Effectiveness, Adverse Events, and Immune Response Following Double Vaccination with BNT162b2 in Staff at the National Comprehensive Cancer Center (NCCC).

Vaccination remains the leading strategy against COVID-19 worldwide. BNT162b2 is among the first licensed vaccines with high effectiveness. However, the role of antibody and cell immunity response monitoring after vaccination remains unclear. We conducted a 6-month prospective study involving the employees of NCCC in Slovakia, who were tested for IgG antibody and cell immune responses after double vaccination with BNT162b2. IgG antibodies were detected at 3, 7, and 26 weeks, respectively. At 6 months, blood samples were tested by two different interferon-γ release assays to determine responses to spike protein antigen and nucleocapsid protein antigen of the novel coronavirus. Results were stratified by gender and body mass index (BMI). Statistical significance was set at p = 0.05. The medical records of 94 respondents (71 females) were analyzed. The mean age was 40.2 years and the mean BMI was 26.4 kg/m2. At 6 months after double vaccination, effectiveness was 97.9%. The side effects of the BNT162b2 vaccine were similar after both doses, with no serious adverse events or new safety signals recorded. The IgG index declined rapidly (p < 0.0001), and 42.6% of subjects had positive and 57.4% borderline or negative immune cell response at 6 months (p < 0.0001). Both T cell activation and IgG counts were lower in morbidly obese patients when compared to some other BMI categories. This study confirmed an acceptable toxicity profile and the high efficacy of BNT162b2 despite a rapid decline of IgG level and negative cell-mediated immunity response in most subjects. An individualized approach to vaccination could be considered in morbidly obese individuals.

COVID-19 and oncological disease.

BACKGROUND: Coronavirus disease 2019 (COVID-19), a respiratory tract infection caused by the severe acute respiratory syndrome coronavirus named SARS-CoV-2, initially emerged in China in late 2019. The rapid global spread of this novel virus led the World Health Organization declare a pandemic with > 30,000,000 confirmed cases, 946,000 deaths and > 21,000,000 recoveries reported as of 18 September 2020, according to the Johns Hopkins Coronavirus Resource Center. Initial reports from Asia suggested that elderly patients with multiple comorbidities, specifically diabetes, hypertension, and obesity were at an increased risk of developing severe COVID-19 following a SARS-CoV-2 infection. As data on these risks have evolved, evidence has increasingly shown that patients with cancer are indeed a particularly vulnerable group. However, the effects of various confounding factors, including an older than average patient population who often have underlying comorbidities including a suppressed immune system and/ or a hypercoagulable state, have been difficult to separate from the effects of having cancer. Common presenting symptoms of SARS-CoV-2 including dyspnoea, cough, fever, fatigue, dysgeusia and, less commonly, diarrhoea and/ or a hyperinflammatory syndrome are equally confusing to clinicians as they all are common symptoms of both cancer and toxicity from anti-cancer therapy. Furthermore, the radiographic dilemma of distinguishing between immune-checkpoint inhibitor-induced pneumonitis from that caused by SARS-CoV-2 infection and conflicting data on the effects of certain therapies on patient outcomes has left clinicians with considerable angst on how to help patients with acute or worsening symptoms in an optimal way. Predicted increase in mortality follows not only from the delay in discovery and progress resulting from temporary closing of research laboratories at cancer centers but also from diversion of resources to patient care and temporary suspension of clinical trial enrolment both by companies and local institutions. The possibilities of travelling to specialized medical centers whose activities are essential for the delivery and improvement of patient care were reduced, too. Viral mutations might also occur during transmission and spread; this leads to a statement that SARS-CoV-2 will forever remain a looming threat to the oncological community. What is crucial to remember is that cancer itself is a pandemic with > 18,000,000 people dia-gnosed worldwide every year. Many societies, including the European Society for Medical Oncology and the American Society of Clinical Oncology, are providing clinical recommendations for the management of patients with cancer during this challenging time, recognizing that continuation in the precise treatment of our patients is critical for our role of physicians. PURPOSE: The aim of the presentation is to point out the contact or overlapping areas of both mentioned disease entities for the purpose of possible simplification of dia-gnostic and therapeutic management of a cancer patient with suspected or already proven  COVID-19 disease.

The first cancer patient with COVID-19 in Slovakia.

BACKGROUND: In December 2019 a new strain of coronavirus SARS-CoV-2 has emerged and affected health care worldwide. Patients with cancer and other comorbidities are at increased risk for adverse outcomes in this infection. CASE: In this case report we present a 75-year-old patient with a localized gastric adenocarcinoma, currently treated by perioperative chemotherapy regimen, who had an rT-PCR proven novel coronavirus SARS-CoV-2 infection. Laboratory and radiologic assessments were performed in order to assess disease severity; however, the findings were not altered in accordance with the findings associated with COVID-19 disease. RESULTS: On the first hospital day the patient had a low grade fever with chills. Subsequently a pharmacological therapy with hydroxychloroquine and azithromycin was started. After pharmacologic and symptomatic treatment, the patient was reassessed for SARS-CoV-2, with negative results. At discharge, the patient was ordered a 14-day mandatory quarantine. After 57 days of follow-up, the patient underwent a new rapid antibody test by Acro Biotech inc., which gave negative results for IgM and IgG. CONCLUSION: An infection with SARS-CoV-2 is associated with a more severe disease in patients with comorbidities and cancer; however, this case patient had a mild course of COVID-19 disease. The aim of this case report is to share the information on the clinical course and outcomes of a patient with malignancy. Rapid spreading of information is crucial in the management of COVID-19.