Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 6 de 6
Filter
1.
Clin Infect Dis ; 75(1): e630-e644, 2022 08 24.
Article in English | MEDLINE | ID: covidwho-1886372

ABSTRACT

BACKGROUND: We studied humoral responses after coronavirus disease 2019 (COVID-19) vaccination across varying causes of immunodeficiency. METHODS: Prospective study of fully vaccinated immunocompromised adults (solid organ transplant [SOT], hematologic malignancy, solid cancers, autoimmune conditions, human immunodeficiency virus [HIV]) versus nonimmunocompromised healthcare workers (HCWs). The primary outcome was the proportion with a reactive test (seropositive) for immunoglobulin G to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor-binding domain. Secondary outcomes were comparisons of antibody levels and their correlation with pseudovirus neutralization titers. Stepwise logistic regression was used to identify factors associated with seropositivity. RESULTS: A total of 1271 participants enrolled: 1099 immunocompromised and 172 HCW. Compared with HCW (92.4% seropositive), seropositivity was lower among participants with SOT (30.7%), hematological malignancies (50.0%), autoimmune conditions (79.1%), solid tumors (78.7%), and HIV (79.8%) (P < .01). Factors associated with poor seropositivity included age, greater immunosuppression, time since vaccination, anti-CD20 monoclonal antibodies, and vaccination with BNT162b2 (Pfizer) or adenovirus vector vaccines versus messenger RNA (mRNA)-1273 (Moderna). mRNA-1273 was associated with higher antibody levels than BNT162b2 or adenovirus vector vaccines after adjusting for time since vaccination, age, and underlying condition. Antibody levels were strongly correlated with pseudovirus neutralization titers (Spearman r = 0.89, P < .0001), but in seropositive participants with intermediate antibody levels, neutralization titers were significantly lower in immunocompromised individuals versus HCW. CONCLUSIONS: Antibody responses to COVID-19 vaccines were lowest among SOT and anti-CD20 monoclonal recipients, and recipients of vaccines other than mRNA-1273. Among those with intermediate antibody levels, pseudovirus neutralization titers were lower in immunocompromised patients than HCWs. Additional SARS-CoV-2 preventive approaches are needed for immunocompromised persons, which may need to be tailored to the cause of immunodeficiency.


Subject(s)
COVID-19 , HIV Infections , Adult , Antibodies, Viral , BNT162 Vaccine , COVID-19/prevention & control , COVID-19 Vaccines , HIV Infections/complications , Humans , Immunocompromised Host , Prospective Studies , SARS-CoV-2 , Vaccination
3.
Head Neck ; 42(6): 1243-1247, 2020 06.
Article in English | MEDLINE | ID: covidwho-125248

ABSTRACT

The 2019 novel coronavirus (COVID-19) pandemic has created significant challenges to the delivery of care for patients with advanced head and neck cancer requiring multimodality therapy. Performing major head and neck ablative surgery and reconstruction is a particular concern given the extended duration and aerosolizing nature of these cases. In this manuscript, we describe our surgical approach to provide timely reconstructive care and minimize infectious risk to the providers, patients, and families.


Subject(s)
Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Head and Neck Neoplasms/surgery , Outcome Assessment, Health Care , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Reconstructive Surgical Procedures/methods , Academic Medical Centers , COVID-19 , Clinical Decision-Making , Coronavirus Infections/prevention & control , Female , Head and Neck Neoplasms/pathology , Humans , Interdisciplinary Communication , Male , Neck Dissection/methods , Occupational Health , Pandemics/prevention & control , Patient Safety , Patient Selection , Pennsylvania , Pneumonia, Viral/prevention & control , Postoperative Care/methods , Preoperative Care/methods , Risk Assessment , Surgical Flaps/transplantation
4.
Head Neck ; 42(6): 1332-1338, 2020 06.
Article in English | MEDLINE | ID: covidwho-116914

ABSTRACT

BACKGROUND: In the context of COVID-19, cancer survivors represent a particularly vulnerable population that may be "doubly hit" by both costs of cancer treatment and financial strain imposed by the pandemic. METHODS: We performed a review of the literature pertaining to cancer, financial toxicity, and economic challenges. RESULTS: Multiple societies have put forth recommendations to modify delivery of cancer care in order to minimize patient exposure to the virus. Cancer survivors, especially patients with head and neck cancer, have been disproportionately affected by rising unemployment levels and economic recessions in the past, both of which are linked to higher cancer mortality. Patients who rely on employer-provided insurance and do not qualify for Medicaid may lose access to life-saving treatments. CONCLUSIONS: It is essential to implement interventions and policy changes in order to mitigate the effects of this pandemic but also to ensure this becomes a nonissue during the next one.


Subject(s)
Betacoronavirus , Cancer Survivors/psychology , Coronavirus Infections/economics , Cost of Illness , Head and Neck Neoplasms/economics , Pandemics/economics , Pneumonia, Viral/economics , COVID-19 , Coronavirus Infections/epidemiology , Head and Neck Neoplasms/psychology , Head and Neck Neoplasms/therapy , Humans , Pneumonia, Viral/epidemiology , SARS-CoV-2
5.
Head Neck ; 42(6): 1310-1316, 2020 06.
Article in English | MEDLINE | ID: covidwho-116760

ABSTRACT

Multidisciplinary conferences (MDC) are an important component of head and neck oncologic care including diagnosis, treatment, and survivorship. Virtual MDC allows for improved collaboration between providers at distant sites and proper allocation of health care resources in a time of crisis. When approached systematically, a virtual MDC is feasible to design and implement in a large academic medical center with multiple satellite hospitals.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Medical Oncology/organization & administration , Pandemics/prevention & control , Patient Care Team/organization & administration , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Telemedicine/organization & administration , Academic Medical Centers , COVID-19 , Coronavirus Infections/epidemiology , Humans , Pennsylvania , Pneumonia, Viral/epidemiology , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL