Non-Dexamethasone Corticosteroid Therapy's Effect on COVID-19 Prognosis in Cancer Patients: A Retrospective Study.

BACKGROUND: Anti-inflammatory corticosteroids are used in cancer treatment and COVID-19 infections. Data on the impact of non-dexamethasone corticosteroids on COVID-19 infection severity in cancer patients are minimal. This study investigates if corticosteroid treatment affects the disease severity in adult cancer patients. METHODS: A total of 116 COVID-19-infected cancer patients on hydrocortisone (H) or prednisone (P) were compared to 343 untreated patients. The study included patients who received corticosteroids before (B), after (A), or both before and after (B and A) COVID-19 infections. Ventilation support, hospitalization and mortality were investigated. RESULTS: Our data showed that a significantly greater number of patients taking H or P required ventilation support and hospitalization and that mortality rates were higher than the control group. Patients who received H or P after COVID-19 infection had a significantly worse prognosis than the other sub-groups and the control group. CONCLUSION: Corticosteroids impacted cancer patients' COVID-19 prognosis. Despite the limited sample size, H- and P-treated patients' corticosteroids performed worse than the control, especially if treatments were received after COVID-19 infection. Hence, when a cancer patient already on H or P treatment is diagnosed with COVID-19, we recommend switching to a steroid treatment as suggested by international guidelines.

Establishing the First COVID-19 Convalescent Plasma Biobank in Jordan.

Background: Antibodies with the specialized ability to fight infection can be found in the blood of individuals who have recovered from or have been vaccinated against COVID-19. As a result, plasma from these individuals could be used to treat critically ill patients. This treatment is known as convalescent plasma (CCP) therapy. Methods: Plasma units from 1555 consented healthy blood bank donors were collected from February to September 2021. Blood units were tested for the quantitative determination of Immunoglobulin G (IgG) antibodies to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus using one of the following assays based on the availability of the kits: The LIAISON® SARS-CoV-2 TrimericS IgG assay or the Abbott SARS-CoV-2 IgG II Quant assay. Results: Among the tested donors, 1027 participants tested positive for neutralizing anti-SARS-CoV-2 IgG antibodies (66.04%). There were 484 donors whose plasma qualified to be used for CCP therapy (47.13%) and 214 CCP units were stored in the COVID-19 convalescent biobank. Conclusion: We were able to identify and store 214 fresh frozen plasma units qualified for CCP-plasma therapy for COVID-19 patients according to World Health Organization standards. Hence, we established the first COVID-19-convalescent plasma data and plasma biobank for treating COVID-19-infected cancer patients in Jordan and the region.

Factors that predict severity of infection and seroconversion in immunocompromised children and adolescents with COVID-19 infection.

Objectives: We aimed to study the outcomes, severity, and seroconversion post SARS-CoV-2 infection in immunocompromised children and adolescents treated at our center. Method: For this observational study, all pediatric patients who had COVID-19 infection from Sep-22-2020 to Nov-10-2021were identified by reviewing our laboratory records. Their charts were reviewed to determine clinical severity and outcome. Blood samples were drawn for anti-SARS-CoV-2 antibody assay. Serious COVID-19 infection (SVI) was defined if the patient had moderate, severe, or critical illness. A cutoff of 100 U/mL anti-SARS-CoV-2 antibodies was used to categorize low and high titer seroconversion. Results: We identified 263 pediatric patients with COVID-19; most (68%) were symptomatic: 5% had severe or critical infection, 25% were hospitalized, 12 required respiratory support, 12 were admitted to the ICU, and five patients (2%) died. Multivariable analysis revealed several factors that predict SVI: Age above 12 years (p=0.035), body mass index above 95th percentile (p=0.034), comorbid conditions (p=0.025), absolute neutrophil count ≤500(p=0.014) and absolute lymphocyte count ≤300 (p=0.022). Levels of anti-SARS-CoV-2 spike antibodies were obtained for 173 patients at a median of 94 days (range, 14-300) after PCR diagnosis; of them 142 (82%) patients seroconverted; the lowest seroconversion rate was observed in patients with hematological malignancies (79%). Our univariable model showed that the following factors were predictive of low titer: lower ANC, p=0.01; hematologic malignancy, p=0.023; receiving steroids in the last 14 days, p=0.032; time since last chemotherapy or immunosuppressive therapy less than 30 days, p=0.002; and being on active chemotherapy in the last 3 months prior to infection, p<0.001. Conclusions: SARS-CoV-2 antibodies developed in most immunocompromised patients with COVID-19 infection in our study. Mortality was relatively low in our patients. Our univariable and multivariable models showed multiple variables that predict severity of infections and antibody response post COVID-19 infection. These observations may guide choice of active therapy during infection and the best timing of vaccination in this high-risk population.

The Effect of Dexamethasone Treatment on COVID-19 Prognosis in Cancer Patients.

BACKGROUND: Dexamethasone is used to treat cancer, relieve chemotherapy-induced nausea and vomiting, enhance cancer patients' appetites, and treat COVID-19 patients. There is little evidence of the impact of a dexamethasone treatment plan on the severity of COVID-19 infections in cancer patients. This study explores whether dexamethasone treatment plan influences the severity of COVID-19 in dexamethasone-treated cancer patients. METHODS: The medical records of 108 cancer patients receiving dexamethasone at King Hussein Cancer Center with a COVID-19 infection and 343 without corticosteroid treatment were reviewed. Patients on dexamethasone within seven days before infection, after infection, or both were included. Ventilation support, hospitalization, and mortality within 28 days of a COVID-19 diagnosis were key severity factors. RESULTS: We found that dexamethasone before a COVID-19 infection increased the risk of requiring ventilation assistance and mortality within 28 days by a factor of 5.8 (2.8-12.0) relative to control (p < 0.005). Continuing dexamethasone treatment after a COVID-19 infection, or starting it after infection, had a risk factor equivalent to control. CONCLUSION: Our data showed that dexamethasone therapy protocol affected COVID-19 prognoses in cancer patients, and it is preferable to not discontinue therapy after infection. A rigorous prospective comparison between early and late dexamethasone dosing is needed to determine the best protocol for treatment.

Factors that predict severity of infection and seroconversion in immunocompromised children and adolescents with COVID-19 infection

Objectives We aimed to study the outcomes, severity, and seroconversion post SARS-CoV-2 infection in immunocompromised children and adolescents treated at our center. Method For this observational study, all pediatric patients who had COVID-19 infection from Sep-22-2020 to Nov-10-2021were identified by reviewing our laboratory records. Their charts were reviewed to determine clinical severity and outcome. Blood samples were drawn for anti-SARS-CoV-2 antibody assay. Serious COVID-19 infection (SVI) was defined if the patient had moderate, severe, or critical illness. A cutoff of 100 U/mL anti-SARS-CoV-2 antibodies was used to categorize low and high titer seroconversion. Results We identified 263 pediatric patients with COVID-19;most (68%) were symptomatic: 5% had severe or critical infection, 25% were hospitalized, 12 required respiratory support, 12 were admitted to the ICU, and five patients (2%) died. Multivariable analysis revealed several factors that predict SVI: Age above 12 years (p=0.035), body mass index above 95th percentile (p=0.034), comorbid conditions (p=0.025), absolute neutrophil count ≤500(p=0.014) and absolute lymphocyte count ≤300 (p=0.022). Levels of anti-SARS-CoV-2 spike antibodies were obtained for 173 patients at a median of 94 days (range, 14–300) after PCR diagnosis;of them 142 (82%) patients seroconverted;the lowest seroconversion rate was observed in patients with hematological malignancies (79%). Our univariable model showed that the following factors were predictive of low titer: lower ANC, p=0.01;hematologic malignancy, p=0.023;receiving steroids in the last 14 days, p=0.032;time since last chemotherapy or immunosuppressive therapy less than 30 days, p=0.002;and being on active chemotherapy in the last 3 months prior to infection, p<0.001. Conclusions SARS-CoV-2 antibodies developed in most immunocompromised patients with COVID-19 infection in our study. Mortality was relatively low in our patients. Our univariable and multivariable models showed multiple variables that predict severity of infections and antibody response post COVID-19 infection. These observations may guide choice of active therapy during infection and the best timing of vaccination in this high-risk population.

An update on the impact of SARS-CoV-2 pandemic public awareness on cancer patients' COVID-19 vaccine compliance: Outcomes and recommendations

Background: Aside from the pandemic's negative health effects, the world was confronted with public confusion since proper communication and favorable decisions became an ongoing challenge. As a result, the public's perceptions were influenced by what they knew, the many sources of COVID-19 information, and how they interpreted it. With cancer patients continuing to oppose COVID-19 vaccines, we sought to investigate the COVID-19 pandemic and vaccine sources of this information in adult cancer patients, which either helped or prevented them from taking the vaccine. We also assessed the relevance and impact of their oncologists' recommendations in encouraging them to take the vaccine. Methods From June to October 2021, an online survey was conducted at King Hussein Cancer Center. A total of 441 adult cancer patients took part in the study. Patients who had granted their consent were requested to complete an online questionnaire, which was collected using the SurveyMonkey questionnaire online platform. Descriptive analysis was done for all variables. The association between categorical and continuous variables was assessed using the Pearson Chi-square and Fisher Exact. Results Our results showed that 75% of the patients registered for the COVID-19 vaccine, while 12% refused vaccination. The majority of participants acquired their information from news and television shows, whereas (138/441) got their information through World Health Organization websites. Because the SARS-CoV-2 vaccines were made in such a short period, 54.7 % assumed the vaccines were unsafe. Only 49% of the patients said their oncologists had informed them about the benefits of SARS-CoV-2 vaccines. Conclusions We found that SARS-CoV-2 vaccine hesitancy in cancer patients might be related to misinformation obtained from social media despite the availability of supportive scientific information on the vaccine's benefits from the physicians. To combat misleading and unreliable social media news, we recommend that physicians use telehealth technology to reach out to their patients in addition to their face-to-face consultation, which delivers comprehensive, clear, and high-quality digital services that guide and help patients to better understand the advantages of COVID-19 vaccines.

Comparison of the Immunogenicity and Protective Efficacy of Various SARS-CoV-2 Vaccines among Healthcare Workers: Are Our White Coat Armies Protected?

BACKGROUND: The effective immunization of healthcare workers (HCWs) plays a vital role in preventing the spread of SARS-CoV-2 infection during the coronavirus disease 2019 (COVID-19) pandemic. There is limited data on the immune response to vaccination among HCWs. We aim to determine seroprevalence rates and neutralizing IgG antibody response to various immunizations among HCWs. METHODS: This study was conducted between July and September 2021, in which blood samples were obtained from HCWs and SARS-CoV-2 IgG neutralizing antibodies were measured. Data regarding vaccination status with Pfizer/BioNTech, Sinopharm, or AstraZeneca vaccines, occupation, and prior COVID-19 infection were analyzed. RESULTS: COVID-19 infection post-vaccination was associated with higher mean antibody titers, regardless of vaccine type. Pfizer/BioNTech vaccination produced higher mean antibody titers for HCWs with prior COVID-19 infection (p < 0.00001) than other types of vaccines. Although 96% of HCWs were vaccinated, 3% were seronegative. For HCWs who were seropositive, there were no significant differences between the mean antibody titers when comparing occupations and blood indices. CONCLUSION: Awareness of the immunity status of HCWs is key to protecting this important group against SARS-CoV-2, especially those without prior COVID-19 infection. Further public health efforts regarding booster vaccination for HCWs are crucial to provide necessary antibody protection.

Dramatic rise in seroprevalence rates of SARS-CoV-2 antibodies among healthy blood donors: The evolution of a pandemic.

BACKGROUND: Seroprevalence studies of SARS-CoV-2 antibodies are useful in assessing the epidemiological status in the community, and the degree of spread. OBJECTIVE: To study the seroprevalence rates of SARS-CoV-2 antibodies among healthy blood donors in Jordan, at various points of time and as the pandemic evolves in the community. METHODS: In total, 1374 blood donor samples, from three groups, were tested for SARS-CoV-2 total immunoglobulin antibodies. In the first group, samples from 734 individuals (from donations made between January and June 2020) were tested in June. In the second group, 348 individuals were tested in September 2020. The third group of 292 individuals was tested in February 2021. A qualitative assay was used for testing (specificity 99.8%, sensitivity 100%). RESULTS: The first two groups, from January-June and September 2020, when confirmed Covid-19 cases numbered between several hundred and 3000, showed a seroprevalence rate of 0% (95% CI 0.00-0.51%). The third group (early February 2021), when the number of confirmed cases had reached 100 times that of September 2020, revealed a seroprevalence of 27.4% (95% CI 22.5-32.9%). CONCLUSIONS: A dramatic rise in seroprevalence of SARS-CoV-2 antibodies was seen among healthy blood donors in Jordan, in parallel with widespread intracommunity transmission of the disease. This information is useful for assessing the degree of herd immunity, and provides for better understanding of the pandemic.