ABSTRACT
Introduction: Vaccines prevent severe disease, but to prevent viral transmission and lessen the risk of new variants emerging they need to also enhance mucosal protection. Intramuscular (IM) vaccines induce systemic antibody and appear to transiently reduce transmission, but their effect on nasal antibody in previously infected subjects has not been studied. Aim(s): To study durability of local and systemic antibody responses after COVID-19 in those subsequently vaccinated. Method(s): Nasal fluid and plasma were collected from 448 hospitalised COVID-19 cases during admission and convalescence via the ISARIC4C/PHOSP-COVID studies. IgA/G to wildtype SARS-CoV-2 S, NP and to receptor binding domain (RBD) of Delta and Omicron variants were measured by ELISA. Result(s): Nasal IgA/G anti-S/RBD responses appeared within 28 days and remained high for 1 year(figure 1). Plasma IgA/G responses to S also remained elevated at 1 year(P<0.001). 87% of those with complete data were vaccinated between 6-12 months after infection;when nasal and plasma anti-NP IgA/G waned, whilst anti-S/RBD responses to Delta and Omicron were maintained or increased. Conclusion(s): This is the first study to demonstrate that IM vaccination may boost nasal antibody 1 year after COVID19. This may explain why IM vaccination reduces transmission, adding to the evidence for booster vaccines in COVID-19 recoverees. (Figure Presented).
ABSTRACT
Background Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care. Methods We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260. Findings Between June 17, 2020, and April 14, 2021, 47 795 (75.2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86.6%] of 12 909 vs 36 415 [72.4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0.79 [95% CI 0.70-0.89], p=0.0001, for 70-79 years;0.52 [0.46-0.58], p<0.0001, for >80 years), independent of patient demographics and illness severity. 84 (54.2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27.5% in the week before June 16, 2020, to 75-80% in January, 2021. Interpretation Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.
Subject(s)
COVID-19 , COVID-19/prevention & control , Hospitals , Humans , Information Services , Semantic Web , VaccinationABSTRACT
Background: The SARS-CoV-2 pandemic in the UK triggered a national characterisation protocol and information on co-morbidities including malignant neoplasm is recorded. A lack of prospective data regarding cancer patients with COVID-19 hampers the development of an evidence based approach in this population. The Clinical Characterisation Protocol-CANCER-UK is a UK multi-disciplinary project aimed at characterising the presentation and course of COVID-19 in cancer patients with the aim of informing practice. Methods: The international Severe Acute Respiratory and emerging Infections Consortium (ISARIC)-4C COVID-19 Clinical Information Network (CO-CIN) collects data on hospital inpatients with proven/high likelihood of COVID-19. Data was collected in 166 UK sites using a questionnaire adopted by the WHO. Data on patients with malignant neoplasm was extracted from the main dataset. We chose a priori to restrict any analysis of outcome to patients who were admitted more than 14 days before data extraction (13th May 2020). Results: As of 13th May 2020 1797 of 16160 participants had malignant neoplasm (8.6% of all cases). Age<50 62 (3.5%), 50-60 378 (21%), 70-79 558 (31%), 80+ 1002 (42%). Male 1147 (64%);Female 645 (36%). Commonest comorbidities chromic pulmonary disease (22%), chronic kidney disease (21%), uncomplicated diabetes (19%) and dementia (14%). Outcomes 35% discharged alive, 30% care ongoing & 35% died. Admiited to ICU: 150 cases (25% discharged alive,31% care ongoing & 45% died). Receiving invasive ventiation: 67 cases (18% discharged alive, 25% care ongoing:25% & 57% died). HR mortality for malignancy (adjusted for age, sex, other comorbidity): 1.13 (1.02-1.24, p=0.017). Data on presentation will be presented. Conclusions: Europe’s largest prospective COVID-19 dataset demonstrates that cancer is independently associated with mortality in patients admitted with COVID-19. Data collection is on-going and updated data will be presented including a comparison of cancer vs. non-cancer cohort with regard to presentation, comorbidity and otucomes. Clinical trial identification: ISRCTN66726260. Legal entity responsible for the study: and international Severe Acute Respiratory and emerging Infections Consortium (ISARIC) WHO Coronavirus Clinical Characterisation Consortium (ISARIC4C). Funding: UK Research and Innovation, Medical Research Council and Department for Health and Social Care. Disclosure: All authors have declared no conflicts of interest.