Prevalence of allergic reactions after Pfizer-BioNTech COVID-19 vaccination

Background: Allergic reactions to COVID-19 vaccines have raised concerns, particularly as repeated doses are required. Skin tests with vaccines excipient were found to be of low value whereas the utility of skin tests with the whole vaccine is yet to be determined. Objective(s): we set to evaluate a panel of skin tests and outcomes of subsequent doses of immunization among subjects that suffered an immediate allergic reaction to the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine. Method(s): In a prospective cohort study during December 27th-2020 to February 22nd-2021 Individuals with allergies who applied to the COVID 19 vaccine referral center at the Sheba Medical Center in israel, underwent risk assessment using an algorithm that included a detailed questionnaire department. Patients were considered to be at high risk for allergic reactions if thery either had: (1) prior anaphylactic reaction to any drug or vaccine, (2) multiple drug allergies, (3) multiplemallergies, or (4) mast cell disorders, as were patients who were deferred by their GP or local allergist or the immunization team from vaccination in the regular setting because of concerns about allergic. reactions. This high-risk group was referred to be immunized with 2 hours of observation by a dedicated allergy team. Result(s): Of the 429/8102 individuals who applied to the COVID-19 referral center and were defined as "highly allergic", 304 (70.8%) were female, mean age was 52 +/- 16 years. This "highly allergic" group was referred to immunization under medical supervision. Following the 1st dose of the BNT162b2, 420/429 (98%) had no immediate allergic event, 6/429 (1.4%) developed minor responses and 3/429 (0.7%) had anaphylactic reactions. During the study period, 218/429 "highly allergic" patients received the 2nd dose, of which 214/218 (98.1%) had no allergic reactions while 4 patients had minor allergic reactions. Other immediate and late reactions were comparable to the general population except for delayed itch and rash that were more common among allergic patients. Conclusion(s): The rate of allergic reactions to BNT162b2 vaccine, is higher among allergic patients, particularly in a sub-group with high-risk history. In this study we showed that the vast majority of patients with a history of allergic diseases and particularly "highly allergic" patients can be safely immunized. Utilizing an algorithm that can be implemented in different medical facilities and include a referral center, a risk assessment questionnaire and a setting for immunization under medical supervision of "highly allergic" patients. Further studies are required to define more specific risk factors for allergic reactions to BNT162b2 vaccine.

Efficient Coronavirus Herd Immunity Optimizer for the UAV Base Stations Placement Problem

This paper proposes an improved version of the Coronavirus Herd Immunity Optimizer (CHIO) algorithm, called RFDB-CHIO, for solving the Unmanned Aerial vehicle carried Base Stations (UAV-BSs) placement problem in 5G networks. The proposed RFDB-CHIO is based on the integration of the Roulette Fitness Distance Balance (RFDB) selection mechanism into the original CHIO algorithm. RFDB-CHIO is validated in terms of user coverage and mean coverage radius under 16 scenarios with different numbers of drones and users. The simulation results demonstrated that RFDB-CHIO obtained better results than CHIO, Whale optimization algorithm (WOA), and Grey Wolf Optimization (GWO) algorithms. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The third dose of mRNA COVID 19 vaccine is safe and efficacious for SLE patients receiving belimumab

IntroductionIn the era of COVID-19 pandemic, data on safety and efficacy of anti-COVID vaccines in SLE patients is needed and scarce. Belimumab is a monoclonal antibody directed at BAFF, an essential cytokine in B cell survival, though it does not impair efficacy of some traditional vaccines. Thus, the aim of our study was to assess immunogenicity and safety of BNT162b2 Pfizer mRNA vaccine in SLE patients treated with Belimumab.MethodsSLE patients treated with Belimumab for at least 6 months in the Sheba Medical Center were included in this study. All were recommended to receive the BNT162b2 COVID-19 mRNA vaccine according to Ministry of Health recommendations, and thereafter to perform a serologic test for CoV-2 IgG 2–6 weeks after receiving the 2nd or 3rd doses. Clinical data included demographics, SLE treatments, adverse effects to the vaccine as well as SLEDAI scores performed 2 weeks before receiving 1st dose and 6 to 8 weeks after receiving 2nd and 3rd doses of the vaccine.ResultsOur cohort included 17 patients, 15(88.2%) were females, median age was 50±14.2 years, and disease duration was 12±10.57 years. Median Belimumab treatment time was 6±2.5 years. In our cohort 2/17 received only 2 vaccine doses as thereafter the suffered mild COVID-19 infection, while 15/17 patients received 3-doses. Serologic assessment was performed for 10 patients, 7/10(70%) became seropositive following the second dose, while 2/3 patients seroconverted only after the 3rd dose. Vaccination was well tolerated with minimal adverse events and no disease flares (e,g. SLEDAI 7.7±5.19 and 7.82±5.2 before vaccination and post 3rd dose respectively).ConclusionsImmunization with 3 doses of BNT vaccine is safe and efficacious for SLE patients treated with Belimumab. Only following the 3rd dose immunogenicity of SLE patients in this cohort mounted to 90%, thereby approximating the general healthy population. Assessment of seroconversion and consideration of subsequent boosters’ vaccine should be considered for SLE patients treated with Belimumab.

DIFFERENT ANTI-SARS-COV-2 VACCINE RESPONSE under B-AND T-CELL TARGETED THERAPIES VERSUS ANTI-CYTOKINE THERAPIES in PATIENTS with INFLAMMATORY ARTHRITIDES

Background: Vaccination against SARS-CoV-2 is effective in preventing severe forms of COVID-19, but there remain concerns about a reduced vaccine response in patients suffering from infammatory arthritides who are treated by immunosuppressive therapies. Objectives: We analysed the impact of bDMARDs on the humoral anti-SARS-CoV-2 vaccine response of patients followed in day hospitals. Methods: We studied the vaccine response after a complete vaccine regimen followed in day hospital in 5 French hospitals and treated with an intravenous bDMARD between September 2019 and August 2021. After obtaining their informed consent, we included patients with an anti-SARS-CoV-2 serology. They were considered non-responders if the antibody level detected was inferior to the threshold of positivity of the kit used. Results: 205 patients were included (148 females/57 males). The median age was 64 years (Interquartile Range [IQR] 56-71). 25 were treated with tocilizumab (TCZ), 36 with abatacept (ABA), 53 with infiximab (IFX) and 91 with rituximab (RTX). When considering both patients after a complete vaccination schema (2 doses, or 1 dose in case of prior COVID-19) and those with 1 booster dose, 34 patients (16.6%) were non-responders (2 [5.9%] treated by IFX, none treated by TCZ, 9 [26.5%] treated by ABA and 23 [67.7%] treated by RTX). In multivariate analysis, the only characteristics that signifcantly and independently differed between respond-ers and non-responders were last bDMARD and corticosteroid therapy at the time of 1st vaccination (Table 1). In RTX-treated patients, the delay from last infusion to 1st vaccine dose was signifcantly shorter in non-responders (median 4.3 IQR [2.9-6.1] months in non-responders versus 8.4 IQR [5.7-14.5] in responders, p=0.0007). Median survival, I.e. achieving a vaccine response in 50% of RTX-treated subjects, was achieved after 277 days (95CI [209-310]) in patients vaccinated with 2 or 3 doses (Figure 1). In ABA-treated patients, the delay from last infusion to 1st vaccine dose was not different between non-responders and responders. Conclusion: ABA and RTX alter the anti-SARS-CoV-2 vaccine response and were associated with nearly all vaccine non-responses in the present study. Cor-ticosteroid therapy was associated with a lower vaccine response regardless of its indication or the concomitant use of bMARD.

Distributed Scalable Association Rule Mining over Covid-19 Data

The worldwide Covid-19 widespread in 2020 has turned into a phenomenon that has shaken human life significantly. It is widely recognized that taking faster measurements is crucial for monitoring and preventing the further spread of COVID-19. The advent of distributive computing frameworks provides one efficient solution for the issue. One method uses non-clinical techniques, such as data mining tools and other artificial intelligence technologies. Spark is a widely used framework and accepted by the big data community. This research used a cross-country Covid-19 dataset to assess the performance of the Apriori and FP-growth through different components of Spark (different numbers of cores and transactions). This involves a scheme for classification and prediction by recognizing the associated rules relating to Coronavirus. This research aims to understand the difference between FP-growth and Apriori and find the ideal parameters of Spark that can improve the performance by adding nodes. © 2021, Springer Nature Switzerland AG.

Ce que nous apprennent nos HDJ sur la réponse vaccinale anti-SARS-CoV-2 différente sous traitements ciblant les lymphocytes B et T par rapport aux traitements anti-cytokiniques

Introduction Les études vaccinales de grande ampleur et les registres apportent des résultats précieux mais souvent de manière retardée par rapport à l’urgence pandémique. Les perfusions de biologiques intraveineux en hôpital de jour (HDJ) permettent de garantir un recueil de données fiables en temps réel. C’est ainsi que nous avions mis en évidence le surrisque d’une forme grave de COVID-19 sous rituximab. Nous avons souhaité étudier l’impact des bDMARDs sur la réponse vaccinale humorale des patients suivis en HDJ. Patients et méthodes Nous avons étudié la réponse vaccinale après un schéma vaccinale complet, 2 ou 3 doses de vaccin, suivis en hôpital de jour dans 5 centres hospitaliers français et traités par un biomédicament intraveineux entre septembre 2019 et août 2021. Après information et consentement des patients, nous avons inclus ceux disposant ou acceptant de réaliser une sérologie anti-SARS-CoV-2. Les patients étaient considérés comme non-répondeurs si le taux d’anticorps détecté était inférieur au seuil de positivé du kit utilisé. Résultats Sur les 925 patients suivis en HDJ dans les 5 centres, les données préliminaires de 205 patients sont disponibles (148 F/57 H). L’âge médian était de 64 ans (Interquartile Range [IQR] 56–71). 25 étaient traités par tocilizumab (TCZ), 36 par abatacept (ABA), 53 par infliximab (IFX) et 91 par rituximab (RTX). 156 étaient traités pour une PR, 33 pour une spondyloarthrite et 16 pour une autre pathologie (connectivite n=5, myosite n=3, vascularite n=2, arthrite juvénile idiopathique n=2, autres n=4). 25 patients étaient co-traités par corticoïdes, 126 par csDMARDs et 2 par d’autres immunossuppresseurs (aziathioprine). Trois quarts des patients traités par RTX ont débuté leur schéma vaccinal plus de 4 mois après leur dernier cycle de traitement. Un total de 23 patients avaient un antécédent de COVID-19 confirmé (par PCR ou sérologie). Un total de 169 patients ont été vaccinés par Pfizer, 16 par Astra-Zeneca, 14 par Moderna, 5 par Janssen et un par Astra-Zeneca puis Pfizer. Un total de 167 patients ont bénéficié d’une sérologie après 2 doses de vaccin (ou un schéma vaccinal complet en cas de COVID-19 préalable). Parmi eux, 28 (16,8 %) étaient non-répondeurs. Il n’y avait pas de différence en fonction de l’âge (p=0,24) ou du sexe des patients (p=0,51), du type de pathologie ou du co-traitement par corticoïdes ou csDMARD. La réponse vaccinale était différente en fonction du bDMARD utilisé (p=0,0003) : aucun patient traité par IFX (0/42) n’était non-répondeur, un seul sous TCZ (1/25, 4 %) contre 25 % sous ABA (8/32) et 27,9 % sous RTX (19/68). Un total de 94 % des non répondeurs après 2 ou 3 doses de vaccin avaient été traités par RTX ou ABA. Chez les patients traités par rituximab, le délai entre la dernière perfusion et la première dose de vaccin était significativement plus courte chez les non-répondeurs (médiane 4,3 IQR [2,9–6,1] mois chez les non-répondeurs versus 8,4 IQR [5,7–14,5] chez les répondeurs, p=0,0007). La diminution de réponse vaccinale post-ABA ou RTX étaient similaires après 3 doses de vaccin (56 patients), 25 % de non répondeurs sous ABA (1/4), 25 % sous RTX (10/40) contre 19 % sous IFX (9/11) et aucun sous TCZ (0/1). 18 des 56 patients ont bénéficié d’une sérologie après 2 doses et également après 3 doses de vaccin. 7 étaient non-répondeurs après 2 doses (6 RTX et 1 TCZ). Parmi eux, 5 sont restés non-répondeurs après leur 3e dose, tous traités par RTX. Conclusion L’ABA et le RTX altèrent la réponse vaccinale anti-SARS-CoV-2 : associés à 94 % des non-réponses vaccinales. La réponse vaccinale est altérée si un délai suffisant n’est pas respecté entre la perfusion de RTX, permettant une repopulation lymphocytaire B, et la vaccination.