVID-19 Pandemic

The emerging novel coronavirus (2019-nCoV) caused by a respiratory syndrome coronavirus 2 (SARS-CoV-2) is the lead cause of threat to life worldwide today. It is important to analyze the worldwide pandemic spread so that certain guide strategies can be set for complete situational awareness and application of conventional methodologies to control the impacts caused by it globally. This paper is composed of the visual exploratory data analysis of the countries based on the number of confirmed, recovered and death cases along with the comparative analysis of the mortality and recovery rate for nearly 222 nations worldwide. Also, K-means clustering is used to cluster the countries according to the number of confirmed and death cases. Hence, this study can be used to evaluate the rise of risks in a given area by comparing the count of the cases via visual analysis and work on the set up of some strategies to control its spread globally. © 2020 IEEE.